Wrist & Hand - final exam Flashcards
degrees for:
- drinking activities:
- using a phone:
- turning doorknob:
- rise from chair:
6-24 ext
40 ext
40 ext, 40 flx, 30 ulnar dev
60 ext, 25 ulnar dev
what is ideal deg of flx, ext, radial dev & ulnar dev?
flx: 30-50
ext: 60
radial dev: 20
ulnar dev: 40
what is the optimal position for strength and precision of the hand?
wrist slightly hyperextended
2-5 fingers slightly flexed
thumb in opposition
what are causes of tendon injuries? (4)
trauma
RSI
overuse
disease (RA)
what is De Quervain’s tenosynovitis?
repetitive thumb use and ulnar deviation and gripping
*directly related to phone use (texting)
decreased grip and pinch strength at thumb
in De Quervain’s tenosynovitis, where would you likely see inflammation and thickening? where would pain be located at?
- extensor pollicis brevis and abductor pollicis longus tendons and sheath
- causing pain proximal to snuff box
what special test would you use for De Quervain’s tenosynovitis?
Finkelstein’s (min support)
PT Rx for De Quervain’s tenosynovitis
POLICED
reduce typing and dictate
tendinosis MET
tendon glides (glide structure within adj. structures)
thumb splint - protected range
many times patients with De Quervain’s tenosynovitis will get ______ instead of do PT
injections (73% successful)
describe the shape and location of the extensor hood
small triangular shaped aponeurosis of connective tissue
hood over MCP jt, holds extensor tendons midline & close to bone
wide at base, narrow distal
starts: metacarpal
ends: base of distal phalanx
what is the extensor hood an attachment site for?
extensor digitorum
lumbricals
interossei
what is mallet finger? results in?
tendon rupture or avulsion fracture of extensor hood mechanism at DIP with trauma or disease
results in DIP jt flexion contracture
Rx for mallet finger
splinting
possible PT to help mobility after mobilization
what is boutonniere deformity? results in?
rupture or stretch of extensor digitorum tendon at PIP with trauma or disease
results in PIP flexion with DIP extension
what is swan neck deformity?
rupture of volar plate at PIP with trauma or disease
results in hyperext. at PIP and flx at DIP
what would a patient’s hand look like if they have a ruptured tendon?
one finger held extended while others are flexed
Rx for ruptured tendon
address consequences of immobilization and focused on tendon repair/remodeling
wrist sprain involves:
primary mechanism?
flexor retinaculum and associated ligaments
hyperextension mechanism with FOOSH
what is the flexor retinaculum and what are its two parts?
fibrous band on volar wrist, runs mediolaterally
two parts:
- palmar carpal ligament
- transverse carpal ligament
what are the functions of the flexor retinaculum?
holds flexor tendons down
supports carpal arch as most activities performed with wrist extended
what is the extensor retinaculum? what are its two attachments?
fibrous band on posterior wrist in a mediolateral direction
attachments:
- ulnar styloid process/pisiform/triquetrum
- radius
what is the function of the extensor retinaculum?
holds extensor tendons close to the wrist
what are the attachments for the dorsal radiocarpal ligament?
posterior surface of distal radius
posterior surface of scaphoid, lunate & triquetrum
is dorsal radiocarpal ligament stronger than palmar radiocarpal ligament?
no
what does dorsal radiocarpal ligament limit?
wrist flexion
what does the collateral ligaments support?
MCP and IP joints on medial and lateral aspects from head of one bone to base of the other bone
MCL/UCL limits:
valgus stresses
LCL/RCL limits:
varus stresses
what is skier’s/gamekeepers thumb?
excessive valgus stress with hyperextension abduction during FOOSH
what does skier’s/gamekeepers thumb involve?
UCL at MCP joint
where is the articular disc located in the hand/wrist? attached to? also known as?
located on distal ulna
attached to triquetrum and lunate
aka triangular fibrocartilage complex
what is the function of fibrocartilage?
resists tension for stability and compression for shock absorption
the articular disc is inflamed/damaged by:
sprains/fractures
repetitive ulnar dev (hammering)
prolonged ulnar dev (cycling)
PT Rx for articular disc?
improve tissue integrity
POLICED
MET - high reps 3x30
stability
proliferation
bracing/taping
what is Dupuytren’s contracture?
a disease process that affects collagen formation of palmar fascia or aponeurosis
Dupuytren’s contracture:
fascia:
_______ in palm of hand
covers:
provides:
distal attachment of
thick triangular shaped
superficial
tendons of extrinsic muscles
some protection
palmaris longus
S&S of Dupuytren’s contracture:
results in:
ROM/accessory motion:
end feels:
involves:
palpation:
results in flexion contractures of MCPs and IPs
limited ROM & accessory motion into ext
elastic & firm end feels
more often involves 4th & 5th digits
palpation: usually have non painful nodules
PT Rx for Dupuytren’s contracture:
MT - emphasize mobility, improve ROM & function
MET - emphasize tissue elasticity and mobility
splinting/bracing - assist mobility
what cervical spinal n if impinged may produce hand symptoms?
