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PHTH 517 > Wrist-Hand Conditions > Flashcards

Wrist-Hand Conditions Flashcards

1
Q

Carpal Tunnel Syndrome

What is the MOI?

A

Median nerve compression neuropathy
- this happens under the transverse carpal ligament at the wrist

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2
Q

Carpal Tunnel Syndrome

What is it also associated with?

A

With pregnancy, diabetes, trauma, tumor in the carpal tunnel

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3
Q

Carpal Tunnel Syndrome

What are the landmarks of the carpal tunnel?

A

On the palmar aspect which is bounded by scaphoid, trapezium, capitate, hook of hamate, pisiform and transverse carpal ligament

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4
Q

Carpal Tunnel Syndrome

What are the subjective findings?

A
  • C/o of numbness in the median nerve, specifically tips of the first 3 fingers
  • C/o of pain in the forearm and wrist
  • Sx may wake up from pain
  • Wrist flexion is uncomfortable
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5
Q

Carpal Tunnel Syndrome

What are the objective findings?

A

Thenar atrophy can be seen if it’s advanced

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6
Q

Carpal Tunnel Syndrome

What are the confirming/special test for a dx?

A

Phalen, tinel and carpal compression test

Plain radiographs can be done for bony abnormalities
EMG/NCS can help with differential dx

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7
Q

Carpal Tunnel Syndrome

What is the main intervention?

A

Splinting

tf that’s it???

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8
Q

De Quervain Tenosynovitis

What is the MOI?

A

Repetitive or unaccustomed use of the thumb

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9
Q

De Quervain Tenosynovitis

What structures are inflammed?

A

Extensor and adbuctor tendons of the thumb extensor pollicis longus and abd. pollic longus

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10
Q

De Quervain Tenosynovitis

What is the subjective findings?

A

Wrist pain on the radial side
Hard time grasping and gripping

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11
Q

De Quervain Tenosynovitis

What are the objective findings?

A

Possible swelling @ radial styloid process
Palpation = pain @ retinaculum of radial styloid

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12
Q

De Quervain Tenosynovitis

What are the special test done?

A

Finkelstein’s
WHAT test
Eichoffs

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13
Q

De Quervain Tenosynovitis

What is the primary goal of interventions?

A

reduce inflammation
prevent adhesions from forming
prevent recurrent tendonitis

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14
Q

De Quervain Tenosynovitis

If steroid injections are in play, where would it be injected?

A

Into the fibrous sheath of the first dorsal compartment

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15
Q

De Quervain Tenosynovitis

What can assist to decrease inflammation?

A

Electrotherapy and thermal modalities

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16
Q

De Quervain Tenosynovitis

What are some other interventions that PTs can focus on?

A

Gentle AROM for short periods –> isometric –> concentric

Grasping and releasing small things

Education on thumb spica splints

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17
Q

De Quervain Tenosynovitis

What is the overall prognosis of the dx?

A

getting treatments within 6 months have very good outcomes

90% of non-severe cases can have relief with conservative mangements

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18
Q

Duprytrens

What is the MOI?

A

Fibroproliferation disease of the palmar fascia
- usually genetic and environmental
- often self limiting

Overgrowth of connective tissues and scarring = fibroproliferation

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19
Q

Duprytrens

What population is affected more?

A

Males

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20
Q

Duprytrens

What are the interventions use?

A
  • Surgical approaches (collage-nase clostridium histolyticum)
  • injection and manipulation
  • needle aponeurotomy
  • percuatenous
  • needle fasciotomy
  • fasciectomy

A LOT OF CRAP NOT FOR US

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21
Q

What is the most common wrist injury for all age groups?

A

Fracture of the distal radius

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22
Q

Fractures

Colles Fx

A

Most comon type!!

