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OCS - Current Concepts of Ortho PT > Wrist/Hand > Flashcards

Wrist/Hand Flashcards

1
Q

Distal row of carpal bones

A

Trapezium, trapezoid, capitiate, and hamate

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2
Q

Proximal row of carpal bones

A

Scaphoid, lunate, triquetrum, pisiform

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3
Q

Pisiform is a sesamoid for what tendon?

A

Flexor carpi ulnaris (FCU)

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4
Q

Most susceptible carpal bone to fracture

A

scaphoid

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5
Q

Most frequently dislocated carpal bone

A

Lunate

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6
Q

Kienbocks disease

A

Avascular necrosis (non-traumatic) of the lunate

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7
Q

Carpal described as the keystone of the transverse arch

A

Capitiate

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8
Q

Normal inclination of the distal articular radial surface

A

15-20°

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9
Q

Ulnar minus variance

A

Distal ulna is proximal to the ulnar surface of the radius

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10
Q

Ulnar positive variance

A

Distal ulna is distal to the ulnar surface of the radius

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11
Q

What ulnar variance is associated with Kienbock disease

A

Negative ulnar variance

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12
Q

Volar tilt of the distal raidus

A

15°

Loss is common post distal radius fx

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13
Q

Volar plate extension toward the proximal segement

A

Check reins

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14
Q

Heberden’s nodes

A

Osteophytes at the DIP joint

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15
Q

Bouchard’s nodes

A

Osteophytes at the PIP joint

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16
Q

What joints in the hand are the most commonly symptomatic joints involved with OA

A

DIP joints and thumb CMC

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17
Q

When MP joint immobilization is required, what is the optimal position for keeping ROM

A

MP flexion (70-90°), collateral ligaments are lax in ext and can become tight if immobilized in extension

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18
Q

LOAF muscles

A

L: lateral two lumbricals
O: opponens pollicis
A: abductor pollicis brevis
F: flexor pollicis brevis

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19
Q

LOAF muscles are innervated by which nerve?

A

Median nerve

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20
Q

Skier’s thumb

A

Acute disruption of the UCL of the thumb

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21
Q

Gamekeeper’s thumb

A

Chronic degenerative changes causing UCL disruption of the thumb

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22
Q

Stener lesion

A

Torn UCL (avulsion) is now seated superficial to the adductor aponeurosis

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23
Q

Tx for Stener lesion

A

Surgery (think Brett Farve)

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24
Q

2 strongest ligaments at the 1st CMC

A

Palmar oblique ligament and dorsoradial ligament

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25
Q

Motion of proximal row of carpal bones during radial deviation

A

Slight flexion and slides ulnarly

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26
Q

Motion of proximal row of carpal bones during ulnar deviation

A

Slight extension and slides radially

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27
Q

Piano key sign

A

Disruption of the ligaments supporting the DRUJ (causing excess ant/post ulnar translation)

Stabilize radius and press ulnar styloid volarly

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28
Q

Space of Poirier

A

Between distal and proximal “V”, very unstable (around lunate)

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29
Q

Mnemonic that describes # of tendons found within each of the 6 extensor compartments from radial to medial

A

221211

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30
Q

Extensor compartment #1

A

APL, EPB

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31
Q

Extensor compartment #2

A

ECRL, ECRB

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32
Q

Extensor compartment #3

A

EPL

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33
Q

Extensor compartment #4

A

ED, EI (extensor indicis)

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34
Q

Extensor compartment #5

A

EDM

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35
Q

Extensor compartment #6

A

ECU

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36
Q

2 tendons commonly involved with De Quervains

A

APL, EPB

aka #1 extensor compartment

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37
Q

Only wrist extensor muscle innervated PROXIMAL to the division of the radial nerve into PIN

A

ECRL

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38
Q

Extrinsic extensors of the wrist and hand are all innervated by what nerve? (exception of ECRL)

