Wrist/Hand Movement Coordination

Question 1

What does the TFCC do?

Answer 1

The TFCC is regarded as the Primary stabilizer of the distal radioulnar joint.

• Its primary function is to enhance joint congruity and to cushion against compressive forces

Question 2

What is the MOI for a sprain/tear in the TFCC?

Answer 2

Fall with supinated forearm or chronic repetitive rotational loading

Question 3

What are the S/S of a TFCC sprain/tear?

Answer 3

• Pt complains of medial wrist pain distal to the ulna
• Pain is increased with end-range of motion with pronation/supination, as well as gripping
• TFCC stress test and compression test

Question 4

Is the TFCC Vascularized?

Answer 4

The majority of the TFCC is vascularized but there is a small part of the disc that is avascular (which may limit recovery)

This should be considered if the patient has not progressed as anticipated

Question 5

What is the treatment for TFCC strain/tear?

Answer 5

• Brace with cock-up splint or wrist widget splint
• Avoiding torsional loads such as loading the wrist in ulnar deviation or extension radial deviation (combined motions)
• Focus on proximal ROM and strengthening exercises at the elbow, shoulder and parascapular mobility. When appropriate, progress to strengthening of the wrist.

Question 6

What is the MOI of UCL injuries?

Answer 6

AKA skiers thumb/Game keepers thumb

• This is caused by a hyperabduction of force

In some cases this may also result of a fracture of the CMC joint called Bennett’s fracture.

Question 7

What are S/S of UCL injury?

Answer 7

• Difficulty using hand/thumb for gripping, typing and utensils
• Pain in the CMC area

Question 8

What may you find objectively with UCL injury?

Answer 8

• Limited/Painfull A/ROM
• Muscle weakness
• Joint laxity

Question 9

What are intervention strategies for UCL injuries?

Answer 9

• Orthosis for 8 weeks in a long opponens brace(If there is a fracture or severe UCL injury)

If injury is mild, do conservative treatment:
- ROM
- Progression of strengthening
- Gripping exercises
- Dexterity

More severe cases will require surgery

Question 10

What type of Orthosis should patients with UCL (wrist/hand) injuries wear?

Answer 10

Hand Finger Orthosis (HFO)

Question 11

What is Bennett’s Fracture?

Answer 11

This is a fracture with an MOI of hyperabduction, however this may occur with or without a UCL strain. Pt may need to be referred for imaging if Sx are severe

Question 12

What is the immediate treatment for Bennett’s Fracture?
What it the treatement post-immobilization?

Answer 12

Treatment involves being casted for 6-8 weeks

Post-Immobilization:
- ROM
- Strengthening
- Joint mobility
- grip strength
- dexterity