Wrist/Hand Muscle Power Deficit Flashcards
What is DeQuervain’s?
Tenosynovitis/Tenovagintis of the first extensor compartment (APL, EPB)
What may you find in subjectivley with DeQuervain’s?
- MOI: Overuse or repetitive motion that involves the thumb or radial ulnar deviation, common in painting, hammering, knitting, lifting a child
- Gradual insidious onset with dull ache over anatomical snuffbox
- Pain over radial styloid process; this may or may not radiate proximal to the forearm or distal into the thumb
- Sx are aggravated with turning doorknobs or keys; may also note a creek in the wrist with certain movements or gripping
What may you find Objectively with DeQuervain’s?
- Severe pain with ulnar deviaton and thumb flexion, (+) Finkelstein’s Test
- Pain with resisted thumb ABD or EXT
- Swelling located around the radial syloid process
- Limited CMC abduction
- Limited CMC mobility
*With this injury you want to rule out Scaphoid Fracture, especially if the injury is related to a fall *
What can be done for treatment of DeQuervian’s?
- Splinting, NSAIDS, ROM, joint mobility, transverse friction massage over 1st compartment
- Some patients may need education on limitations of daily activities and job duties, as well as changes in their workstation or tools
Splinting here involves the use of a forearm based thumb spica splint, where the IP joint is free in order to allow the tendons to rest
In more severe cases cortisone injections may be necessary ; if 2 or 3 injections do not provide lasting relief, then surgery to release the tendon sheath may be considered
What type of Orthosis should be used for patients with DeQuervian’s Syndrome?
Wrist Hand Finger Orthosis (WHFO)
What is Jersey Finger?
Avulsion of the Flexor Digitorum Profundus at insertion on distal phalanx
- This is the most common sports injuries
How does Jersey Finger happen?
This occurs from forceful grasping, like in football, wrestling, rugby.
The finger is forcefully extended while the FDP contracts, resulting in avulsion
The majority of cases involve the ring finger; studies show that the strength of insertion of the ring finger is less than others
What does treatment include with Minor injuries compared with more severe cases?
- Minor Injuries might do well with splinting
- More severe cases require surgical revision
What is Mallet Finger?
Another common sports injury
Hyperflexon of the DIP causing rupture of the extensor terminal tendon at insetion on distal phalanx
- The patient presents with a “droopy finger”, they are unable to actively extend the DIP, so it rest in flexion. It can be moved passively.
What is the focus on treatment with Mallet Finger?
Splinting and Orthosis.
- This involves a finger extension orthosis to support the DIP in hyperextension.
- The pt should stay in the orthosis for 8-10 weeks; if there is no extension lag after 10 weeks of wearing the orthosis, then the patient can transition out of the splint. Often a double band-aid around supports it enough in this phase, they should wear this double band-aid for about 2 weeks before returning to full ROM and strengthening
Surgery may be considered if injury is not responding to splinting or if its significantly limiting the patients functional activities
What is Trigger Finger?
Stenosis or Tenosynovitis of the distal flexor tendon sheath in area of the A1 pully
- This condition may develop idopathically or secondary to repetitive gripping or grasping of and object with a sharp edge
With Trigger Finger, what may you see with A/PROM and Palpation?
AROM: Intermittent finger locking during active flexion that requires passive force to extend the finger
PROM: Normal
Palpation: Pt may develop a palpable tender nodule proximal to the A1 pulley
What should be done for Interventions for those with Trigger Finger?
- Avoidance of repetitive gripping, rest, PRICE
- Hand Based or Finger Splint that positions the MCP joint at 0° and allows full DIP joint movement
If Sx persist the patient may undergo surgical release of the A1 pulley system
