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DPT MSK - fall 22 > Wrist & Hand - final exam > Flashcards

Wrist & Hand - final exam Flashcards

1
Q

degrees for:
- drinking activities:
- using a phone:
- turning doorknob:
- rise from chair:

A

6-24 ext
40 ext
40 ext, 40 flx, 30 ulnar dev
60 ext, 25 ulnar dev

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2
Q

what is ideal deg of flx, ext, radial dev & ulnar dev?

A

flx: 30-50
ext: 60
radial dev: 20
ulnar dev: 40

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3
Q

what is the optimal position for strength and precision of the hand?

A

wrist slightly hyperextended
2-5 fingers slightly flexed
thumb in opposition

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4
Q

what are causes of tendon injuries? (4)

A

trauma
RSI
overuse
disease (RA)

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5
Q

what is De Quervain’s tenosynovitis?

A

repetitive thumb use and ulnar deviation and gripping
*directly related to phone use (texting)
decreased grip and pinch strength at thumb

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6
Q

in De Quervain’s tenosynovitis, where would you likely see inflammation and thickening? where would pain be located at?

A
  • extensor pollicis brevis and abductor pollicis longus tendons and sheath
  • causing pain proximal to snuff box
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7
Q

what special test would you use for De Quervain’s tenosynovitis?

A

Finkelstein’s (min support)

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8
Q

PT Rx for De Quervain’s tenosynovitis

A

POLICED
reduce typing and dictate
tendinosis MET
tendon glides (glide structure within adj. structures)
thumb splint - protected range

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9
Q

many times patients with De Quervain’s tenosynovitis will get ______ instead of do PT

A

injections (73% successful)

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10
Q

describe the shape and location of the extensor hood

A

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

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11
Q

what is the extensor hood an attachment site for?

A

extensor digitorum
lumbricals
interossei

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12
Q

what is mallet finger? results in?

A

tendon rupture or avulsion fracture of extensor hood mechanism at DIP with trauma or disease
results in DIP jt flexion contracture

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13
Q

Rx for mallet finger

A

splinting
possible PT to help mobility after mobilization

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14
Q

what is boutonniere deformity? results in?

A

rupture or stretch of extensor digitorum tendon at PIP with trauma or disease
results in PIP flexion with DIP extension

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15
Q

what is swan neck deformity?

A

rupture of volar plate at PIP with trauma or disease
results in hyperext. at PIP and flx at DIP

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16
Q

what would a patient’s hand look like if they have a ruptured tendon?

A

one finger held extended while others are flexed

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17
Q

Rx for ruptured tendon

A

address consequences of immobilization and focused on tendon repair/remodeling

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18
Q

wrist sprain involves:
primary mechanism?

A

flexor retinaculum and associated ligaments
hyperextension mechanism with FOOSH

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19
Q

what is the flexor retinaculum and what are its two parts?

A

fibrous band on volar wrist, runs mediolaterally
two parts:
- palmar carpal ligament
- transverse carpal ligament

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20
Q

what are the functions of the flexor retinaculum?

A

holds flexor tendons down
supports carpal arch as most activities performed with wrist extended

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21
Q

what is the extensor retinaculum? what are its two attachments?

A

fibrous band on posterior wrist in a mediolateral direction
attachments:
- ulnar styloid process/pisiform/triquetrum
- radius

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22
Q

what is the function of the extensor retinaculum?

A

holds extensor tendons close to the wrist

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23
Q

what are the attachments for the dorsal radiocarpal ligament?

A

posterior surface of distal radius
posterior surface of scaphoid, lunate & triquetrum

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24
Q

is dorsal radiocarpal ligament stronger than palmar radiocarpal ligament?

A

no

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25
Q

what does dorsal radiocarpal ligament limit?

A

wrist flexion

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26
Q

what does the collateral ligaments support?

A

MCP and IP joints on medial and lateral aspects from head of one bone to base of the other bone

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27
Q

MCL/UCL limits:

A

valgus stresses

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28
Q

LCL/RCL limits:

A

varus stresses

29
Q

what is skier’s/gamekeepers thumb?

A

excessive valgus stress with hyperextension abduction during FOOSH

30
Q

what does skier’s/gamekeepers thumb involve?

A

UCL at MCP joint

31
Q

where is the articular disc located in the hand/wrist? attached to? also known as?

A

located on distal ulna
attached to triquetrum and lunate
aka triangular fibrocartilage complex

32
Q

what is the function of fibrocartilage?

A

resists tension for stability and compression for shock absorption

33
Q

the articular disc is inflamed/damaged by:

A

sprains/fractures
repetitive ulnar dev (hammering)
prolonged ulnar dev (cycling)

34
Q

PT Rx for articular disc?