C6-8
what is the most common entrapment?
carpal tunnel syndrome
what are the strongest link risk factors for carpal tunnel syndrome?
obesity
> 45 years
female
forceful hand activity with work
what are three big causes of carpal tunnel syndrome?
local inflammation at wrist
– repetitive/forceful use
– age related joint changes
– trauma
systemic inflammation
– auto immune conditions
– circulatory conditions
benign ganglion cyst
CT contains ___ tendons:
10
FCR, FPL, FDS, FDP, plus nerve under transverse carpal ligament
palmar digital branches of median nerve supplies sensation to?
volar surface of first 3.5 fingers and their dorsal tips - NOT entire palm
palm over scaphoid and 1st CMC is innervated by?
palmar branch of median n. that branches prior to carpal tunnel
superficial branch of median n provides motor input to:
1st/2nd lumbricals
opponens pollicis
abductor pollicis brevis
flexor pollicis brevis
what are symptoms of carpal tunnel syndrome?
gradual onset of tingling that can become numb in 1st 3.5 digits
worse at night and with other prolonged/repetitive wrist positions, esp flx
shaking hands relieves symptoms
weakening grip, tip or pinch strength
what would a PT see in someone with carpal tunnel syndrome?
function:
observation:
ROM:
resisted:
neuro:
accessory motion testing:
- lose fine motor control
- possible thenar atrophy
- symptoms w prolonged wrist flx and ext
- weakening pinch, tip and pinch strength
- diminished sensation w fast progression to numbness in cutaneous nerve pattern & DTRs and myotomes WNL –> peripheral n not spinal n.
- hypo or hypermobility with carpal, RC or distal RU jts
what are special tests for carpal tunnel syndrome?
carpal tunnel compression - inconsistent
Wainner’s CPR
two point discrimination
Tinel’s - inconsistent
wrist ratio index > .67
decreased sensation on involved fingers –> thermal sensation, monofilament testing
Phalen’s & reverse Phalen’s - inconsistent
PT Rx for carpal tunnel syndrome
POLI (NO C) ED
patient education
– pathology and risk factors
– aggravating factors
modalities
use computer mouse less
keyboards with lower strike force
orthoses –> neutral wrist splint
JM to neck, forearm, & wrist
neural glides
MET - lack of research
** combination of orthoses and stretching ** most support ^
how often should someone with carpal tunnel syndrome see a PT? what would the PT do?
3 weekly sessions and HEP
combination of STM and neural and tendon glides
what results should you expect to see for a patient with carpal tunnel syndrome who goes to PT?
better pain relief and functional reporting at 1 and 3 months
equal to sx with pain and function at 6 and 12 months
what is the gold standard MD Rx for carpal tunnel syndrome? what other 2 things are MD options?
nerve conduction study
cortisone injection and surgery
what is cut during a carpal tunnel release?
transverse ligament
what nerve is damaged with ape hand?
median
what happens to someones hand if they have ape hand?
weakness in thenar muscles
thenar atrophy w the thumb held more in the plane of the hand
inability to flx, oppose or abduct the thumb
where does the ulnar nerve enter? what is this formed by?
guyon’s canal
formed by pisiform and hook of hamate
what nerve is damaged with claw hand?
ulnar
what happens to someones hand if they have claw hand?
atrophy of hypothenar eminence
deficient interossei muscles
claw like deformity
what is the most common fracture and occurs primarily in women via FOOSH? what is it?
colles: distal radius within 2.5 cm of wrist and is displaced dorsally resulting in dinner fork deformity
which is the most common carpal to be fractured? how does this happen
scaphoid
wrist hyperextension with ulnar deviation (FOOSH)
what is the primary complaint of a scaphoid fracture?
pain at anatomic snuffbox
what may be a complication of a scaphoid fracture?
avascular necrosis
where would you get pain with a scaphoid fracture?
pain with thumb to index pinch
pain with wrist ext and pronation
what is the most common fracture of the fingers?
boxer’s (fighter’s) fracture
neck of 2-5th fingers
what is the most common fracture of the thumb?
bennett’s fracture
subluxation of proximal 1st MC
which carpal is the most commonly dislocated?
lunate
what is the most common instability of the carpals?
scapho-lunate
how should you treat a dislocation of the carpals?
assess stability –> do in closed pack position