A

PIN

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39
Q

What extrinsic hand tendon rupture is common with distal radial fractures

A

EPL

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40
Q

Structure that connects ED tendons

A

Juncturae tendinae

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41
Q

What tendon uses the pisiform as a sesmoid bone

A

Flexor carpi ulnaris (FCU)

Goes around it to hook to 5th metacarpal

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42
Q

What muscle tendons run through the carpal tunnel

A

FDS (x4), FDP (x4), FPL

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43
Q

Chaism of Camper

A

Where the FDS splits into 2 slips (FDP passes through the chaism)

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44
Q

Finger flexor tendon sheath includes how many annular or cruciate regions

A

5 annular (O), 3 cruciate (X)

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45
Q

Which finger flexor annular pulleys are the most important

A

A2 & A4

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46
Q

Which finger flexor pulley is ruptured in 75% of rock climbers finger injuries

A

A2

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47
Q

Which finger flexor pulley is most common site for trigger finger

A

A1, can be released without significant deficits

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48
Q

Lumbrical muscles arise from what tendons

A

FDP

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49
Q

What muscles are significant contributors to the “intrinsic plus position”

A

Lumbricals, they help with MP joint flexion

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50
Q

Which lumbricals are unipennate and bipennate?

A

Lumbricals (radial to ulnar):
I-II = unipennate
III-IV = bipennate

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51
Q

Action of the dorsi interossei (DI)

A

finger abduction

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52
Q

Action of the palmar interossei (PI)

A

finger adduction

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53
Q

Action of the lumbricals

A

MP flexion

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54
Q

The lateral bands of the extensor mechanism sit dorsal or volar to the axis of rotation

A

dorsal

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55
Q

Boutonniere deformity

A

PIP flexion, DIP extension

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56
Q

Swan-neck deformity

A

PIP extension, DIP flexion

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57
Q

What causes boutonniere or swan-neck deformities

A

Disruption of the bands (triangular ligament, transverse retinacular ligament)

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58
Q

Ulnar nerve travels through the cubital tunnel and then between the heads of what muscle?

A

FCU

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59
Q

Guyon canal

A

Ulnar tunnel between the pisiform and hook of hamate

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60
Q

Only muscle that is a primary hand or wrist motor innervated by the radial nerve?

A

ECRL

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61
Q

Self report measures for wrist and hand

A

DASH, QuickDASH, Carpal Tunnel Questionnaire (CTQ)

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62
Q

Claw hand can indicate damage to which nerve

A

Ulnar nerve

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63
Q

Ape hand can indicated damage to which nerve

A

Median, or can be from long standing CTS

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64
Q

Ulnar drift is caused by what condition

A

Rheumatoid arthritis

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65
Q

Objective assessment for scars

A

Vancouver Scar Scale

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66
Q

Dry skin in hand/forearm can indicate damage to what structures?

A

Peripheral nerve lesion

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67
Q

Clubbing of nails can be due to

A

Pulmonary OR inflammatory bowel disease

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68
Q

Spoon nails can be due to

A

Iron deficiency, Raynauds, or Lupus

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69
Q

Best methods to measure edema or atrophy

A

Volumetry (preferred) and circumferential

Both are reliable

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70
Q

Lister’s tubercle

A

Anatomic process on the dorsum of the radius that functions as a pulley to the EPL

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71
Q

Bossing of CMC joints

A

Excessive bone growth on back of hand

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72
Q

Dupuytren’s contracture

A

Abnormal thickening of tissues in the palm of the hand

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73
Q

If wrist/hand PROM exceeds AROM by >10° there is likely what?