A

improve tissue integrity
POLICED
MET - high reps 3x30
stability
proliferation
bracing/taping

35
Q

what is Dupuytren’s contracture?

A

a disease process that affects collagen formation of palmar fascia or aponeurosis

36
Q

Dupuytren’s contracture:
fascia:
_______ in palm of hand
covers:
provides:
distal attachment of

A

thick triangular shaped
superficial
tendons of extrinsic muscles
some protection
palmaris longus

37
Q

S&S of Dupuytren’s contracture:
results in:
ROM/accessory motion:
end feels:
involves:
palpation:

A

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

38
Q

PT Rx for Dupuytren’s contracture:

A

MT - emphasize mobility, improve ROM & function
MET - emphasize tissue elasticity and mobility
splinting/bracing - assist mobility

39
Q

what cervical spinal n if impinged may produce hand symptoms?

A

C6-8

40
Q

what is the most common entrapment?

A

carpal tunnel syndrome

41
Q

what are the strongest link risk factors for carpal tunnel syndrome?

A

obesity
> 45 years
female
forceful hand activity with work

42
Q

what are three big causes of carpal tunnel syndrome?

A

local inflammation at wrist
– repetitive/forceful use
– age related joint changes
– trauma
systemic inflammation
– auto immune conditions
– circulatory conditions
benign ganglion cyst

43
Q

CT contains ___ tendons:

A

10
FCR, FPL, FDS, FDP, plus nerve under transverse carpal ligament

44
Q

palmar digital branches of median nerve supplies sensation to?

A

volar surface of first 3.5 fingers and their dorsal tips - NOT entire palm

45
Q

palm over scaphoid and 1st CMC is innervated by?

A

palmar branch of median n. that branches prior to carpal tunnel

46
Q

superficial branch of median n provides motor input to:

A

1st/2nd lumbricals
opponens pollicis
abductor pollicis brevis
flexor pollicis brevis

47
Q

what are symptoms of carpal tunnel syndrome?

A

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

48
Q

what would a PT see in someone with carpal tunnel syndrome?
function:
observation:
ROM:
resisted:
neuro:
accessory motion testing:

A
  • 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
49
Q

what are special tests for carpal tunnel syndrome?

A

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

50
Q

PT Rx for carpal tunnel syndrome

A

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 ^

51
Q

how often should someone with carpal tunnel syndrome see a PT? what would the PT do?

A

3 weekly sessions and HEP
combination of STM and neural and tendon glides

52
Q

what results should you expect to see for a patient with carpal tunnel syndrome who goes to PT?

A

better pain relief and functional reporting at 1 and 3 months
equal to sx with pain and function at 6 and 12 months

53
Q

what is the gold standard MD Rx for carpal tunnel syndrome? what other 2 things are MD options?

A

nerve conduction study
cortisone injection and surgery

54
Q

what is cut during a carpal tunnel release?

A

transverse ligament

55
Q

what nerve is damaged with ape hand?

A

median

56
Q

what happens to someones hand if they have ape hand?

A

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

57
Q

where does the ulnar nerve enter? what is this formed by?

A

guyon’s canal
formed by pisiform and hook of hamate

58
Q

what nerve is damaged with claw hand?

A

ulnar

59
Q

what happens to someones hand if they have claw hand?

A

atrophy of hypothenar eminence
deficient interossei muscles
claw like deformity

60
Q

what is the most common fracture and occurs primarily in women via FOOSH? what is it?

A

colles: distal radius within 2.5 cm of wrist and is displaced dorsally resulting in dinner fork deformity

61
Q

which is the most common carpal to be fractured? how does this happen

A

scaphoid
wrist hyperextension with ulnar deviation (FOOSH)

62
Q

what is the primary complaint of a scaphoid fracture?

A

pain at anatomic snuffbox

63
Q

what may be a complication of a scaphoid fracture?

A

avascular necrosis

64
Q

where would you get pain with a scaphoid fracture?

A

pain with thumb to index pinch
pain with wrist ext and pronation

65
Q

what is the most common fracture of the fingers?

A

boxer’s (fighter’s) fracture
neck of 2-5th fingers

66
Q

what is the most common fracture of the thumb?

A

bennett’s fracture
subluxation of proximal 1st MC

67
Q

which carpal is the most commonly dislocated?

A

lunate

68
Q

what is the most common instability of the carpals?

A

scapho-lunate

69
Q

how should you treat a dislocation of the carpals?

A

assess stability –> do in closed pack position

DPT MSK - fall 22 (18 decks)

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