Wrist/Hand

Question 1

What is usually the first symptom of pain with CTS? When does it occur and what relieves it?

Answer 1

Pain at night is usually first symptom, relieved by dangling or shaking the hand

Question 2

Pain with CTS is initially associated with _____, but may progress over time to _____.

Answer 2

Paraesthesia; anesthesia

Question 3

What can CTS be a secondary problem from?

Answer 3

Tenosynovitis, metabolic conditions, pregnancy, endocrine disorders, degenerative arthritis of the carpal bones, Colles’ fx, and C-spine pathology.

Question 4

Explain the “double crush” vs. “single crush”.

Answer 4

Double crush: Nerve is crushed at the root and at a peripheral nerve.
Single crush: Peripheral nerve ONLY is crushed.

Question 5

What are the 4 clinical tests for CTS?

Answer 5

Phalen’s Test
Tinel’s Test for the Wrist
Median Nerve Compression Test
Sensory and motor test

Question 6

How do you perform the Median Nerve Compression Test?

Answer 6

Apply pressure directly over the median nerve in the CT for 15 sec- 2 min. Report how long it takes for the pain to come on and how long after pressure is released the symptoms last.

Question 7

What are some of the non-surgical ways to treat CTS?

Answer 7

NSAIDS, splinting in neutral/slight extension, rest, Ionto (works well because of thinness of skin), Modalities, Tendon gliding exercises,and reduction of provocation.

Question 8

Ulnar Nerve Entrapment (UNE) has two mechanisms or injury. What are they?

Answer 8

1) Repetitive blows to the area (catchers)

2) With sustained pressure (cyclists)

Question 9

What are some of the S/S of UNE?

Answer 9

Altered sensation in the little finger and possible atrophy of hypothenar eminence, interossei, and medial two lumbricals with longstanding issues.

Question 10

What are 3 clinical tests for UNE?

Answer 10

Froment’s Sign
Interossei: ABD and ADD fingers away against resistance
Isolated movements of little finger away from other fingers.

Question 11

Explain Froment’s sign.

Answer 11

Thumb ADD: Grip a piece of paper between thumb pad and radial side of proximal phalanx. If muscle is weak the thumb will flex to hold the paper by using the long thumb flexor (innervated by median nerve)

Question 12

What are the reasons that surgery would be indicated for CTS?

Answer 12

1) Conservative Measures fail

2) Significant thenar atrophy or there is sensory loss and the lesion is identified as CTS.

Question 13

How would you treat UNE?

Answer 13

Cessation of the activity causing pain and later modifications of activity once symptoms are resolved. It rarely results in surgery.

Question 14

What are the injuries associated with DeQuervain’s Tenosynovitis?

Answer 14

• Tendons of ABD Pollicus Longus and Extensor Pollicus Brevis (mainly) and Longus
• Stenosis of tendon sheath
• Repetitive injury (factory, swinging hammer)

Question 15

S/S of DeQuervain’s Tenosynovitis?

Answer 15

Pain in tendons of anatomical snuffbox, Finkelstein’s Test, Resisted Radial Deviation, Crepitus from tendon trying to slide through.

Question 16

How would you treat DeQuervain’s Tenosynovitis?

Answer 16

TFM, Modalities, Rest, Change performance of activity, stretching, cortisone injection, thumb spica splint.

Question 17

How do you differentiate between DeQuervain’s Tenosynovitis and Wartenbergs?

Answer 17

Ask about N/T and check ULTT

Question 18

Explain Finkelstein’s Test.

Answer 18

Detects stenosing tenosynovitis of APL and EPB tendons (DeQuervain’s).
Have pt. make a fist (thumb tucked inside). Stabilize forearm and then ulnarly deviate wrist.
Pain is positive test.

Question 19

What are you looking for with Palpation of Anatomical Snuffbox and Lunate?

Answer 19

Find this with a hyperextension injury; palpate scaphoid and lunate for pain.

Question 20

Explain Tinel’s Sign of the Wrist

Answer 20

Dx CTS; tap over velar surface of wrist in the midline. Positive test= pain and/or N/T in thumb, index, and middle fingers.

Question 21

How would you perform Phalen’s Test?

Answer 21

Also assess CTS, Have pt maximally flex both wrists and place back to back, Hold for at least one minute. Positive= Pain and tingling in median nerve distribution.

Question 22

What would cause atrophy at the hypothenar eminence?

Answer 22

Compression of ulnar nerve in its tunnel between hook of hamate and pisiform. Also proximal compression in the extremity can cause muscle wasting.

Question 23

What does the Allen Test look for?

Answer 23

Patency of the ulnar and radial arteries.

Question 24

How would you perform the Allen Test?

Answer 24

Have patient make a tight fist to push blood out of palm. Put pressure on either the ulnar or radial artery and then have pt. uncurl hand. Positive= failure of rapid capillary return when uncurled. Indicates a problem with the vessel occluded.

Question 25

Pressure on the Radial artery shows an occlusion on which artery?

Answer 25

Ulnar Artery.

Pressure on Ulnar= Radial Artery Occlusion