Wrist/Hand Flashcards
What tenderness should be considered a fracture unless ruled otherwise?
Scaphoid
What is a Colles fracture?
Distal radius fracture with dorsal wrist displacement
What is a Smith fracture?
Distal radius fracture wiht volar wrist displacement
What is a Barton Fracture?
Intraarticular fracture of the radius
What is a Boxer’s fracture?
4th and 5th metacarpal fracture
What is a Bennett’s fracture?
Fracture of the base of the thumb metacarpal, often with dorsal displacement
What is Kienbock’s disease?
AVN of the lunate
What is the Schuck test?
Flexing the fingers and then extending against resistance; with pain at the carpal row. For Kienbock’s disease
What is Preiser’s disease?
AVN of the scaphoid
What are three carpal bones most concerned with AVN?
Scaphoid, Lunate, Triquetrum
What are the 4 radial nerve entrapements?
-Radial nerve palsy at the spiral groove
-Radial Tunnel syndrome
-Posterior interosseous nerve entrapment
-Superficial radial nerve entrapment
What are 4 Median nerve entrapments?
-Pronator teres syndrome
-Carpal Tunnel Syndrome
-Anterior interosseous nerve entrapment
-Bowler’s thumb (distal branch of median sensory nerve)
What are 2 Ulnar nerve entrapments?
-Cubital Tunnel Syndrome
-Guyon’s Cannal syndrome
What are the 4 criteria for a positive neurodynamic test?
-Reproduction
-Structural Differentiation
-Left/Right Difference
-Supported by history and physical examination
What nerve palsy contributes to claw fingers?
Median and ulnar nerve palsies
What nerve palsy contributes to Ape hand?
Median nerve palsy
What nerve palsy contributes to benediction sign?
Ulnar nerve palsy
What nerve palsy contributes to drop wrist?
Radial nerve palsy
What findings make you think
myelopathy hand?
+triceps
+Hoffmans reflex
What are the categories of signs and symptoms of complex regional pain syndrome?
-Positive sensory abnormalities
-Vascular abnormalities
-Edema, sweating abnormalities
-Motor and trophic changes
What are positive sensory abnormalities of complex regional pain syndrome?
-Spontaneous pain
-Mechanical hyperalgesia
-Thermal hyperalgesia
-Deep somatic hyperalgesia
What are vascular abnormalities of complex regional pain syndrome?
-Vasodilation
-Vasoconstriction
-Skin temperature asymmetries
-Skin color changes
What are edema, sweating abnormalities of complex regional pain syndrome?
-Swelling
-Hyperhidrosis
-Hypohidrosis
What are motor and trophic changes of complex regional pain syndrome?
-Motor weakness
-Tremor
-Dystonia
-Coordination deficits
-Nail and hair changes
-Skin atrophy
-Joint Stiffness
-Soft tissue changes
What are 4 causes of radial wrist pain?
-CMC arthritis
-Scaphoid or radius fracture/AVN
-DeQuervain’s tenosynovitis
-Skier’s Thumb
What is Skier’s thumb?
1st MCP UCL sprain
What has the best Sn and Sp for wrist pain?
MRI
What is the test for DeQuervain’s?
Finkelstein’s Test
What are treatment options for CMC OA?
-Activity modification
-Joint protection
-Splinting
-Exercise
-Injections
-Surgery
What to do for PT for DeQuervain’s?
-Manual Therapy
-Orthotic
-AROM
-Tendon Glides
-Exercise (APL and EPB stretches)
-Education
-Ionto
What is Intersection syndrome?
-overuse affecting the radial forearm at the intersection of the APL/EPB and ECRL/ECRBW
What are the criteria for Intersection syndrome?
-5 points tender in dorsal forearm
-Crepitus, swelling
-Pos Finkelstein’s, Isometric tests
How to treat Intersecion syndrome?
Mulligan taping technique
What are 5 causes of ulnar wrist pain?
-TFCC
-Wrist and hand OA
-Carpal Instability
-Ganglion Cyst
-Kienbock’s Disease
What are signs of TFCC issues?
-Pain with compression/pronation
-Limited wrist ext>flexion
-Painful resisted pronation
-Pain on AP glide of RC joint
-Pain over lunate & lateral wrist
What is Murphy’s sign and what does it indicate?
A deviation of knuckle pattern - one depressed or sunken in.
Indicated lunotriquetral instability
What is treatment for TFCC tear?
Splinting and exercise; if chronic or positive ulnar variance - recommend surgery
How to manage ganglion cysts?
-50% resolve spontaneously
-Watchful wating, nonoperative aspiration/injection
-Surgical excision
What are 6 sources of finger pain & deformity?
-Trigger finger
-Mallet finger
-Swan neck deformity
-Boutonniere deformity
-Dupuytren’s Contracture
-Fracture
What causes mallett finger and what is it?
Rupture of avulsion of the extensor tendon
Inability to extend distal phalanx
(think of the area that would be hit with a mallett)
What is sweater finger?
inability to flex distal phalanx
What is trigger finger?
Thickening of the flexor tendon sheath causing snapping with flexion/extension
What causes boutonniere deformity and what is it?
Rupture of the central tendon slip of extensor hood
Extension of the MCP/DIP with flexion of the PIP
What causes swan neck deformity and what is it?
Volar plate tear at PIP joint with intrisic contracture
Hyperextension of PIP and inability to flex PIP joint actively
What is Dupuytren’s contracture
Contracture of typically the 4th and 5th MCP and PIP
What is the treatment for mallet finger, sweater finger, Boutonniere, and Swan Neck Deformities?
-Splinting
-Manual Therapy
What is treatment for trigger finger?
-Corticosteroid injections
-Splinting
What is treatment for Dupuytren’s contracture?
Surgical release/fasiotomy
Post-operative splinting and hand therapy
Which surgical release has lower rates of minor complications?
Endoscopic