Distal radius fx fragment - tilted upward (dorsally)

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23
Q

Fractures

Smith Fx

A

Distal fragments - tilted downward (volarly)

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24
Q

Fractures

Barton Fx

A

Intra-articular fx associated with sublux of the carpus (forward or back)
- also have a displaced articular fragment of the radius

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25
# Fractures Chauffeurs Fx
Oblique fx through the base of the radial styloid
26
# Fractures Die-punch Fx
Depressed fx of the articular surface that is opposite the lunate or scaphoid bone
27
# Fractures What are the subjective findings?
Acute pain tenderness swelling deformity of the wrist hx of FOOSH
28
# Fractures What are the objective findings?
- swelling, deformity, discoloration around the wrist and distal radius - may have associated skin injury and bleeding - may have loss sensation in the median, radial or ulnar nerve - possible decreased circulation to the hand
29
# Fractures What are the confirming tests?
imaging (hello obvious????) - AP and lateral
30
# Fractures - Intervention What are the conservative interventions with immobility?
AROM: shoulder in all planes elbow flexion and extension finger flexion and extension
31
# Fractures - Intervention What must finger exercises include?
Isolated MCP flexion complete flexion (full fist) intrinsice minus fisting (MCP extension with IP flexion)
32
# Fractures - Intervention After immobilization, what is limited?
extenion and supination needs mobilization
33
# Fractures - Intervention After immobilization, what are initated?
AROM exercises of: - wrist flexion and extension - ulnar and radial deviation
34
# Fractures - Intervention When is PROM performed?
performed according to the MD protocol - right away or after 1-2 week
35
# Fractures - Intervention What are some strenghtening exercises adapted?
AROM ex for wrist and forearm --> strength with light weights and tubes with putty for grip strength --> functional ex
36
# Fractures What is the prognosis?
Typically uncomplicated course Occasional malunion or posttraumatic wrist arthritis
37
What is the most comon fractured carpal bone?
Scaphoid
38
# Fractures of Scaphoid What is the population that this mostly affect?
young male adults
39
# Fractures of Scaphoid Where does scaphoid span?
The **distal and proximal rows** of the carpals and consequently vulnerable to FOOSH
40
# Fractures of Scaphoid What are the subjective findings?
- Hx of a FOOSH type injury - C/o of dorsal wrist pain (especially with gripping) - Tender @ anatomical snuffbox
41
# Fractures of Scaphoid What are the objective findings?
- tender snuffbox - decreased AROM of wrist - Decreased grip strength - normal neuro exam
42
# Fractures of Scaphoid What are the confirming/special test for dx?
- possible axial compression - often not visible on PA and lateral radiographs - so get a scaphoid or oblique view
43
# Fractures of Scaphoid What is the current opinion of interventions?
conservative is controversial - **no agreement on the optimum position for immobilization**
44
# Fractures of Scaphoid What is the current management?
Currently immobilization >>
45
# Fractures of Scaphoid After immobilization, how should interventions be addressed?
Capsular pattern of the wrist!! AROM exercises for: - wrist flexion and extension - radial and ulnar deviation Do as early as possible after immobilization with PROM as well
46
# Gamekeepers (Chronic) or Skier (Acute) What structure is injured?
Ulnar collateral ligament
47
# Gamekeepers (Chronic) or Skier (Acute) What is the MOI?
Injury or repetitive use disrupted ligament = instability of MCP joint Decreased functioning for pinching and opposition
48
# Gamekeepers (Chronic) or Skier (Acute) What is the subjective findings of the acute phase?
Pain and swelling @ ulnar side of MCP joint
49
# Gamekeepers (Chronic) or Skier (Acute) What is the subjective findings of the chronic phase?
C/o of pain, weakness or loss of stability
50
# Gamekeepers (Chronic) or Skier (Acute) What is the objective findings?
- local tenderness and swelling @ ulnar side of MCP joint - pain or lots of motion with valgus stress test of UCL - impaired MCP joint flex and ext - Decreased pinching strength = instability or acute pain
51
# Gamekeepers (Chronic) or Skier (Acute) What is the confirming/special test to determine dx?
MCP stability tested in full extension and @ 30deg of flexion allows to stress the accessory collateral liament and UCL
52
