Wrist/Hand / Test 3 Flashcards
Pain over radial styloid process with gripping activities
dequervain’s syndrome
Insidious onset numbness and tingling in 1st three fingers worse at night
carpal tunnel
Paresthesia over dorsal aspect of ulnar border of hand and digit 4-5
ulnar compression at guyon tunnel
Inability to extend MCP or PIP joint
Dupuytren’s contracture
Pain with loading of wrist, fall on hyper extended wrist
scaphoid fracture instability
two ways to measure edema of hand
figure 8 tape measure, volumetric (water)
protective shield of nail
nail plate
root of nail, produces keratin that makes nail plate
matrix
protect the matrix, there are proximal and lateral
nail folds
part of nail that acts as a barrier seal to bacteria
eponychium
true cuticle of nail that is dead skin cells attached to nail plate from the nail fold
ptygerium
part of nail that is the front end of the matrix. keratin cells have not yet flattened
lunula
pulmonary disease characterized by a convex nail
club nail
loosening of nail plate that can be from graves disease, psoriasis, reactive arthritis
onycholysis
aka spoon nail, characterized by concave nail from psoriasis, syphilis, thyroid dysfunction, rheumatic fever
koilonychia
acute systemic illness, can be from local trauma or result from chemotherapy that shows lines on nails
beau’s lines
heart attack, endocarditis, vasculitis, and renal failure can cause tiny bloody cracks in nails called blank
splinter hemorrhages
white nail syndrome from arsenal poisining, renal failure, malnutrition
leukonychia
normal wrist extension
20 to 35
normal ulnar deviation
10-15
radioulnar joint
resting position:
close pack position:
capsular pattern:
10 supination
5 supination
pain at extreme of rotation
radiocarpal joint
resting position:
close pack position:
capsular pattern:
neutral w/ slight ulnar dev
extension
flex/ext equally limited
intercarpal joint
resting position:
close pack position:
capsular pattern:
neutral/slight flexion
extension
none
midcarpal joint
resting position:
close pack position:
capsular pattern:
neutral/slight flexion
extension/ulnar deviation
limited flex/ext
stable segment of hand
distal carpal row and 2/3 metacarpals
mobile segment of hand
five phalanges and 1,4,5 metacarpals
there is flexion of mcp/dip and extension of pip in this finger deformity
swan neck
extension of mcp and dip, flexion of pip in this finger deformity
boutonniere
thickening of flexor tendon sheath
trigger finger
finger deformity that is a loss of intrinsic mm action and over dominance of extrinsic extensors acting on proximal phalanx. only median or ulnar nerve
claw fingers
finger deformity that is wasting of hypothenar muscle, interossei, two medial lumbricals (ulnar nerve paralysis)
bishops/benediction hand
wasting of thenar eminance from median nerve paralysis where thumb falls back in line with fingers due to pull of extensor muscles in this deformity
ape hand
finger deformity that is distal phalanx resting in flexion
mallet finger
contracture of palmar fascia that causes fixed 4th/5th digit mostly in older men
duputren’s contracture
paralysis of extensor muscle from radial nerve paralysis
drop wrist
thumb flexed at mcp and extended at ip (ra or heredity)
z deformity
osteoarthritic enlargement of PIP
bouchard’s nodes
osteoarthritic enlargement of DIP
heberden’s nodes
movements of wrist that should be harder end feel rather than firm
pronation, radial deviation
A passive loss of motion in a ratio that occurs when the capsular ligament of a joint loses its elasticity uniformly throughout its full extent. The ratio is specific for each different joint.
capsular pattern
capsular pattern is full rom with pain at extreme of supination/pronation
distal radioulnar joint
capsular pattern is equal limitation of flexion/extension
wrist
capsular pattern is flexion more limited than extension
mcp/ip joints
capsular pattern is abduction more limited than extension
trapeziometacarpal joint of thumb
loss of hand accounts for what percent loss of function
90
aka preparatory nerve that positions wrist and controls tension in digital flexors
radial
aka power nerve that innervates abductor digiti minimi, flexor digiti minimi…..
ulnar nerve
nerve that provides ability for precision manipulation.
median nerve
two grip strength tests
dynamometer, pinch meter
↓capsulolig extensibility
↓muscle flexibility
↓ capsulolig restraint
indicate blank
passive inadedquacy
Tissue reactivity
↓ muscular contractility
↓ motor control
indicate blank
active inadequacy
two pulleys of the fingers
annular, cruciate
annular pulley of fingers are usually at blank
joints
cruciate pulleys are where
on bones not at joints in fingers
without pulley system there would be a blank causing excessive extension of finger
bowstring effect
swan neck deformity is flexion of these two joints but extension of this joint
mcp/dip, pip
ape hand is a blank nerve palsy
median
a contracture needs a blank to be relieved
surgical release
drop wrist is a blank nerve palsy
radial
losing thumb function causes blank percent functional loss of hand
40-50
growth plate break and acute pediatric wrist fractures often present with blank instead of deformities
point tenderness
two types of distal radius fractures
colles, smith’s
three types of carpal fractures
scaphoid (most common), triquetral, hook of hamate
bone takes about blank to fully heal
2 yrs
circulation in carpals (scaphoid) enters through blank pole
distal
blank pole has poor circulation
proximal
metacarpal fracture of thumb
bennet’s
4th and fifth metacarpal fractures are called
boxer’s
extensor tendon repair heals blank than flexor tendon repairs after surgery
faster
carpal tunnel syndrome causes weakness or atrophy of these muscles
thenar, first 2 lumbricals (median nerve innervation)
where the ulnar nerve runs through the wrist
tunnel of guyon
