-
ROM - Wrist
- Flexion - 80
- Extension - 70
- Radial deviation - 20
- Ulnar deviation - 30
-
ROM - 2-5 MCP - flexion; hyperextension
- Flexion - 90
- Hyperextension - 45
-
ROM - 2-5 PIP - flexion; hyperextension
- Flexion - 100
- Hyperextension - 45
-
ROM - 2-5 DIP - flexion; hyperextension
- Flexion - 90
- Hyperextension - 10ish
-
ROM - thumb - MCP flexion; IP flexion
- MCP flexion - 50
- IP flexion - 80
-
Radiocarpal joint articulates what w/what?
- Convex scaphoid & lunate articulate w/concave radius
- Ulna is convex at its distal end relative to triquetrum
-
Wrist flexion/extension is predominantly at what joint?
- Flexion - mid carpal jt
- Extension - Radiocarpal jt
-
What range of wrist is needed for optimal use of hand?
Wrist extension of 20°-30°
-
Distal aspect of proximal row is ______ at lunate/capitate & triquetrum/hamate articulations
Concave
-
Scaphoid is _______ anterior/posterior & ______ medial/lateral relative to trapezium/trapezoid
-
Capitate is ____, & articulates w/concavities of what carpal bones?
- Convex
- Scaphoid - inferiorly
- Hamate - medially
- Trapezoid - laterally
-
Radiocarpal joint - Resting position
Neutral w/slight ulnar deviation
-
Distal radioulnar jt - Closed-packed position for 2
- Extension
- Radial deviation
-
Proximal carpals lateral to medial
- Scaphoid
- Lunate
- Triquetrium
- Pisiform
-
Distal carpals from lateral to medial
- Trapezium
- Trapezoid
- Capitate
- Hamate
-
Which bone is most frequently fractured carpal bone? Why?
- Scaphoid
- Poor blood supply - frequently develops avascular necrosis during healing
-
Anterior dislocation of lunate - can compress what nn against flexor retinaculum?
Median
-
Volar plate is present on what aspect of MCP, PIP, DIP joints? Does what?
- Palmar
- INC articular surface during extension & protect joint volarly
-
Collateral ligament - which fibers tighten w/flexion/extension
- Flexion - all fibers
- Extension - Volar fibers
-
Transverse ligament - present at what jts? Provide reinforcement to capsule how?
-
1st CMC - concave/convex
- flex/ext
- ABD/ADD
- Flex/Ext = Concave moving on convex
- ABD/ADD = Convex moving on concave
-
Which muscle holds the wrist in extension?
Extensor carpi radialis brevis
-
MMs - functional power vs fine control
- Functional power - Extrinsic muscles
- Fine control - Intrinsics
-
W/RA pts what splint is used & describe?
- Intrinsic plus splint
- Flex @ MPs/ Ext @ PIP/DIP
-
Carpal Tunnel Syndrome - S/S + if splinting is needed what position?
- Sensory changes aggravated by prolonged use of hand - Worst at night
- Onset - Insidious; 40-60
- Weakness in pinch
- Seen w/RA, DM, pregnancy
- Long-term compression causes atrophy/weakness of thenar mms & lateral 2 lumbricals
- Splinting - Wrist in neutral - wrist flat/fingers relaxed & slightly curved
-
De Quervain's tenosynovitis - 7
- Pain at anatomical snuffbox
- Tenderness to palpation over radial styloid
- Swelling
- Weak thumb ABD
- DEC grip & pinch strength
- Tendons affected - EPB, ABD pollicis longus
- Complication of swelling during pregnancy
-
What deformity is pictured?
- Dupuyten’s Contracture
- Painless fibrosis of palmar aponeurosis - Palmar nodule or contracture
- Diabetic - contracture of 3rd, 4th digits
- Non-diabetic - contracture of 4th, 5th MCP & PIP
- Inability to extend digits
-
What deformity is pictured?
- Buttonier’s deformity
- Rupture of central tendinous slip of extensor hood
- Extension of MCP/DIP w/flexion of PIP
- RA pts
-
What deformity is pictured?
- Swan neck deformity
- Contracture of intrinsic muscles w/dorsal subluxation of lateral extensor tendons
- Flex MCP & DIP/Hyperextension PIP
- Onset - trauma; RA
- PT - Splinted in slight flexion
-
What deformity is pictured? 2 names; what lig is torn; pain INC w? what type of instability? PT
- “Gamekeeper’s thumb” + “Skier’s thumb”
- Injury of ulnar collateral ligament of thumb MCP
- Pain INC w/PINCH GRASP
- Results in medial instability of thumb
- PT - immobilization for 6 wks
-
What deformity is pictured? another name; mechanism of injury; how is radius displaced? complications; PT
- Colles' fracture - “Dinner fork” deformity
- Extension fx of radius - Fall on an outstretched hand
- Distal fragment of radius dislocated in dorsal (posterior) direction
- Complications - DEC grip strength, carpal tunnel syndrome, CPRS
- PT - immobilized for 5-8 weeks
-
What deformity is pictured? another name; mechanism of injury; how is radius displaced? complications; PT
- Smith’s fracture - "Garden spade" deformity
- Flexion fx of radius - falling onto FLEXED wrist
- Distal fragment of radius dislocated in VOLAR direction
- PT - immobilized for 5-8 weeks
-
Scaphoid fracture - mechanism of injury; immobilization for how long?
