wrist and hand worksheet Flashcards
Know as the dinner fork, radial fracture) – fall on the palm of an outstretched hand. (Distal frag is displaced in the dorsal direction, within 2.5 cm of the wrist)
Colles fracture
(reverse Colles) – fall on the dorsum of the hand. (Radial frag displaced in the palmar direction)
-Smith’s fracture
What is the MOI of scaphoid fractures?
The result of a minor fall on the palm with the wrist hyperextended and radially deviated.
What type of strengthening exercises should be implemented when appropriate with a patient that has experienced a scaphoid fracture?
Putty
sustained grip activities
gradual closed-chain activities
progressed to tolerance.
What interventions can assist the patient if they are having difficulty regaining motion?
Static progressive splinting
dynamic splinting
jt mobilization can help restore full range.
What structures are affected with a boxer’s fracture?
4th and 5th metatarsals
What is the position of immobilization?
The wrist in slight ext and MP jt flexed for 3-4 wks
What structures are affected with a Bennett fracture?
The palmar base of the proximal first metacarpal
What types of interventions can be implemented once the bennett fracture is stable?
- Resistance exercises
- pinch
- grip
- WBing on the palm with the thumb ABD can be progressed.
What is skier’s thumb?
- An acute sprain of the ulnar collateral ligament of the thumb.
- Sudden valgus stress and hyperextension of the thumb, resulting in either partial ligament tear or a complete rupture.
You are treating a patient recovering from skier’s thumb and the patient asks when you think that they can return to unrestricted use of the affected hand. What is the best answer?
30 days
3 months
6 months
1 year
Never
3 months
What structures does De Quervain disease affect?
- The abductor pollicis longus
- extensor pollicis brevis tendons and sheaths.
What motion may provoke painful symptoms in a de quervain patient?
Ulnar deviation of the wrist when the thumb is clasped in the palm.
Note: Tendon Injuries are classified into zones. See K & C
Which zone is referred to as “no man’s land”?
Zone II
What is the significance of extensor tendon injuries that makes strengthening so important?
An intact extensor mechanism is essential for functional grasp and release
What structure does mallet finger affect?
- Closed rupture of the terminal extensor tendon in zone 1
- usually from forceful hyperflexion.
What structures does the swan neck deformity affect?
- The unopposed force of the flexor digitorum profundus muscle
- positions the DIP jt in flex
- may lead to hyperextension of the PIP
If splinting is recommended for a swan neck defromity, what joint is immobilized, what position and what is the time frame?
- The unopposed force of the flexor digitorum profundus muscle
- positions the DIP jt in flex
- may lead to hyperextension of the PIP
At what point in the recovery process of a swan neck deformity can active flexion of DIP begin to be implemented?
6 weeks
What education should be provided to a swan neck defromrity patient regarding contraindicated movements?
No using strong muscle contractions or passive flexion.
Under normal circumstances and with patient compliances, what is the expected time frame that a swan neck deformity patient can expect to achieve full active motion?
Could take up to 6 months
What is a boutonniere deformity?
- PIP flexion and DIP extension
- caused by rupture of the central band of the extensor hood
What signs and symptoms would cause the PTA to alert the PT about a boutonniere deformity?
The goal is to approximate the ends of the tendon so they can heal together.
Alert the PT If swelling decreases and the splint or cast is loose.
What motions are encouraged for a boutonniere deformity?
Active and passive DIP flexion
After 6weeks active motion of the PIP is initiated but the digit is splinted in between sessions for 2 to 4 weeks.
Flexor tendon injuries will lead to loss of what motion?
Loss of active flexion
Which zone is the most difficult to treat? What structure(s) are involved?
- Zone two is the most difficult.
- It extends form the level of the MP joint to the insertion of the flexor diitorum superficialis just distal to the PIP loint. Injuries int his zone may involve both the FDS and the FDP tendons
What are the 3 approaches to flexor tendon rehab?
- Immobilization
- Early passive mobilization
- Early active mobilization
When are strengthening exercises implemented for flexor tendon injuries?
it is initiated at about 8 weeks
an abnormal thickening of the tissue just beneath the fascia. A formation of pits and firm nodules. The nodules can be composed of overactive fibroblasts producing collagen or can be from “bunching” of the skin in response to a longitudinal contraction
Dupuytren Disease shank 392
What structure is affected with Carpal Tunnel Syndrome (CTS)?
- the median nerve is compreesed or entrapped at the wrist.
- the carpal tunnel is formed by the carpal boneds and the trasvers sarpal ligament and contains the median nerve and nin flexor tendons
What are the possible causes of CTS?
- Anatomic changes of arthritis
- fractures
- cysts
- diabetes
- hypothyroidism
- aging
- pregnancy
- alcohol abuse
What are the clinical signs of CTS?
- numbness of the thumb and radial digits
- tingling
- pain that is often worse at night
- clumsiness in hand activity
- weakness of grip and pinch
- atrophy of the thenar muscles
- swelling in the hand and forearm
What type of education is important to provide to a CTS patient?
- avoid extreme flex and extension
- no tight sleeves
- watchbands
- braclets
- applying pressure over the median nerve when the pronated arm is resting against a desk
If a patient has surgery to correct CTS, what motions must be avoided to prevent bowstringing?
the pt is taught to avoid simultaneously flexing the wrist and fingers
What is CRPS?
Complex Regional Pain Syndrome- Is where the pain of an injury is abnormally severe and /or prolonged
What types of interventions may be implemented with a CRPS patient?
Pain control may be helped by the use heat or cold modalities, contrast baths in which extremes of temperture are avoided , TENS,CPM, hydrotherapy
