Wrist & Hand Common Presentations: Fractures, RA & the rest Flashcards
what are the types of distal radial fracture
- most common wrist injury for any age group
- 2 most common: colles and smith
colles fx
- complete fx of distal radius with posterior displacement of distal fragment
smith fx
sometimes called reverse colles, complete fx of distal raidus with anterior displacement of distal segment
scaphoid fx
most common fractured carpal bone
pain in radial side, pain with gripping
symptoms felt with scaphoid fx
- tender at snuff box
- swelling may prevent concavity of snuffbox
whats important about catching a scaphoid fx early
can become necrotic early
hook of hamate fx
pain, tender, swelling in area
what neurologically would you check during your eval given they have a hook of hamate fx?
ulnar - gyons canal
boxers fx
- fx of fifth metacarpal
- MOI: punching
rheumatoid arthritis
- effects entire body
- lifelong disease
- pain, swelling, warmth, limited motion, commonly in the hands and wrists bilaterally
ulnar drift
- imbalance which results fingers being pulled into ulnar deviation and anterior palmar dislocations
boutonniere deformity
- rupture of the central band of the common extensor tendon that inserts on base of middle phalanx is damaged
- leads to flexed PIP and extended MCP and DIP
treatment for boutonniere deformity
- presence of a mobile correctable deformity typically requires 6-8 weeks of immobilization
- PIP held in full extension with DIP & MCP free to move
- gentle ROM can begin 4-8 wks with splint reapplied btw exercises
- strengthening around 10-12wks
swan neck deformity
- disruption of the volar plate at the PIP joint
- flexion at DIP and hyperextension at PIP
- inability to bring tips of fingers into grasp items
treatment for swan neck deformity
depends on etiology and status of related anatomical structures
interventions for RA of the hand/wrist
- control inflammation
- focus on joint system rather than isolated joint
- active/isometric exercise
- ROM focused on long flexor tendons
- squeezing items
- resistance introduced slowly
- education on jt protection
- splinting
- pain management
primary osteoarthritis symptoms
- crepitus
- ROM loss in multiple directions
- pain at end range of motion
- joint line tenderness
- joint hypomobility
- +CMC grind test
dupuytren contracture
- active cellular process in fascia of hand in which knots or nodules of fascia eventually create a thick cord that can pull on one or more fingers preventing them from fulling straightening
factors contributing to dupuytren contracture
alcoholism
diabetes
epilepsy
tobacco dependence
complex regional pain syndrome (CRPS)
- reflex sympathetic dystrophy
- describes excess and prolonged pain and inflammation that follows an injury to the arm or leg
what is CRPS caused by
caused by improper function of peripheral C-fiber nerves that carry pain messages to the brain leading to excess firing and trigerring inflammation
symptoms with CRPS
- unprovoked or spontaneous pain that can constant or fluctuate with activity
- excess or prolonged pain after use or contact
- change in skin temp, color or swelling
- change in skin texture
- abnormal sweating, nail and hair growth
- stiffness in joints
- impaired muscle strength and movement
treatment for CRPS
- earlier intervention the better
- minimize pain, get person moving
- elevate limb as often as possible
- progression should be slow and gentle
- desensitization
what would immobilization and overprotecting the limb with someone who has CRPS do
may make it worse
when would you use grip and pinch strength testing
loss of hand strength