- FOOSH (fall onto outstretched hand) in younger person
- PT - immobilized for 4-8 weeks
-
What deformity is pictured? describe; PT initial vs later
- Boxer's fracture
- Fx of neck of 5th metacarpal
- Sustained during a fight, or from punching a wall
- PT initial - 2-4 weeks in cast
- PT later - Strengthening initiated when flexibility is restored
-
What deformity is pictured?
- Mallet finger
- Rupture or avulsion of extensor tendon at its insertion into distal phalanx of digit
- Deformity - Flexion of DIP joint
- Trauma - forcing distal phalanx into a flexed position
-
Kienbock's Disease - S/S - 5
- Blood supply to lunate is interrupted
- Onset - trauma
- Wrist pain
- Pain INC by wrist flexion/extension
- Lunate tender to palpation
- Progressive limitation of wrist motion
-
Name test; what is tested? describe; (+)
- Finkelstein's test
- de Quervain's disease - 1st dorsal compartment tenosynovitis
- MMs - ABD pollicis longus &/or extensor pollicis brevis
- Pt makes fist w/thumb inside
- PT passively moves fist into ulnar deviation
- (+) Pain in wrist
-
Name test; what is tested? describe; (+)
- Bunnel-Littler Test
- Differentiates between tightness @ MCP jts - capsule or intrinsic mms
- MCP in slight extension & PIP joint is flexed
- MCP in flexion & PIP joint is flexed
- (+) Capsule tightness = If flexion @ PIP is limited in both cases
- (+) Intrinsic mm tightness = If flexion @ PIP is limited more w/MCP flexion
-
Name test; What is tested? describe; (+)
- Tight retinacular test
- Differentiates bet tightness @ PIP jt - capsule or retinacular ligaments
- PIP stabilized in neutral --> DIP is flexed
- PIP is flexed & DIP is flexed
- (+) Capsule tightness = flexion limited in both cases
- (+) Ligament tightness = more DIP flexion w/PIP flexion
-
Name test; what is tested? describe; (+)
- Phalen's test
- Identifies carpal tunnel compression of median nn
- Pt maximally flexes both wrists holding them against each other for 1 minute
- (+) tingling and/or paresthesia into hand following median nn distribution
-
Name test; what is tested? describe; (+)
- Allen 's test
- Identifies vascular compromise
- Find radial & ulnar arteries at wrist
- Pt open/closes fingers quickly several times & then make a closed fist
- PT occludes artery & have patient open hand
- Release compression on artery & observe for vascular filling
- (+) Will present by abnormal filling of blood within hand during test
- Under normal circumstances, there is a change in color from white to normal appearance on palm of hand
-
Name test; what is tested? describe; (+)
- Watson’s tests
- Scaphoid-lunate instability
- Palpate at bottom of thumb
- Ulnar deviation
-
Name test; what is tested? describe; (+)
- Murphy test
- Dislocation of lunate
- Pt makes fist
- (+) 3rd MCP is level
-
Convex/Concave - what glide to INC radiocarplal
- Flexion
- Extension
- Radial deviation
- Ulnar deviation
- Flexion = dorsal
- Extension = volar
- Radial deviation = ulnar glide
- Ulnar deviation =radial glide
-
W/all - Convex on concave
-
CMC of thumb - INC flexion/extension what glide?
- Flexion - Ulnar
- Extension - radial
w/flex/ext - concave on convex
-
CMC of thumb - INC ABD/ADD what glide?
w/ABD/ADD - convex on concave
-
MCP/IP - INC flexion/ext what glide?
- Flexion = Volar
- Extension = Dorsal
Convex on concave
-
To INC wrist flexion - radius on what carpal bones & in what direction? - 4
- Radius volar on scaphoid/lunate
- Trapezium-trapezoid volar on scaphoid
- Lunate volar on capitate
- Triquetrium voler on hamate
-
Finger tendon repair - PT starts when? why? what type?
- Within a few days after surgery
- To preserve tendon gliding - PROM & AAROM (promote collagen remodeling & allow free tendon gliding)
-
Damage to posterior interosseous nn - impairment
Wrist extension - primarily controlled by posterior interosseous nn (branch of radial nn)
|
|
