Wrist&Hand Flashcards
1
Q
Fracture type: MOI: Flexion plus compression
A
Smith’s
1
Q
Q: What does compression of the median n. lead to? (4)
A
- Ischemia 2. Edema 3. Reduced nerve gliding 4. Eventually fibrosis
2
Q
Q: In which direction does lunate typically dislocate?
A
Volarly
3
Q
Anatomy: stabilizes the RU joint and protects against compressive forces
A
Triangular fibrocartilage complex (TFCC)
3
Q
Q: What is the most important part of the SE?
A
The body chart
4
Q
Content: Scaphoid-Lunate Disassociation: Watson’s test/scaphoid shift test (5)
A
- Seated, elbow flexed 90 2. forearm pronated 3. Passively move from UD to RD while stabilizing scaphoid 4. + = increase movement, pain or clunk into dorsal direction 5. 70% sensitivity and specificity
5
Q
CPR: MCP/IP
A
Equal loss of flexion/extension
5
Q
CPR: CMC Thumb
A
Limitation of ABD and slight limitation of extension
5
Q
Content: Carpal tunnel syndrome: Manual therapy
A
carpal bone mobilization
6
Q
Describe: Ulnar border of carpal tunnel
A
Hook of hamate
7
Q
Closed pack position: MCP
A
full flexion
7
Q
Content: Complex regional pain syndrome - Differential diagnosis (3)
A
- RA 2. Peripheral neuropathy 3. Vascular disease
8
Q
Arthrokinematics: CMC Thumb flexion
A
CMC glides volarly/ulnar
8
Q
Content: Acute or traumatic MOI (2)
A
- FOOSH 2. Radius, ulna, or carpal fx
8
Q
Content: OE (fracture) (4)
A
- Deformities (ex. dinner fork) 2. Girth measurement (edema) 3. PROM/AROM 4. Functional tests (ex. grip strength)
8
Q
Fracture type: OE: deformity of DIP
A
Mallet finger
9
Q
Content: SE (6)
A
- Age 2. Occupation 3. Recreation 4. History/MOI 5. Past History 6. Special questions
9
Q
Content: Description: Median n. compression in carpal tunnel
A
Carpal tunnel syndrome
9
Q
Content: Carpal tunnel syndrome: Exercises
A
nerve and tendon glides
10
Q
Q: Where do IP joints have the least force?
A
When the wrist is in fexion
11
Q
Closed pack position: IP
A
full extension
11
Q
Content: OE (7)
A
- Observation 2. ROM 3. Strength 4. Palpation 5. Special tests 6. Neuro/segmental exam 7. Nerve mobility
12
Q
Q: What is the difference between intrinsic and extrinsic hand muscles
A
Intrinsic = originate and insert within hand Extrinsic = originate in forearm and insert on wrist/hand
14
Q
Arthrokinematics: MCP/IP extension
A
surfaces glide dorsally
15
Arthrokinematics: Radiocarpal UD
Carpals glide radially
15
Content: Scaphoid-Lunate Disassociation: Symptoms (4)
1. Localized pain, 2. Swelling 3. Clicking 4. Pain with extension
17
Joint type: CMC Thumb
Saddle/Sellar
18
Content: SE questions (6)
1. ADL’s 2. Hand dominance 3. Lifting/pushing/pulling 4. Opening a door 5. Writing 6. N/T and pattern
20
Arthrokinematics: CMC Thumb ADD
CMC glides volarly
21
Content: Scaphoid-Lunate Disassociation: MOI (2)
1. Fall 2. Trauma
22
Idenfity the stage of CRPS: continue skin changes, worsening pain, hair loss, limited joint mobility, muscle weakness
Stage 2; 3-6 mo
23
Q: What is the main goal of hand interventions?
Function, function, function
24
Content: Lunate dislocation Intervention (3)
1. Surgical reduction 2. Immob 3-4 wks 3. Limit wrist extension ~2mo
25
CPR: Radiocarpal
Equal loss of flexion and extension
26
Fracture type: Description: Fx of neck of 5th MC
Boxer's
27
Arthrokinematics: CMC Thumb ABD
CMC glides dorsally
28
Fracture type: Description: Fracture of distal radius with volar displacement
Smith's
29
Q: What is the intervention for Mallet finger?
Volar splint or surgical fixation with exercises
30
Arthrokinematics: Radiocarpal flexion
Carpals glide dorsally
31
Fracture type: MOI: Fall with extension plus RD
Scaphoid
32
Idenfity the stage of CRPS: skin and temp changes, muscle spasms, joint pain, intense burning and aching
Stage ; 1-3 mo
33
Arthrokinematics: MCP/IP flexion
surfaces glide volarly
33
Q: What FOOSH MOI causes carpal fracture?
Wrist extended \> 80
33
Fracture type: MOI: Extension plus compression
Colles'
34
Closed pack postiion: CMC Thumb
Full opposition
35
Q: What is the success rate of surgical treatment of carpal tunnel syndrome?
70-90%
36
Joint type: IP
Hinge joint
37
Fracture type: Description: Fracture of distal radius with dorsal displacement
Colles'
37
Content: Carpal tunnel syndrome: OE (6)
1. Electrophysiology 2. ROM 3. Palpation 4. Grip strength 5. Special tests 6. Rule out cervical / shoulder / elbow involvement
39
Content: Intercarpal joint (4)
1. Articulation between proximal and distal rows 2. Articulation between individual carpals 3. Flexion: mid carpal joints 4. Extension: RC joint
40
Joint type: Distal/Proximal radioulnar
Pivot
40
T/F: There is little evidence supporting the efficacy of conservative treatments for carpal tunnel syndrome.
