wrist/hand Flashcards
ext retinaculum hood mechanism?
?
volar plate prevents…
hyperext
hand accounts for % of upper limb function
90
thumb is involved in % of hand function
40-50
functional ROM of wrist
10 ext
30-35 degrees flex
functional position
20 wrist ext 10 ulnar dev 45 MCP flex 30 PIP flex slight DIP flex
distal RU joint
TFCC (triangular fibrocartilage complex: includes disc and ligaments) helps stabilize
distal RU positions
open-10 sup
closed- 5 sup
capsular pattern- pronation=supination, pain at extremes of pro/sup
TFCC
triangular fibrocartilage complex (includes disc and ligaments) helps stabilize
fibrocartilage disc between distal ulna and carpals in medial wrist
dorsal and volar radio-ulnar lig
ulnar-carpal lig
enhance joint congruity and cushion against compressive forces (transmits about 20% load from hand to forearm)
ECU attaches to TFCC
can get torn
popping and clicking
radiocarpal joint
distal end of the radius, scaphoid, lunate and the TFCC
open- 10 wrist flex and slight ulnar dev
closed- full ext with radial dev
capsular pattern- equal limitation all directions
midcarpal joint
proximal-scaphoid, lunate, triquetrum
distal- trapezium, trapezoid, capitate, hamate
open- neutral or slight flex with ulnar dev
closed-ext with ulnar dev
capsular pattern- equal limitations in all directions
first CMC joint
articulation between 1st metacarpal and trapezium
saddle/sellar joint
open- mid abd/add/flex/ext
closed-full opposition
capsular-abd most limited, followed by extension
CMC 2-5
open- neutral position of wrist
closed- not described
capsular pattern- equal limitation in all directions
MCP 1st digit
open- slight flex
closed- maximal opposition
capsular pattern- greater limitation in flex than ext
MCP, PIP, DIP, 2-5
MCP open- slight flex closed- full ext capsular pattern- equal restriction in all directions PIP open- slight flex closed-full ext capsular pattern- greater limitation in flex than ext DIP open- slight flex closed-full ext capsular pattern- greater limitation in flex than ext
extensor retinaculum
prevents tendons from bowstringing
forms 6 compartments
extensor hood
complex tendon covering post aspect of the digits
combination of ED,EI,EDM
distal portion of hood receives tendons of lumbricles and interossei over prox phalanx
between MCP and PIP, complete tendon splits into 3 parts: central slip and 2 lateral bands
arrangement creates cable system for ext MCP and IP joints
oblique retinacular ligament (ORL)
runs from solar side proximal to PIP - dorsal terminal extensor tendon
links DIP and PIP movement
can measure length: measure DIP flex with PIP ext and measures DIP flex with PIP flex
contracture ORL- increased DIP flex with PIP flexed
unchanged- joint capsule contracture
flexor retinaculum
flexor retinaculum- between pisaform, hamate, scaphoid, and trapezium
serves as attachment site for thinner and hypothenar muscles
maintains transverse carpal arch
acts as restraints against bowstringing of flexor tendons
protects median N
flexor pulleys
annular and cruciate connective tissues restrain flexor tendonos to metacarpals and phalanges, contribute to tunnels through which the tendons travel
volar plate
very thick fibrocartilage band which joins 2 bones in the finger, reinforces joint capsule
9 structures that go through carpal tunnel
4 FDP, 4 FDS, median N, FPL
carpal bones
numerous ligaments
pisaform has 2 attachments- FCU is the only extrinsic forearm muscle to insert on carpal bone and abductor digit minim also inserts
tenodesis
passive hand grip and release mechanism, effected by wrist flexion or extension
moving the wrist in ext will cause the fingers to curl or grip
moving the wrist in flex will cause fingers to straighten or release
tunnels
carpal- median N and 9 flexor tendons
tunnel of guyon- located between hook of hamate and pisiform
passageway for ulnar N and artery into the hand
arches
proximal transverse- carpal bones, rigid, immobile
distal transverse- heads of metacarpals, mobile
longitudinal- flex, mobile
RA pathology
systemic disease
use adaptive equipment
heat/parafin
AROM
cycles of stretching, healing and scarring that occurs as a result of inflammatory process
causes significant damage to soft tissues and periarticular structures
can lead to pain, stiffness, joint damage, instability, deformity (swan or buttonier)
ulnar drift
result of interaction of forces and damage to collateral log and ext mechanisms
pulls the finger into ulnar deviation, pronation, ant subluxation
up to 45 deg of lat deviation can occur at the MCP joint
boutonniere deformity
deformity of ext of MCP and DIP and flex of PIP
occurs when common ext tendon that inserts on base of middle phalanx is damaged
damage to central slip insertion requires extra effort to extend joint, causing hypertext at DIP
lateral bands drift forward past axis of rotation of pip and act as flexors while hyperextending DIP
caused by division, rupture, avulsion, or closed trauma to common ext tendon; RA
2nd most common closed tendon injury in sports
if more than 30 degree ext lag is present at PIP, boutonniere lesion should be suspected
immobilize PUP FULL EXT with MCP and DIP for 6-8 weeks
swan neck deformity
flex of DIP and hypertext of the PIP
destruction and oblique retinacular ligament of the extensor mechanism leads to posterior displacement of the lateral bands resulting in hypertext of PIP
pull on FDP tendon causes flexion of DIP
intervention-silver ring slip for neutral PIP
TFCC lesion
disruption of articular disc
occur following fall on supinated outstretched wrist or chronic repetitive rotational loading (golfing)