A

Weakness or tendon adhesions

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74
Q

Jersey finger

A

Avulsion of the FDP tendon

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75
Q

Kapandji scale

A

Measure of thumb CMC joint opposition
(0-10, 10 = good)

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76
Q

Finkelstein test

A

For De Quervain’s
Ulnar deviation (no thumb unless need more provocation)

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77
Q

Eichoff test

A

Thumb in palm and passively ulnarly deviate wrist

78
Q

Which De Quervain’s test is better: Finkelstein vs Eichoff

A

Finkelstein (less false positives)

79
Q

Intersection syndrome

  • What it is
  • Symptoms
A

Result of repetitive friction at the junction in which the tendons of the #1st extensor/dorsal compartment cross over the #2nd, creating a tenosynovitis

  • Symptoms: Pain 2-4cm proximal to wrist, friction or squeaking in distal forearm w/ movement of wrist and hand, pain with resisted extension
80
Q

Test for scaphotrapeziotrapezoid (STT) jt arthritis

A

Pressure to scaphoid tubercle while radially/ulnar deviating the wrist

No evidence on accuracy

81
Q

Finger extension test

  • Used for
  • Method
A

To diagnose occult dorsal wrist ganglion

  • Wrist and MP jts in flexion and resists long-finger ext
    • sign is pain

Test has 100% sensitivity

82
Q

Scaphoid shift test

A

Tests for SL instability

Passively ulnar deviate and slight ext, put dorsal pressure on scaphoid tubercle, passively radially deviate and slight flexion

  • Pain or clunk = positive test
83
Q

Is the Scaphoid shift test enough to conclude SL instability?

A

No, use in combo with hx of wrist trauma (FOOSH)

Up to 1/3 of patient have false + due to ligament laxity

84
Q

SL ballottement test

A

Move scaphoid volarly/dorsally, lunate is stabilized

+ = pain, laxity

85
Q

Lunotriquetral (LT) ballottement test

A

Move pisotriquetral complex dorsally and volarly, lunate is stabilized

+ = pain, laxity, clicking, crepitus

86
Q

Midcarpal instability test

A

Volar force at capitate while applying an axially directed load to the wrist, then ulnar deviates the wrist

+ = painful clunk

NOTE: test is not good

87
Q

Ulnar fovea sign

A

Pressing the examiner’s thumb distally into the interval between the ulnar styloid process and flexor carpi ulnaris tendon

  • Detects foveal disruption of the distal radioulnar ligaments and ulnotriquetral ligament injuries

+ = pain

88
Q

Is the ulnar fovea sign good?

A

Yes, comparable to MRI for detection of ligament injury of the DRUL or ulnotriquetral

88
Q

TFCC load test

A

Pronation, ulnar devation, make a fist, axial load

+ = pain

89
Q

Pisiform boost test

A

Tests for ulnomeniscotriquetral region issues

Push pisiform dorsally and ulna volar

+ = Pain and laxity

90
Q

Tests for CMC arthritis

A
  • Pressure shear test (AP/PA of 1stMC on trapezium)
  • CMC grind test (axial load and rotate)

Both are good SN/SP, shear just slightly better overall

91
Q

UCL stress test

A

Valgus force on 1st MP joint at 0° and 30° of flexion

+ = >35° laxity or >15° vs other side

92
Q

Bunnell-Littler test

A

Test intrinsic muscle length

MCP extended, PIP flexed, then MCP flex

+ capsule tightness = If PIP ROM doesn’t change

+ muscle tightness = PIP ROM increases w/ MCP flexion

93
Q

Clinical tools to assess dexterity and functional testing of the wrist/hand

A

1) Functional dexterity test
2) Nine-Hole Peg Test
3) Purdue Pegboard
4) Jebsen-Taylor Hand Function Test

94
Q

If suspect sensory deficits which is better: Monofilaments or 2 point discrimination

A

Start with monofilaments for touch threshold (affected w/ vibratory loss PRIOR to loss of 2PD)

95
Q

Normal 2 point discrimination (2PD)

A

Less than 6mm

96
Q

OK sign

A

Test for AIN lesion, unable to do so if damaged (tear drop shape)

97
Q

Froment sign

A

Test for ulnar nerve lesion - unable to use AP and FPB, ends up using FPL for thumb IP flexion

98
Q

Tendon injuries in the hand are worst post-op outcomes if in what zone?