True
42
Content: Areas of symptoms in the hand (4)
1. Palmar 2. Dorsal 3. Radial 4. Ulnar
43
Q: Name the carpal bones
Prox: Scaphoid, lunate, triquetrum, pisiform, Distal: Trapezium, trapezoid, capitate, hamate
45
Content: Overuse MOI (2)
1. Repetitive 2. Tendinopathies or neuropathies
46
Q: Which muscle group is stronger, flexor or extensor?
Flexors
46
Q: What is important about the quantity for intervention?
High repetition throughout the day
48
Q: What FOOSH MOI causes radius or ulnar fracture?
wrist flexion
49
Q: What are the 2 most important parts of intervention?
Edema management and scar formation
50
T/F: Nerve glides have no effect on symptoms of carpal tunnel syndrome.
False: some
51
Closed pack position: Radiocarpal
Extension with radial deviation
52
Idenfity the stage of CRPS: chronic and irreversible, joint contractures, muscle wasting, extreme pain
Stage 3; \> 6 mo
55
Content: Observations (5)
1. Deformity 2. Swelling 3. Atrophy 4. Color 5. Scars
56
Q: What are two tests for Carpal tunnel syndrome?
1. Tindel's test (at the wrist) 2. Phalen's and Reverse
58
Joint type: MCP
Diarthrodial condyloid joint
60
Content: Clinical syndromes caused by traumatic/FOOSH (7)
1. Colles and smith fractures 2. Scaphoid fracture 3. Boxer’s fracture 4. Mallet finger 5. Lunate dislocation 6. Scaphoid-lunate dissociation 7. Kienbock’s disease
60
Q: What FOOSH MOI causes radius fracture?
Wrist extended \< 35
61
Fracture type: OE/Diagnostics: Pain in anatomical snuffbox, painful/limited wrist movement, painful compression/load
Scaphoid
63
Q: Where do IP joints have the most force?
When the wris tis in extension
64
Content: Complex regional pain syndrome - OE (4)
1. Pitting edema 2, Skin changes 3. Lack of wrist/elbow motion 4. Muscle weakness
65
Content: Complex regional pain syndrome - SE (5)
1. Sensitive to touch 2. Guarded movement 3. Painful movement 4. Increased sensitivity to temp 5. Emotional and behavioral changes
67
Loose pack position: Radiocarpal
10 wrist flexion and slight UD
68
Describe: Floor of carpal tunnel
Carpal bones and palmar ligaments
69
Content: Complex regional pain syndrome (3)
1. Unusual pain in a arm or leg due to injury or surgery 2. Pain out of proportion to the severity of the injury 3. more common in women ages 30-60
71
Q: As you flex your fingers they __________ rotate, as you extend your fingers they __________ rotate
External, internal
72
Content: Carpal tunnel syndrome: AD
Wrist splint
73
Describe: Radial border of carpal tunnel
Trapezium
74
Fracture type: MOI: direct force causing forced flexion
Mallet finger
75
Arthrokinematics: Radiocarpal extension
Carpals glide volarly
76
Content: Carpal tunnel syndrome: History (2)
1. Trauma 2. Over use of flexors/posture of hand
77
Content: SE - first things first (2)
1. What is the origin of the pts complaint? (cervical/shoulder/forearm) 2. Co-existing conditions with overlapping symptoms
78
Content: Clinical syndromes caused by overuse
Carpal tunnel syndrome
79
Q: What is the conservative tx for scaphoid fx?
Immbolization and US
81
Q: What FOOSH MOI causes scaphoid fracture?
Wrist extension with RD
82
Content: Lunate dislocation OE (4)
1. Pain with palpation 2. Limited/painful motion 3. Positive xray 4. N/T median n. distribution
83
Content: Carpal tunnel syndrome: Education
Modify activity and ergonomics
85
Fracture type: Description: Avulsion of extensor tendon from DIP
Mallet finger
87
T/F: Convex portion of CMC glides in same direction of motion
False: Opposite
88
Q: If pt. can point out pain with one finger than it is probably __________ in the \_\_\_\_\_\_\_, if not, then is may be __________ from \_\_\_\_\_\_\_\_\_\_.
locally, wrist, referred, elsewhere
90
Fracture type: MOI: boxing or punching
Boxer's
91
Fracture type: OE: swelling and pain with MMT
Boxer's
92
Joint type: Radiocarpal
Diarthrodial ellipspoid
93
Describe: Roof of carpal tunnel
Flexor retinaculum
94
Q: Who has strongest intrinsic hand muscles?
Climbers
95
Content: Description: Osteonecrosis/AVN of lunate following a fx.
Kienbock's disease
96
Content: Carpal tunnel syndrome: SE (5)
1. Pain and paresthesia 2. Numbness 3. Noctural pain 4. Hand falling asleep 5. Thenar atrophy
97
Arthrokinematics: Radiocarpal RD
Carpals glide ulnarly
98
Arthrokinematics: CMC Thumb extension
CMC glides dorsally/radial
99
Content: Kienbock's disease Intervention (5)
1. Goal to restore blood supply/revascularization 2. Initial immob 3. Thermal modality 4. ROM/glide 5. Sx - bone graph or prosthetic lunate
100
Loose pack position: CMC Thumb
Midrange Abd/Add and Flexion/Extension
