Ppii - Wrist And Hand

Front 1

Types of pinch

Back 1

1. pulp pinch: thumb + index/middle finger - pin
2. lateral pinch: thumb and lateral side of index finger - key
3. tripod pinch: thumb + middle and index finger - pen
4. 5 finger pinch: thumb + forefingers, no contact w/ palm - probe
5. diagonal volar: thumb + across fingers on diagonal - screw driver
6. transverse volar: thumb and fingers wrapped around - hammer
7. spherical: object surrounded by thumb and 4 fingers - ball
8. extensor grip: held on palm w/ fingers and thumb spread – tray

Hint 1

Front 2

Grasping – a 3 phase process

Back 2

1. Transport: moving the hand into the optimal position to grasp
2. Grasp: object is held in the hand
3. Object manipulation: object is
used as intended, e.g. moving it to another locaiton

Front 3

Development of hand function:
sensory information is used to refine grasp stability

Back 3

1. tactile information: size, shape, surface texture, firmness of object
2. visual information: to guide the hand to the object

Front 4

Development of writing

Back 4

↑ vision, ↑ time to reach, ↑ tactile information before grasping
TO
↓ vision, ↓ time to reach, ↓ tactile information before grasping

Front 5

Assessment
1. outcome measure
2. physical exam

Back 5

- Assess the impact of the disorder. Note that compensatory strategies may “hide” issues
- Consider personal goals of treatment
- Assess grips and relate to aggravating factors
- Assess upper limb joints and structures, and the cervical spine
- Assess sensation

Front 6

Assessment - Physical examination

Back 6

1. Observation
2. Palpation
3. ROM
4. intrinsic M anatomy - dorsal interossei, palmar interossei, lumbricals
5. Strength - MMT, specific nerve
6. Sensation - detection, discrimination

Front 7

Assessment
1. Observation
press H

Back 7

1. Observation: wounds, scars, laceration
skin condition
oedema
deformity and wasting

Hint 7

Front 8

Assessment
2. Palpation

Back 8

2. Palpation: temp, sweating
scar tethering
hypersensitivity
M spasm
tenderness

Front 9

Distal Radial #
1. Population
2. contributing factor for #
3. MOI:
4. Classification (press H)

Back 9

1. Population:
-young patients high energy injuries
-older patients low energy, falls
2. contributing factor for #:
osteoporosis, ↑
incidence in falls in women
3. MOI: FOOSH, axial compression, wrist E or F
4. Classification:
-colles, smith, bartons #

Hint 9

Front 10

Indications for non-operative Mx for DR#

Back 10

Front 11

Indications for Surgical Mx for DR#

Back 11

Front 12

Physiotherapy Mx for DR#

Back 12

1. Management of oedema and pain
2. Maintain active motion of unaffected proximal joints
3. Maintain motion of fingers and thumb
4. Increase motion of wrist and forearm
5. Increase strength of wrist and hand musculature

Front 13

Complex regional pain syndrome (CRPS)
1. Definition
2. Risk factors
press H for picture

Back 13

1. Definition
A systemic disorder, involving PNS & CNS
Type 1: without peripheral nerve injury
Type 2: with peripheral nerve injury
2. Risk factors
» Tight cast
» Median Nerve compression
» Injury to Median and Ulna nerves
» Over distraction to reduce fracture

Hint 13

Front 14

CRPS
3. Rx for adults and kids

Back 14

3. Rx:
Role of physiotherapy
- Early diagnosis

Treatment in adults
- Graded motor imagery (mirror imagery) + medical management ↓ pain for 6/12
- Pain management (connective tissue massage, coping skills, relaxation, compensatory skills) + medical management

Treatment in children
- May consist of hydrotherapy,
strengthening, stretching, proprioceptive exercise, aerobic exercise, weightbearing, desensitisation

Front 15

Flexor Tendon injuries
1. definition
2. tendon healing
3. post op dependent on
4. Mx

Back 15

1. definition
-Laceration to flexor tendon
-nerve injury
2. tendon healing
1-10 days post op:
Inflammatory phase, Decrease in strength of repair
3-6 weeks post op
Strength increases with the formation of granulation tissue
7-12 weeks post op
Remodelling phase, Gains full strength at 12 weeks post op
3. post op dependent on
-Mechanism of injury: clean, jagged
-Surgeon’s preference
-Type and position of repair (zone)
-Condition of the tendon: amount of repair
-Involvement of other issues, e.g. digital nerve, artery
-Patient
4. Mx
-Surgery –6/52: protection in splint, no use of the hand
-6-8/52: light functional use of the hand, use splint in risky situations
-8-12/52: no protection required, gradually progress to full use

Front 16

Extensor tendon injuries
press H for picture

Back 16

» Zone 1 & 2: Mallet finger
» Zone 3 & 4 central slip –
Boutonneire deformity
» Zone 5: level of MCP jts

Hint 16

Front 17

Mallet finger
1. definition
2. Mx

Back 17

1. definition
- Injured through passive DIP flexion with resisted extension
- May involve a fracture
2. Mx
- Immobilise DIP in 5-15° hyperextension with PIP jt free for 6-8/52
- ROM of unaffected joints
- At 8/52 commence gentle DIP F

Front 18

Radial wrist pain

Back 18

-scaphoid #
-de quervains disease
-CTS

Front 19

de quervains DDx
scaphoid # DDx

Back 19

1. 1 CMC jt OA
2. Intersection syndrome
3. Wartenburg’s Syndrome

1. distal radius #
2. FCR/ECR strain
3. scapholunate dissociation

Front 20

test scaphoid # with which tests

Back 20

- Tenderness in the anatomical snuff box
(90% sensitivity, 40% specificity)
- Pain with scaphoid compression test
(70% sensitivity, 22% specificity)

Front 21

scaphoid #
Rx *2
Mx

Back 21

1. Closed treatment
» Stable, non-displaced # of waist or distal pole
» Immobilised in POP until radiological evidence of union
(usually 12/52)
2. Surgical treatment
» Proximal pole fractures, unstable fractures, fracture dislocations
» ORIF +/- bone graft

» While in POP: control oedema,
maintain motion of uninvolved joints
» Post POP removal: wrist & thumb active motion, progress to
resistance exercises
» Use wrist splint for protection

Front 22

de quervains disease
Mx

Back 22

Rest – immobilise in a rigid splint day & night
- ADL / work modification
- When pain free
» Gentle wrist / thumb ROM
exercises

Front 23

CTS
Mx

Back 23

- Work / ADL modification: avoid
prolonged / repeated gripping
- Manage inflammatory conditions and obesity if present

» Night splints
» Oral corticosteriods
» Surgery