Wrist/Hand Eval & Treat Flashcards by Tori Chatman

29 Bones

2 forearm
8 carpals
5 metacarpals
14 finger bones

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Distal Radio-Ulnar Joint

Conave radius on Convex Ulna head

CPP: 5 supination
OPP: 10 supination
Capular Pattern: pain at extremes of SUP/PRO

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Ulnar Variance

-ulnar head in relation to radius in DRUJ
-changes in % of load bearing

(+): ulna >2mm distal to radius= longer
-TFCC and scaphulolunate instability tears

(-): ulna >2mm proximal to radius= shorter
-Kienbock Malacia

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Radio-Carpal Joint

Convex carpals on Concave radius = opp

CPP: full ext with rad dev
OPP: neutral with slight ulnar dev
Capular Pattern: flexion= ext

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Carpal Bones

-8
Proximal Row: scaphoid, lunate, triquetrum, pisiform (palmar) (Slow loris takes poops)

Distal Row: Trapezium, tappezoid, capitate, hamate (toe taps cause hemroids)

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Intercarpal Joints

-plan joints btwn carpals

CPP: full ext
OPP: neutral to slight flx

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Mid Carpal Joints

-joints between proximal and distal rows

CPP: full ext w/ ulnar deviation
OPP: neutral to slight flexion w/ ulnar deviation
Capsular Pattern: flex= ext

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Thumb CMC Joint

-saddle joint

CPP: full opposition
OPP: midway ABD/ADD and flx/ext
Capsular pattern: ABD loss > ext

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Finger CMC Joint

-plane joints

CPP: full flx
OPP: midway flx/ext

2nd/3rd immobile
4tth/5th mobile for grip

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MCP Joints

-coondyloid

CPP: full opposition (thumb); full flx (2nd-5th)
OPP: slight flexion
Capsular Pattern: flx >ext

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PIP/DIP Joints

-hinge

CPP: full ext
OPP: slight flx
Capsular Pattern: flx > ext

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Distal Radio-Ulnar Joint Ligaments

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Dorsal Wrist Ligaments

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Palmar Wrist Ligaments

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Dorsal and Palmar Intercarpal Ligaments

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Intterosseous Ligaments

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Triangular Fibrocartilage Complex (TFCC)

Made up of :
-palmar and dorsal ulnoo-carpal ligs
- UCL
-radio-ulnar disc
-extensor carpi ulanris tendon sheath

when disc is removed radius bears 95% of axial load

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Extensor Retinaculum

-where tendons cross wrist joint
-prevents bowstringing
-extensor tendons are flat

Flexor Retinaculum

-transverse carpal lig
-mainttains carpal arch
-sight of carpal tunnel
-attachement for thenars and hypothenars
-flexor tendons are round

Anatomic Snuffbox

Radial border: APL/EEPB
Ulnar border: EPL
Sub-floor: scaphoid and trapezium

Carpal Tunnel

Floor: palmar ligament complex
Roof: transverse lig/flexor retinaculum
Side: hood of hamate and trapezium
Contents: medial nerve; 9 flexor tendons

Ulnar Nerve Hand Distribution

Sensation:
-medial palm and dorsum
-pinky finger (tip is eclusive)
-medial half of ring finger
-bottom half of middle finger

Motor:
-Mmedial 2 lumbricals
-Adductor Policis
-Interossei
-Palmaris Brevis

Median Nerve Hand Distribution

Sensation:
-lateral palm
-top half of fingers 2 and 3 (exclusive)
-palmar side of thumb

Motor:
LOAF
-lateral lumbricals
-Opponens pollicis
-Abd policis brevis
-Flexor policis brevis

Radial Nerve Hand Distribution

Sensation:
-Lateral dorsum of hand excluding top half of digits 2 and 3
-dorsum and lateral of thumb

Motor:
-wrist and finger extensors

Dermatomes of Hand

C6: palmar and dorsal thumb C7: palmar and dorsal fingers 2 and 3 C8: [palmar and dorsal fingers 4 and 5

DDx Wrist Injuries

Fx: -Distal Radius (Colles' vs Smith) -Scaphoid -Hook of Hamate Sprains: -TFCC -Radioscapholunate Ligament -Lunotriquetral Volkmann's Ischemic Contracture OA Tendinopathy/Tenosynovitis: -De Quervains -EPL, EI, ECU -FCR, FCU Carpal Instabilities Peripheral Nerve Injuries

Colles' Fx

-FOOSH onto extened wrist -dorsal displacement of Radius S/s: -shortening of forearm

Smith's Fx

-FOOSH onto flexed wrist -volar displacement of radius

Scaphoid Fx

-FOOSH -heals in 8w to 4 months S/s: -pain in snuffbox -poor healing Tx: -cast 6-8w -surgery

Hook of Hammate Fx

-Repetitive torque stresses -common with bat/raquet/club sports S/s: -pain on ulnar side w/ gripping -pain w/ resisted 4th/5th finger flx Tx: -cast for 12w -surgical excision

TFCC Tear

MOI: -FOOSH -repettitive loading -ulnar distraction S/s: -wrist pain on ular side -click or crepitus during gripping or rotation Test: -Piano Key Test Tx: -bracing 4-6w -activity modification

Volkmann's Ischemic Contracture

-UE compartment syndrome w/ deformity of wrist/hands/fingers that causes lack of blood flow and eventual contractures from scar tissue -medical EMERGENCY MOI: -major crush injury S/s: -swelling

1st CMC OA CPR

1. Hand pain or stiffness 2. Hard tissue enlargement of >2 joints AND 2nd/3rd DIPs and PIPS and 1st CMC 3. <3 swollen MCPs 4. Hard tissue enlargement of >2 DIPs 5. Deformity of >2 selected joints *>2 = greater than or equal to*

De Quervain's Tenosynovitis

-inflammation of synovial shealth of APL and EPB MOI: -over use (MC) -direct trauma S/s: -TTP radial styloid -TTP of snuffbox -Pain with active thumb ABD -PAin with passive thumb ADD Test; -Finkelstein's Test Tx: -spica splint -steroid injection -surgical release

Scapholunate Dissociation

-lunate MC dislocated carpal -might take 1 year MOI: -FOOSH S/s: -schapoid shifts volarly -lunate shifts dorsally Test: -Watson Shift Test Tx: -immobilization 6-12w -sugery -strengthen surrounding muscles

DDx Hand Injuries

-Heberden's Nodes -Bouchard's Nodes -Swan Neck -Boutonnniere -Trigger Finger -Mallet Finger -Jersey Finger -Ulnar Drift -Ape Hand -Boxer's Fx -Dupuytren's Contracture -Gamekeeper's Thumb -Peripheral Nerve Entrapment

Heberden's Nodes

-enlargement of Dorsal DIP w/ OA

Bouchard's Nodes

-enlargemen of dorsal PIP w/ OA

Swan-Neck Deformity

-Flx MCP -EXT PIP -FLX DIP -contracture of intrinsics or tearing of volar plate from RA or trauma

Boutonniere Deformity

-EXT MCP -FLX PIP -EXT DIP -contracture of intrinsics or tearing of extensor hood from RA or trauma

Trigger Finger

-thickening of A1 Pully in flexor shealth causing catch -cannot extend -common with RA

Mallet Finger

-avulsion of extensor tendon MOI: -forced flx of DIP

Jersey Finger

-avulsion of FDP tendon