Wrist/Hand Slides Flashcards
What are the expected ROM for the wrist?
ext 70*
flex 80*
radial deviation 20*
ulnar deviation 30*
1st metacarpal mainly articulates with…
trapezium
2nd metacarpal mainly articulates with…
trapezoid, also trapezium/capitate a bit
3rd metacarpal mainly articulates with…
capitate
4th metacarpal mainly articulates with…
hamate, also capitate
5th metacarpal mainly articulates with…
hamate (4th MC)
Which 2 fingers are more mobile than the other 2?
1st & 5th
What is the volar plate?
multilayered condensation of fibrocartilagenous tissue originating from the proximal phalanx and inserts onto the middle phalanx
What passes through the carpal tunnel?
4 FDP tendons
4 FDS tendons
1 FPL tendon
median nerve
The median nerve travels between which two muscles in the forearm?
FDS and FDP
Once the median nerve reaches the carpal tunnel, the ____ goes anterior to the flexor retinaculum to innervate the palm.
palmar cutaneous branch
The radial nerve is a continuation of the ____ cord, composed of nerve roots __ to ___. It emerges from between the ___ and ___ heads of the triceps, continuing through the spiral groove of the humerus.
posterior cord
C5-T1
long and medial
The ulnar nerve originates from the ___ cord, composed of nerve roots __ to __.
It follows along the __ wall of the axilla beneath the ___ muscle
medial
C8-T1
posterior wall
beneath pec minor
The ulnar nerve travels between which two muscles in the forearm?
FCU and FDP
Ganglion cysts tend to develop where?
areas of high friction, especially along tendons of the hand/wrist
Risk factors for ganglion cysts include…
being female
age 20-40
OA or RA
wrist injury hx
What ROM clue would you have when a dorsal ganglion is still developing?
pain on pROM ext of wrist
or sense of pressure within the joint
It’s important to ddx Dequervain’s from…
How would you do so?
OA of trapezium/1st MCP
joint play will be painful and restricted
What is flexor tenosynovitis?
nodule on flexor tendon becomes entrapped behind thickened tendon sheath, usually at MCP joint, causing finger to become stuck in a flexed position
Digital tenovaginitis stenosans is also called…
trigger finger or flexor tenosynovitis
A Galeazzi fracture of the radius is accompanied by a dislocation of the ___, while a Monteggia fracture of the ulna results in a dislocated ___
ulna
radius
With FOOSH injuries, the lunate is commonly dislocated in what direction?
palmarly
Colles Fractures were named for WHO?
Abraham Colles, who first described the condition in 1814
The most common fracture in older people is the…
Colles fracture (of the distal radius)
“Boxer’s fractures” =
metacarpals, M/C 4th or 5th
Which carpal bone is the most commonly fractured? What % does it account for?
scaphoid, 85%
The more proximal the scaphoid fracture, the more likely ___ is - which occurs in what percentage of proximal scaphoid fractures?
avascular necrosis
99%
Displaced scaphoid fractures have a non-union rate of approx…
60%
Differentiate type 1 vs. type 2 TFCC injuries.
type 1: direct trauma
type 2: repetitive overuse
General degeneration of the TFC begins at age __, but most people over age __ have some degeneration
30
50
Type 1 TFCC injuries are often d/t…
FOOSH or oversupination/pronation when using tools like a drill
What is: a progressive disease of genetic origin resulting in contracture of palmar fascia and fixed flexion deformity of the MCP and PIP joints?
dupuytren’s contracture
True or false: Bouchard’s nodes are distal, Heberden’s are proximal
false, it’s the reverse
What are the MC deformities in RA?
ulnar drift
palmar subluxation of MCP joints
Swan Neck & Boutonniere deformities
also Bouchard’s & Heberden’s nodes
What is: rupture of central band of extensor hood leading to flexion of PIP and extension of DIP?
Swan neck deformity
What is: laxity of PIP joint with bowstringing of lateral bands of the extensor hood leading to hyperextension of PIP and flexion of DIP?
boutonniere deformity
What causes the zigzag deformity of the thumb commonly seen in arthritis?
mm imbalance and ligament laxity with adductor pollicis tension
What is Sweater/Jersey finger?
the inability to flex the affected DIP joint due to rupture of the FDP tendon
common in football/rugby players
Which is more common: extensor or flexor tendon ruptures?
extensor d/t superficial location and thinness
What is mallet finger?
flexion deformity at the DIP d/t extensor tendon avulsion from distal phalanx
CTS usually sees paresthesia to which fingers?
1-3, sometimes 4
The following are all symptoms of?
clumsiness with fine motor skills of the hand
pain/paresthesia awakens patient at night
usually insidious
CTS
What testing would you use for carpal tunnel syndrome?
thenar mm weakness
Phalen’s
Tinel’s
Carpal compression
How would you ddx between CTS and C6-7 nerve root involvement?
C6-7 involvement:
use of hand will NOT increase symptoms
no nocturnal pain
Loss of thumb function affects what percentage of total hand function?
40-50%
Where is the surgical ‘no man’s land’ of the hand?
between the distal palmar crease and mid portion of the middle phalanx
Ape hand deformity is characterized by ____ and is d/t ___ nerve palsy
thenar eminence atrophy
median nerve
Bishop’s hand is characterized by ___ and is d/t ____ nerve palsy
hypothenar eminence wasting, flexion of fingers 4&5
ulnar nerve
Pulp to pulp pinch would be a functional assessment for the __ nerve. Tip to tip would be a functional assessment for the ___ nerve.
ulnar
median
If pt c/o pain on wrist flexion, lesion is probably in the…
midcarpal joints
Flexion sees more movement at the ___ joints and extension sees more movement at the ___ joints
flexion: greater at intercarpal
extension: greater at radiocarpal
Wrist flex/ext AND radial/ulnar deviation primarily happen through which carpal?
capitate
True or false: scaphoid moves more in relation to the radius than to lunate or triquetrum
true
What is the volar plate/its function?
limiting hyperextension
tough fibrocartilage on the palmar side of the fingers
Which branch of the median nerve goes anterior to the flexor retinaculum?
palmar cutaneous branch
The EPL tendon passes around what bony landmark?
Lister’s tubercle