A

Zone II (between insertion of FDP and heads of MC’s)

99
Q

Is prolonged immobilization post-tendon repair good or bad?

A

Bad, early mobilization without load is recommended to limit tissue adhesions

100
Q

Post-operative protocol for flexor tendon repair

A

Early stages (3-4wks) - application of cast (wrist in slight flexion, MP jts in 50-60° flexion)

Intermediate stage (4wks) - Progress to neutral orthosis, begin PROM finger flex and AROM finger ext

1-2 wks post-immobilization can start AROM

Late stage (4-6wks) - orthosis di/c, being gentle isolated jt blocking exercises

8wks - add light resistance

10-12wks - add heavy resistance (>10#)

101
Q

Should tendon glides or edema/stiffness control be done first in tx?

A

Edema/stiffness control BEFORE glides

102
Q

Place-hold exercise

A

Fingers passively put in flexion and then pt asked to hold position

Use is questionable due to high stress/snap put on tendon from lax to active

103
Q

Zone I finger/hand repairs tend to only include which tendon?

A

FDP

104
Q

T/F: Tendon gliding concerns are less in zones III and IV

A

True, no finger pulleys

105
Q

Mallet finger disruption is in which zone?

A

Extensor zone I

106
Q

Extensor tendons have how many zones

A

8 (+ thumb)
I-VIII and TI-IV

107
Q

Flexor tendons have how many zones

A

5 zones (I-V)

108
Q

Chronic mallet finger can turn into what condition/deformity?

A

Swan-neck deformity, especially in hypermobile individuals

109
Q

What can develop if there is a loss of balance of flexors and extensors

A

Boutonniere deformity

109
Q

Disruptions to the triangular ligament, lateral ands, and/or central slip cause the lateral bands to migrate which direction (dorsal/volar)

A

Volar, if volar to axis they become flexors instead of extensors (aka loss of balance of flexors & extensors)

110
Q

Amount of motion that is helpful for tendon nutrition post-extensor repair in zones V & VI

Index/middle:
Ring/small:

A

Index/middle: 30-45°
Ring/small: 40-50°

111
Q

Tenolysis

When should it be done?

A

Surgical removal of adhesions limiting tendon excursion

Used if no improvement with therapy in 3 months

112
Q

Complications of tenolysis

A

Tendon rupture, degradation of the neurovascular system, worsening symptoms/function

113
Q

4 stage tendon gliding

A

1) open hand
2) Hook fist (IP flexion)
3) Straight fist (DIP ext)
4) Full fist

114
Q

Rehab post-tenolysis

A

Immediately: AROM, place-and-hold, 4 stage tendon gliding

2wks post-op: Jt blocking exercises

May use orthotic for comfort and to prevent adhesions

6 wks post-op: resistance (gentle)

115
Q

Most frequently fractured bone in the body

A

Distal phalenx (Tuft fx)

116
Q

Tuft fx

A

Distal phalenx fx, often comminuted

Healing involves short term immobilization (2-3wks), often heals with fibrous union vs ossification

6-8wk min immobilization if avulsion fx

117
Q

Boxer fx

A

Fx of the 5th metacarpal neck from punch w/ closed fist

Flexed position of up to 70° is okay because 5th ray is very mobile and deformity doesn’t affect function

118
Q

Bennett fx

A

Triangular portion of bone if fx at base of thumb MC, requires surgery

119
Q

Rolando fx

A

2 or more pieces of bone fx at base of CMC jt

More complicated vs Bennett fx, can lead to gripping issues

120
Q

What precaution must be taken when buddy taping a finger?

A

Can exacerbate PIP jt effusion

121
Q

When is surgery indicated in PIP jt sprains?

