Wrist & Hand Ax and Rx Flashcards
1
Q
SQs
A
- ?Trauma - FOOSH
- ?surgery
- ?onset/cause
- ?Neuro symptoms
- ?Aggs & Eases
- Red Flags: Infection symptoms, wrist #: localised tenderness, pain on AROM and PROM, on grip and supination + other # signs, RA
- Dominant hand - Overuse
2
Q
CAD signs
A
- 5 D’s – Dizziness, Drop Attacks, Diplopia, Dysarthria, Dysphagia
- 3 N’s – Nystagmus, Nausea, Numbness
- Cerebral or Cerebellar signs, e.g. ataxic gait
3
Q
Red Flags
A
- CAD (Cerebral Arterial Dysfunction)
- Myelopathy
- Infection
- Inflammatory disorders
- Age of onset of new symptoms <20 or >55 years
- Violent trauma, e.g. FOOSH - wrist #)
- Constant, progressive, non-mechanical pain
- Thoracic pain
- PMH – Carcinoma
- Systemic steroids
- Drug abuse, HIV
- Systemically unwell
- Unexplained weight loss
- Widespread neurology
- Structural deformity
- TB
4
Q
Infection symptoms
A
- General feeling unwell
- High temperature (fever)
- IVDU (intravenous drug use)
- Recent surgery / open wounds
5
Q
Cancer signs
A
- Previous Hx of cancer in themselves or family
- Unexplained weight loss
- Non- mechanical, constant pain
- Night sweats
- Generally feeling unwell
6
Q
Fracture signs
A
- Major trauma (FOOSH)
- Minor trauma or strenuous lifting in an older or osteoporotic patient
- Constant pain, worse on weight bearing
- Swelling/ bruising
- Steroid use
- Osteoporosis/ osteopenia
7
Q
Inflammatory Disorders (Ankylosing spondylitis etc.) signs
A
- Gradual onset
- Marked morning stiffness
- Persisting limitation of spinal movements in all directions
- Peripheral joint involvement/tendionpathies/aches
- Iritis, skin irritation (psoriasis), colitis, urethral discharge
- Family history
8
Q
Myelopathy (Central cord compression in cervical (most common), thoracic or lumbar (rare) spine) signs
A
- Neck, arm, leg or lower back pain
- Tingling, numbness or weakness
- Difficulty with fine motor skills, such as writing or buttoning a shirt
- Increased reflexes in extremities or the development of abnormal reflexes
- Difficulty walking (ataxic gait)
- Loss of urinary or bowel control
- Issues with balance and coordination
9
Q
CAD risk factors
A
- Hypertension
- Hypercholesterolemia
- Hyperhomcysteinemia – an alteration in the enzymes responsible to maintaining the metabolism of homocysteine can alter the effects of mechanisms of homocysteine, which include increased peroxidation injury, proliferation of smooth vessel, promotion of monocytic chemotaxis, enhanced cytotoxicity and inflammation, promotion of clotting, inhibition of anticoagulation, direct effects on endothelial cells, and activation of platelet aggregation.[
- Diabetes
- BMI >30 (obesity)
- Family History of MI/Angina/TIA/CVA/PVD
- Upper Cervical Instability
- Latrogenic Causes (Surgery/Medical Intervention)
- Genetic clotting disorders
- Infections
- Smoking
- Direct vessel trauma (previous trauma to Cx spine)
- Repeated injury
- Immediately post-partum
- Absence of plausible mechanical explanation of symptoms
10
Q
Pathology of CAD
A
- Endothelial Atherosclerosis – arteries are narrowed due to plaque formation, which can predispose the vessles to dissection.
- Trauma – Deformation of nerve endings, compression or local structures and/or altered haemodynamics, e.g. Whiplash, intubation, repeated sustained movements, manual therapy
- Connective Tissue Abnormalities – vessel wall weakness leading to spontaneous arterial dissection
- Temporal Arteritis – chronic inflammation of the arteries restricting blood flow. Small arteries are more affected.
- Upper Cervical Instability – Could be associated with RA or acute whiplash.
11
Q
How would you manage the care of a patient with signs and symptoms of CAD?
A
- If signs and symptoms are borderline… monitor closely, avoid end range and/or sustained rotation and extension.
- If post Rx soreness is present consider vascular and haemodynamic response.
- Discuss with senior
- If an arterial injury is suspected send to A&E.
12
Q
List the risk factors for Cervical Instability.
A
- Whiplash/Acceleration injuries
- Spondylosis
- RA
- Sustained Neck Flexion
- Downs Syndrome
- Tonsilitis
- Nasopharyngitis
13
Q
Identify the Subjective signs and symptoms of cervical instability
A
- Feeling of instability, ‘head may fall off’
- Neck/Shoulder pain
- Symptoms of VBI/CAD
- Chronic Headaches
- Episodes of locking
- Paraesthesia of lips, tongue, bilateral hands and feet
- Lump in throat
- Metallic test
- Inflammation or local surgery
14
Q
How would you objectively assess a patient with signs and symptoms of Cervical Instability?
A
- AROM & PROM limited
- Hypertrophy of ant neck musculature
- Overactive SCM
15
Q
Functional Assessment
A
- ? Interference with job, home, social life or sports.
- Turning doorknob, holding key, key grip, opening a jar, turning a tap, lifting a saucepan.
- Obtain * to reassess after intervention.
- This will help aid and direct your objective assessment.