medial wrist pain distal to ulna, increased with end-range forearm pronation/supination and forced gripping
painful click during wrist motions
tenderness localized to distal to ulnar head
pain with ulnar (compression) and radial deviation (stretch)
joint distraction, wrist strengthening, avoid pronation/supination
long arm cast or splint 6 weeks
surgical
OA
primary-commonly involved 1st CMC joint or scapotrapezioid joint
secondary- attributed to old trauma or infection
1st CMC
womens > men
45 yo
joint pain at base of thumb which increases with use, restricted ROM in capsular pattern, joint crepitus
joint compression/rotation reproduces pain
heberdans nodes
DIP jt
caused by formation of osteophytes of articular cartilage in response to repeated trauma at the joint
Z deformity of thumb
flexed MCP and hyperext IP
may be due to arthritis or hereditary
dupuytren contracture
active cellular process in the fascia of the hand, characterized by nodules in palmar and digital fascia
pathologic changes in fascia result in tendon-like cords
contractors form mally at MCP and PIP, little finger involved in 70% of patients, usually bilateral
caucasian men later in life
alcoholic, diabetes, epileptic, tobacco, hereditary
inability to straighten fingers, primarly 4th and 5th
UCL sprain
gamekeepers thumb or skiers thumb
injury to MCP of thumb
most common ligament injury of hand
pain or tenderness on ulnar aspect of the MCP joint
direct force causing hypertext and abduction MCP joint or repeated trauma
may need splinting
ganglia
thin walled cysts containing hyaluronic acid that develop spontaneously over a joint capsule or tendon sheath
can occur overnight
pain with flex, limited ext
backside of wrist
tendonitis
common cause of overuse
APL and EPB often involved
tenosynovitis
inflammation of tendon sheath
frequently seen in inflammatory rheumatic disease, DM, hypothyroid conditions
DeQuervain disease
progressive tendinitis or tendonsynovitis involving tendon sheaths of first post compartment of wrist (APL and EPB) resulting in sickening of the extensor retinaculum, stenosing of the fiber-osseus canal and eventual entrapment and compression of tendons
gradual and insidious onset, can be associated with DM and hypothyroid
creak in wrist
sever pain with ulnar deviation and thumb flex/adduction
localized swelling and tenderness in region radial styloid process
loss of abduction of CMC joint
texting can cause
more localized
trigger finger
painful snapping or triggering of the fingers due to disproportion between the flexor tendon and its tendon sheath
more common in thumb, ring, and middle finger
more common in pots with DM, young children, menopausal women, RA
limited finger motion especially PIP
crepitus or moving nodular mass near A1 pulley with finger movement
swelling
splint MCP joint
excise pulley surgery
can happen in kids also
tendon gliding exertion
straight hand
hook hand-greatest excursion between FDP and FDS
full fist- full excursion FDP
flat fist- full exertion FDS
mallet finger deformity
traumatic disruption of the terminal tendon from DIP
loss of active ext of the DIP, can be ext passively
flex deformity of the DIP
can turn int swan neck deformity if not treated
splint in DIP ext
carpel tunnel syndrome
ischemic compression of median nerve at the wrist
increase in synovial fluid pressure
intermittent pain and paresthesia in median nerve distribution of hand
worse at night
pregnancy, short/stiff finger flexors
can be bilateral
decreased grip strength
claw hand
median N
ape hand
median N
radial N entrapment
weak wrist and finger ext
wrist drop
weak hand grip
wartenberg syndrome
compression of the super sensory radian N
pain and parenthesis numbness on radial aspects of hand and wrist (ECRL and brachioradialis) all sensory but some motor somewhere else
ulnar N entrapment
tunnel of guyon (pisiform and hamate)
claw hand of ulnar N
bishops hand
can’t ext bc of lumbricles
nerve regeneration
1 inch a month (1mm/day) order: pain/temp 30 cps vibration moving touch constant touch 256 cps vibration
chronic regional pain syndrome
RSD persisting pain edema stiffness skin temp changes, sweating hyperalgia mirror therapy
colles fracture
distal radius fracture
complete fracture with POST displacement
FOOSH
smith fracture
complete fracture of distal radius with ANT displacement
fall on back on a FLEXED HAND
boxers fracture
transverse fractures of the 5th metacarpal
MOST COMMON type of metacarpal fracture
usually ulnar gutter splint
scaphoid fracture
most commonly fractured carpal bone (waist of scaphoid)
FOOSH with fist pronated
post radial side wrist pain
tender anatomical snuff box
pain with axial thumb compression
***treat all wrist pain with swelling and pain in snuffbox as fx until proven otherwise
want to diagnose early bc poor blood supply
CT or bone scan
kienbock disease
lunate injury
aseptic necrosis or osteonecrosis of lunate
pain over lunate, FOOSH, decreased grip strength
lunate dislocation
volar displacement
FOOSH or hit by outside force, pain over lunate, deformity, inability to move wrist, median neuropathy
avoid extension until healed
raynauds phenomenon
vasospasm of distal vessels of hand and toes
decreased circulation of distal UE
diffuse pain in hand
pale fingers
cold may trigger
+ Allen
blanching of fingers followed by reddening
Volkmans ischemic contracture
hook like contracture of flexor muscles due to meurovascular trauma, fracture
hook grip
median and ulnar
power grip
median and ulnar
lateral pinch
ulnar
precision pinch
median N
cylindrical grip
median, ulnar, radial