A

If the jt cannot be stabilized using non-surgical tx OR those that are unstable at angles >25° flexion

122
Q

Long-term consequences of a scaphoid nonunion

A

SNAC wrist (scapho-nonunion advanced collapse), may ultimately result in complete carpal breakdown

123
Q

Pain with gripping, weight bearing through hand, TTP over medial carpals

A

Consider hook of hamate fx (not usually seen on standard XR, need carpal tunnel viewe)

Can cause distal ulnar neuropathy

124
Q

DISI pattern

A

Dorsal intercalated segmental instability, scapholunate angle >60°

Lunate instability - lunate is pulled into extension

125
Q

VISI pattern

A

Volar intercalated segmental instability
Scapholunate angle <30°

Lunate instability - lunate is pulled into flexion

126
Q

Normal scapholunate angle

A

30-60°

127
Q

SL disassociation symptoms/signs

A

Symptoms:
- Pain @ radial side of wrist at rest and w/ activity
- Decreased grip
- Pain w/ weight bearing

Signs:
- TTP scaphoid tuberosity/waist/SL jt line
- Laxity w/ ballottement test
- Possible + scaphoid shift test
- XR findings

128
Q

Compare outcomes of non-surgical vs surgical repair of distal radius fx

A

Same, although grip strength is BETTER in surgical group

129
Q

Colles fx

A

Distal radius fx with hyperextended wrist

VOLAR angulated distal fragment

130
Q

Smith’s fx

A

Distal radius fx w/ flexed wrist

DORSAL angulated distal fragment

131
Q

Indications for surgery of distal radius fx

A

Significant loss of radial height or excessive dorsal angulation

132
Q

Best surgical option for distal radius fx

A

Volar plate

133
Q

Most appropriate rehab interventions for non-surgical distal radius fx in elderly low demand patients

A

Wrist work in combo with home evaluation for balance and fall assessment

134
Q

What ligament injuries occur in 1/3 of distal radius fx’s

A

SL and LT

135
Q

What tendon rupture/damage can occur commonly post-distal radius fx

A

EPL

136
Q

AROM of wrist can start how soon post-ORIF in distal radius fx’s:
- Extra-articular
- Intra-articular
- Non-surgical cast immobilization

A
  • Extra-articular (1-3wks)
  • Intra-articular (4-6wks)
  • Non-surgical cast immobilization (5-6wks)
137
Q

Common substitution pattern for lack of forearm supination

A

Humerus adduction and shoulder ER

138
Q

Is formal PT vs independent HEP indicated in uncomplicated fractures?

A

Good outcomes with independent HEP

HOWEVER,
Pt’s >60y/o or w/ complications or co-morbidities did better with formal therapy supervision

139
Q

What condition puts you more at risk for symptomatic dorsal ganglion cysts

A

Generalized ligament hyperlaxity

Common around SL region and scapholunate instability is commonly associated with the cysts

140
Q

How to differentiate between a ganglion cyst and tenosynovitis lump?

A

Tenosynovitis cyst will move during tendon excursion, ganglion cyst does not move

141
Q

3 Treatment options for ganglionic cysts

A

1) observation
2) aspiration (usually w/ steroid injection)
3) surgical excision

142
Q

Indications for surgery for Dupuytren disease

A

MP contracture >30°
or
PIP contracture of >20°

143
Q

Known demographics/risk factors for dupuytren disease

A

Male, northern European, increased age

144
Q

Evidence on use of rehab for tx of dupuytren disease

A

Limited and inconclusive, surgery is usually main tx

145
Q

Rehab management of patients following a fasciectomy for dupuytren disease

A

Typically NO-TENSION technique

146
Q

T/F: De Quervain Tendinopathy is a tendon entrapment issue (aka tenovaginitis - inflammatory thickening of the fibrous sheath containing one or more tendons)

A

True

147
Q

De Quervain Tendinopathy is common in which populations?

A

Women (especially late stage pregnancy or lactation periods)

Levels of estrogen receptor expression correlated to disease activity (1 study)

148
Q

Is imaging needed for De Quervain Tendinopathy

A

Not usually, unless to rule out other things

149
Q

Recommendations for rehab of De Quervain Tendinopathy

A

Corticosteroids & orthosis

150
Q

Trigger finger

A

Commonly around MP jt or distal palmar crease around the A1 pulley

Can be nodule proximal to A1 pulley sheath

151
Q

Non-operative treatment for trigger finger typically include:

What are the only evidence based interventions?

