Wrist & Hand Common Presentations Flashcards
intersection syndrome
- tenosynovitis of extensor carpi radialis longus and brevis where they cross under the abductor pollicis longus and extensor pollicis brevis
- pain typically at distal forearm 4-8cm proximal to lister tubercle
how is pain exacerbated with intersection syndrome
pain exacerbated by passive wrist flexion and resisted wrist extension
de quervain tenosynovitis
- sheaths of first dorsal compartment of wrist involving the abductor pollicis longus and extensor pollicis brevis
- common overuse injury with actions that overexert the thumb and/or repeated ulnar and radial deviation
what pain do you feel with de quervain tenosynovitis
- dull ache over radial wrist, may radiate into forearm
- pain with ulnar deviation, combined with thumb flexion and adduction
- pain with resisted thumb abduction and/or thumb extension
TFCC lesion
- fall on supinated outstretched hand, chronic repetitive rotational loading
- pain at medial wrist just distal to ulna
- painful click with wrist motions may be present
ROM/Palpation/Joint mob symptoms with a TFCC lesion
ROM: end range supination/pronation
palpation: tenderness localized to posterior depression just distal to ulnar head
joint mob: radiocarpal assessment
treatment for TFCC lesion
- dependent on location, outer would need surgery
- long arm cast or splint
- active, AAROM emphasizing flexion and extension initially, then supination/pronation and radial/ulnar deviation
- more functional and less of a shearing force to start this way
wrist sprain
traumatic force on the wrist that exceeds limits of ROM
integumentary/palpation symptoms for wrist sprain
- swelling
- tender at site of sprain
interventions for wrist sprain
- RICE, move in pain free range
- focus on ROM
intercarpal instability
- depends on interosseous and midcarpal ligaments, carpals move as a unit
- pain, weakness with grasping, tenderness over carpal, laxity
treatment for intercarpal instability
- trial of immobilization
- regain pain free ROM
- strengthening muscles that attach to carpals or cross the joint
gamekeepers thumb
- sprain of 1st MCP UCL
- MOI: valgus moment at 1st MCP, traumatic
gamekeepers thumb
- sprain of 1st MCP UCL
- MOI: valgus moment at 1st MCP, traumatic
integument/ROM/strength symptoms of game keepers thumb
integument: local tenderness, swelling, possible bruising
ROM: limited
strength: limited
treatment for gamekeepers thumb
- spica brace
- AROM of flexion and extension avoiding abduction stress to the MCP for at least 6 weeks
- strengthening surrounding areas
ganglion cyst
- thin walled cysts that develop spontaneously over a joint capsule or tendon sheath, no clear cause
- can be pain free
- can compress ulnar/median n.
ganglion cyst symptom relief
- immobilization
treatment for ganglion cyst
- may resolve on its own
- needle aspiration
- cortisone injxn
- sometimes surgery
mallet fingers
rupture or avulsion of extensor tendon at its distal phalanx of a digit
treatment for mallet finger
- acetaminophen for pain
- NSAID for pain/inflammation
- edema management
- splinting
- flexibility exercises
- functional strengthening/endurance/coordination
trigger finger
- one finger gets stuck in bent position
- inflammation in tendon sheath narrows the space for the tendon to glide
- may snap to bend/straighten
- may lock in flexed position and pt would have to physically extend finger with the other hand
risk factors for trigger finger
- DM
- RA
- female
- repeated gripping
treatment for trigger finger
- acetaminophen
- NSAIDs
- edema management
- splinting
- tendon gliding exercises
- flexibility exercises
- functional strengthening/endurance/coordination
- sometimes cortisone injxn
