Wrist/Hand Mobility Deficits Flashcards
What is the most common joint disease?
Osteoarthritis
What is the most 2nd most common place to develop OA in the hand?
At the thumb, specifically the CMC joint and the wrist.
- This is often due to Primary OA
- This is also the most disabiling
With OA, what may you find subjectively?
- More common in Post-menopausal woman
- Pain at the base of the thumb
- Pts often have pain and difficulty with opening jars, gripping, and buttoning buttons
With CMC OA, what may you find Obectively?
- May find limited joint mobility and decreased ROM
- (+) Adduction Stress Test
- (+) Grind Test which reproduces symptoms
- Crepitus may be present
What may cause OA at the wrist?
This is typically Secondary to a previous injury, trauma, or infection
- May present with the same crepitus, limited ROM and decreased joint mobility
What treatments should be done with CMC OA?
- Activity modification/rest
- Education on joint protection
- NSAIDs
- Orthosis: Hand based thumb spica
- Injections: Corticosterioids, Hyaluronic acid derivatives
- Hand Therapy: Evidence suggest Orthosis + Exercise
- The GOAL is to wean out of orthosis
Surgical options include:
- Denervation
- Trapeziectomy
- Ligament Reconstruction Tendon Interpositoin (LRTI)
Interventions also include:
Maintaining “C” position (first pic)
Chip clip in adductor webspace - keep webspace wide (second pic)
Activate 1st dorsal interossei and opponenes pollicis, key stabilizers (third pic)
What is this Orthosis commonly used for?
CNC OA
- Hand based thumb spica
What is Dupuytren’s Contracture?
This is a progressive fibrosis of the Palmar Aponeurosis
This condition effects the Palmar fascia longitudinal lines to become tendon like cords. The fascia becomes short and thick and causes contracture.
What causes Dupuytrens Contracture?
The cause is unknown, however affects caucasian men >50 years old
- Theres a high incidence in individuals with comorbilities such as: Diabetes, Epilepsy, or chronic smoking or alcohol use
- This may also develop after a hand injury or surgery
What are the S/S of Dupuytrens Contracture?
What ADLs are typically affected by this?
- Lumps or pits within the palm
- Involvement the fourth and fifth digit
- Palpable nodules, skin changes, changes of the fascia, joint contracture
ADLs affected by this include washing, wearing gloves, shaking hands, and putting hands into pockets
What is the treatment for Dupuytrens Contracture?
Conservative treatment includes:
- Splinting, ROM, long load low duration stretching, MFR, heat, modalities
- Often requires surgical intervention in more severe cases
What type of fracture is the most common carpal bone fracture?
What is the MOI for this fracture?
Scaphoid Fracture
- Disruption of the scapholunate ligament and/or lunotriquetral ligament may result in wrist instability
- Usually caused by FOOSH
- A high-energy wrist injury may also result in a scaphoid fracture
What are some findings with Scaphoid Fracture?
- Chronic Pain, limited mobility, and decreased strength
- Pt. may also complain of wrist pain and have tenderness over the anatomical snuffbox
- Swelling may also be noted
Falls resulting in pain at the anatomical snuffbox should be treated as potiential scaphoid fractures until proven otherwise
What happens if the patient has pain over the anatomical snuffbox but initial radiographs for fracture are negative, what should you do?
Place the patient in a splint/brace for 2-3 weeks and repeat the radiograph within 2 weeks.
- If radiographs are still normal but pain persist consider a bone scan or an MRI
With Scaphoid Fractures, what are secondary causes of pain at the Anatomical snuffbox?
- Radial Nerve Entrapment
- DeQuervains Tenosynovitis
- CMC OA/joint hypomobility