A

ROM and tendon gliding, modalities, orthosis, or steroid injection.

Only interventions with evidence include orthoses and injection

152
Q

What stage (early/late) of trigger finger responds well to orthosis

A

Early/mild - orthosis in extension

153
Q

What stage (early/late) of trigger finger responds well to orthosis PLUS cortisone injection

A

Late

154
Q

Rehab considerations for post-cortisone injection to treat trigger finger

A

Avoid physical activity/overload to affected part for 3 wks to allow tendon healing to avoid tendon rupture

155
Q

Neuropraxia:
- Prognosis
- Healing time
- Cause
- Clinical signs/symptoms

A
  • Prognosis: GOOD
  • Healing time: Hrs to 3 months (post-removal of compression)
  • Cause: Formation of endoneurial edema
  • Clinical signs/symptoms: Sensory dysfunction, NEG TInel, EMG normal
156
Q

Axonotmesis:
- Prognosis
- Healing time
- Cause
- Clinical signs/symptoms

A
  • Prognosis: GOOD
  • Healing time: Occurs almost immediately
  • Cause: axon damage (non to connective tissues around it - endo/peri/epineurium)
  • Clinical signs/symptoms: Sensory & motor deficits, POS+ TInel, EMG decreased nerve conduction
157
Q

Neurotmesis:
- Prognosis
- Healing time
- Cause
- Clinical signs/symptoms

A
  • Prognosis: BAD
  • Healing time: Does not heal without surgery
  • Cause: Laceration
  • Clinical signs/symptoms: Complete functional loss
158
Q

Axonal regeneration and remyelination begins how soon post-repair of a nerve injury?

A

As early as 2-3 wks

159
Q

What are the order of return for sensation post-nerve repair

A

1) PAIN
2) Vibration, proprioception, motor function

160
Q

Rate for axonal regrowth

A

1mm/day

161
Q

Outcomes of nerve repair better for young or old?

A

Young!!

NOTE: Adults will have some sort of deficit, likely due to brain reorganizing tasks as soon as it notices a deficit

162
Q

Presentation of median nerve traumatic injury -
PROXIMAL

A

Sensation: deficits in volar thumb-radial 1/2 of ring finger

Motor deficits: PT, FCR, PL, FDP (index/middle), FPL, LOAF muscles (lat lumb, OP, APB, FPB)

163
Q

Presentation of median nerve traumatic injury -
DISTAL

A

Sensation: deficits in volar thumb-radial 1/2 of ring finger

Motor deficits: Weakness of LOAF muscles (thenar eminence) causing difficulty with opposition and pinch

164
Q

Ulnar nerve bifurcates at Guyon’s canal into which nerves?

A

1) Superficial sensory branch
2) Deep motor branch

165
Q

Presentation of ulnar nerve traumatic injury -
HIGH

A

Sensation: deficits in volar/dorsal 1/2 ring and small finger

Motor deficits: FCU, FDP (ring and small finger), hypothenar, dorsal/palmar interossei, medial lumbricals, AP, FPB (deep head)

166
Q

Presentation of ulnar nerve traumatic injury -
LOW (proximal to ulnar tunnel)

A

Sensation: ONLY volar ulnar aspect of hand (dorsal sensory split posteriorly before wrist)

Motor deficits: Same as high except for NO FCU and FDP

167
Q

Presentation of ulnar nerve traumatic injury -
LOW (distal to ulnar tunnel/bifurcation - DEEP Branch)

A

Sensation: None (hint: deep motor branch)

Motor deficits: hand intrinsics

168
Q

Presentation of ulnar nerve traumatic injury -
LOW (distal to ulnar tunnel/bifurcation - SUPERFICIAL Branch)

