Wrist & Hand - final exam Flashcards by Gabrielle Otremba

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

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

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

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

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

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what are causes of tendon injuries? (4)

trauma
RSI
overuse
disease (RA)

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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

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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

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

Finkelstein’s (min support)

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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

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

injections (73% successful)

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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

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what is the extensor hood an attachment site for?

extensor digitorum
lumbricals
interossei

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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

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Rx for mallet finger

splinting
possible PT to help mobility after mobilization

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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

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what is swan neck deformity?

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

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

one finger held extended while others are flexed

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Rx for ruptured tendon

address consequences of immobilization and focused on tendon repair/remodeling

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wrist sprain involves:
primary mechanism?

flexor retinaculum and associated ligaments
hyperextension mechanism with FOOSH

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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

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what are the functions of the flexor retinaculum?

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

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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

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what is the function of the extensor retinaculum?

holds extensor tendons close to the wrist

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what are the attachments for the dorsal radiocarpal ligament?

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

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is dorsal radiocarpal ligament stronger than palmar radiocarpal ligament?

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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