# Gamekeepers (Chronic) or Skier (Acute) How long does grade 1 and 2 immobilized?
In a thumb spica cast for 3 weeks + splinting for 2 weeks
53
# Gamekeepers (Chronic) or Skier (Acute) When is AROM initiated?
Flexion and extension exercises start @ 3 weeks --> strengthening @ 8 weeks
54
# Gamekeepers (Chronic) or Skier (Acute) What is avoided for the first 2-6 weeks?
to avoid any abduction stress to the MCP
55
# Gamekeepers (Chronic) or Skier (Acute) How are grade 3 tears treated?
any tears and displaced bony avulsions are treated surgically and immobilized
56
# Gamekeepers (Chronic) or Skier (Acute) What is the postsurgical rehab involving?
thumb spica cast or splint for 3 weeks + 2 weeks of splinting rehab is then like grades 1 and 2 ## Footnote Except during active flexion and extension
57
# OA of the thumb What is the common population affected?
More common women - usually around after 40 y.o
58
# OA of the thumb What is the possible hx to point you to OA?
Past fx or other injuries to the joint = more likely to develop
59
# OA of the thumb What are the sx? ## Footnote This a long one
* Pain with gripping or pinching * swelling and tender @ base of thumb * aching discomfort after long use * loss of strength with gripping or pinching * out of joint look * bump over the joint * limited motion
60
# OA of the thumb What is ligament reconstruction?
stabilizes the CMC joint by taking off a portion of the damanged ligament then replacing it with a their own wrist flexor tendon
61
# OA of the thumb Who can benefit from a ligament reconstruction?
adults with no cartilage loss where the sx result from joint laxity
62
# OA of the thumb What are the pros of ligament reconstruction?
people with very early or pre-arthritis experience for good to excellent pain relief
63
# OA of the thumb What are the cons of ligament reconstruction?
the procedure stabilizes the joint BUT **doesn't repair the damaged cartilage or bone**
64
# OA of the thumb What is the most comon surgery?
Ligament reconstruction and tendon interposition (LRTI)
65
# OA of the thumb How is the LTRI procedure performed?
the arthritic joint surface removed and then replaced with tendon that keeps the bones separated - surgeons will take off part of the trapezium
66
# OA of the thumb Who does LTRI help with?
Helps adults with mod to severe arthritis with pain and hard time pinching or gripping
67
# OA of the thumb What are the pros of LTRI?
By removing the whole trapezium takes out the arthritis coming back
68
# OA of the thumb What is the success rate of LRTI?
96% success rate last at least 15-20 years
69
# OA of the thumb What are the cons of LRTI?
Has a long and painful recovery - 4 weeks of wearing a thumb cast - decreased pinch strength
70
# OA of the thumb How is the total joint replacement (TJR) procedure completed?
removes all or part of the damanged thumb joint and replaces it with an artificial implant
71
# OA of the thumb Who can benefit fom TJR?
Metal joint replacements are an option for older patietns with few functional demands since it will fail with heavier use Spacers = lower fail rates but higher complication rates
72
# OA of the thumb Who are spacers reserved for?
For younger or very active adults with more advanced disease
73
# OA of the thumb What are the pros of TJR?
Less invasive surgery (since no grafting) with a faster recovery and rehab some impants can be done without taking off trapezium to preserve healthy tissues and improve strength
74
# OA of the thumb What are the cons of TRJ?
Spacers have high complication rates for some patient's that includes bone damage, persistent pain and inflammation
75
# OA of the thumb What is the procedure method for fusion?
takes pain away by fusing bone together - creating a socket by hallowing out the thumb's MT bone --> shaping the trapezium into a cone that fits inside the socket - a metal pin holds bones together to keep alignment and prevent movement while bones fused
76
# OA of the thumb Who can benefit from fusion?
* Younger, active patients who have posttraumatic arthritis or physically demanding jobs * people with RA * those who have done thumb surgery but no sx relief
77
# OA of the thumb What are the pros of fusion?
makes a stable, pain free thumb that can grasp and pinch
78
# OA of the thumb What are the cons of fusion?
Has relatively high complication rate - can damage nearby joint and causes loss of mobility in the CMC joint - ability to lay the palm flat and put the fingers and thumb together in a cone shape

PHTH 517 (16 decks)

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