A

Sensation: Volar-ulnar aspect of the hand
(hint: superficial sensory branch)

Motor deficits: Not common, can be some in palmaris brevis

169
Q

What injuries are commonly associated with radial nerve injuries

A

Humeral shaft fx or elbow dislocations

170
Q

Presentation of radial nerve traumatic injury -
PROXIMAL to bifurcation

A

Sensation: Radial side of hand including dorsal thumb/index/middle

Motor deficits: Anconeous, brachioradialis, all wrist/thumb/finger extensors (“Wrist drop”)

171
Q

Presentation of radial nerve traumatic injury -
DISTAL to bifurcation = Superficial sensory branches

A

Sensation: Radial side of hand including dorsal thumb/index/middle

Motor deficits: NONE

172
Q

Presentation of radial nerve traumatic injury -
DISTAL to bifurcation = PIN

A

Sensation: NONE

Motor deficits: all wrist/thumb/finger extensors (can have some wrist extension (strong radial deviation) d/t ECRL branching off nerve prior to bifurcation)

173
Q

Radial nerve bifurcates in forearm into which 2 nerves

A

1) PIN
2) Superficial sensory nerve

174
Q

Good or bad: use of ice on nerve repairs?

A

Controversial - if applied at or distal to repair = slows nerve conduction and may harm insensate tissues

175
Q

2 phases of Sensory re-education
- When to start
- brief overview

A

Phase 1: Starts immediately, maintain cortical hand map in the brain, use mirror therapy

Phase 2: Starts after touch localization is present, performs shape/texture/object identification

176
Q

Which should happen first: Desensitization vs sensory reeducation

A

Desensitization

177
Q

Carpal Tunnel Syndrom CPR:

A

1) Shaking hands for symptom relief
2) Wrist-ratio index greater than .67
3) Symptom Severity Scale score >1.9
4) Decreased thumb sensation
5) Age greater than 45 years

178
Q

How to assess the severity of nerve compression in carpal tunnel syndrome?

A

Tinel’s sign, sensory threshold testing, and 2PD

If inconclusive = electrodiagnostic studies can be helpful

179
Q

Is PT indicated in post-op carpal tunnel release?

A

No, unless there’s complications

180
Q

When is surgery indicated in carpal tunnel syndrome?

A

When severe or failure to improve after non-surgical management

Surgery results are good in majority of patients post-CTR

181
Q

Ulnar tunnel syndrome involves what canal?

A

Guyon Canal

182
Q

Are CTS and UTS related?

A

Not directly, BUT high percentage (85%) of people with idiopathic UTS ALSO had CTS

183
Q

Symptoms of ulnar tunnel syndrome

A

Pain, N/T, weakness in ulnar distribution of hand, may have clawing (ring/small fingers), intrinsic muscle wasting, atrophy in thumb web space

184
Q

Does UTS cause a + Allen’s test?

A

It can be + if there is arterial involvement

185
Q

Is surgery or non-surgical management better for UTS?

A

In mild cases WITHOUT motor loss = PT

In cases WITH motor loss = Surgery

186
Q

Is PT common post-UTS release?

A

No, unless there are complications

187
Q

Is PT indicated in post-op radial nerve release?

A

No, unless there are complications

188
Q

What is the first sign of nerve regeneration (test-wise)?

A

+ Tinel’s test

Then progress to pin prick and 2PD

189
Q

Of all types of scaphoid fractures (displaced, unstable, proximal pole, waist or mid-pole fx) which is least likely to require surgical fixation?

A

Waist or mid-pole

D/T prevalence of non-union or delayed union, unstable and displaced are an absolute MUST. There is limited vascularity at the PROXIMAL pole of the scaphoid leading to need for surgical fixation

190
Q

Post-ORIF distal radius fx with volar plate (2wks), what should be the goal of PT?

A

Achieve full tendon excursion and a full fist

Yes, A/PROM is important, but finger mobility is MOST

OCS - Current Concepts of Ortho PT (12 decks)

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