• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/101

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

101 Cards in this Set

  • Front
  • Back
Name all of the carpal bones starting with the scaphoid.
1) scaphoid
2) lunate
3) triquetrum
4) hamate
5) pisiform
6) capitate
7) trapezoid
8) trapezium
What is the closed pack position of the wrist?
* full extension with supination
In full extension of the wrist, describe the motion of the scaphoid on the radius.
during full extension, the scaphoid supinates on the radius
During radial deviation, what does the scaphoid do?
Radial deviation -- the scaphoid flexes
During ulnar deviation, what does the scaphoid do?
ulnar deviation -- the scaphoid extends
What is the importance of the scaphoid supinating?
it locks the radial/mid-carpal, ligaments get taut and don't allow separate motions between two carpal rows

** scaphoid moves with mid-carpal row
Which digits are considered the stable ones?
2, 3

** we want stablility proximally in order to move distally
Which digits have plane joints at their CMC?
2, 3, 4 are all plane joints
What motion do palmar/volar plates limit?
1) prevents hyperextension of the IPs
2) keeps the finger flexors out of the joint (CT around palmar plate)
3) protects areas of unprotected articular cartilage
4) creates a bigger joint surface area
In what motion do the collateral ligaments which support the joint get taut?
in flexion at the MCP due to the shape of the proximal joint which stretches the ligament
What is the difference between the radial and ulnar collateral ligaments at the MCP joints?
the radial collateral is longer and more lax than the ulnar

** in rheumatoid arthritis, this is seen -- MCP drifts ulnarly
Dorsal interossei innervation and function
ulnar nerve
abduction
Palmar interossei innervation and function
ulnar nerve
adduction
The lumbricals come off of the tendons of which muscles?
The tendons of FDP -- we need tension in these tendons for the lumbricals to work (they provide stability for muscle contractions)
How can a person distinguish between the dorsal and palmar surface of the hand by only looking at the interossei?
*Dorsal --> there are 2 interossei for the 3rd digit

*Palmar --> there are 3 main interossei that abduct (2, 3, 5th)
In rheumatoid arthritis, which set of ligaments is lax?
radial collateral ligaments
What is the purpose of the extensor hood?
It allows the fingers to extend while maintaining a good moment arm
Why is an extensor mechanism necessary? Why can't we just have one extensor tendon?
They are geared toward getting the fingers to extend. They allow the fingers to have a small moment arm (NO BOWSTRINGING!)
Describe how the lateral bands get to the DIPs?
they split around the PIP and come back together at the DIP
What do the interossei do as a whole?
1) adduct toward middle finger
2) MCP flexion
3) extend the IPs (assisting the lumbricals) when the MCP is extended
What do the lumbricals do?
1) MCP flexion
2) extend the IPs -- they will do this in extension OR flexion of the MCP
What are the conditions under which the lumbricals and interossei will extend the IPs?
The lumbricals extend in either MCP flexion or extension while the interossei only extend if the MCP is already extended
What does the oblique retinacular ligament do?
it assists in MCP extension, this limits the ability to flex the DIP (when PIP is extended)
When going from flexion to extension, what happens to the oblique retinacular ligament?
the PIP makes the ORL taut -- as we flex, it gets taut and pulls the DIP into extension
How does the extensor mechanism relate to the movement of finger flexion?
if the extensor tendons come around with the lateral bands, there would be a very large excursrion
If the lateral bands get scarred, what happens to mobility?
there is a huge effect, mobility is greatly decreased
Which muscle has a longer excursion? FDP or FDS?
FDP at 5 cm vs. FDS at 4 cm.
What is the point of having cruciate ligaments in the hand? What joints are they at?
They are at the PIP and DIPs. X shaped and they hold down the flexor tendons...no bowstringing
If scarring occurs between the FDS and FDP what happens?
You will lose function of the FDP
Where is a Colles fracture?
at the distal radius
What age group generally suffers from Colles fractures?
elderly (younger people break their scaphoids)
What direction is a Colles fracture often displaced?
posterior/dorsal with some supination
What is a MOI for a Colles fracture?
FOOSH
What position might a physician cast a person in if they have a Colles fracture?
slight flexion, ulnar deviation, and supination

** above is the tradition position for immobilization, but some chose extension instead of flexion
What is another name for a Colles fracture?
dinner fork deformity
Where are the pins in an external fixation device for the Colles fracture
2 in the 2nd MC and 2 in the radius
During immobilization of a Colles fracture, what happens to the muscles (while in a cast)?
What can an external device help prevent?
passive muscle tension can shorten the joint and effect the whole upper extremity

external devices can have some traction to prevent shortening
Name some "tissue issues" after a Colles fracture immobilization.
1) CT -- capsule, ligaments, nerve, muscles
2) atrophy of muscles
3) articular cartilage (thickness)
Name some impairments seen after a Colles fracture.
1) decreased ROM (all throughout UE)
2) decreased strength
How long is a person generally casted after a Colles fracture?
6 - 8 weeks

** STIFFNESS
What are some things that can be done as rehab for after removal of a cast for a Colles fracture?
1) A-AROM with decreased reps, many times a day (to gain range) Ex: 5 reps x 10/daily

2) increased AROM early on the better

3) increase ROM with joint mobs (grade 1 - 2) -- distracting and not gliding

4) soft tissue stretching

5) submaximal isometrics
Why don't we use PROM as an exercise soon after a person gets uncasted after a Colles fracture?
we want them to be comfortable moving their arm on their own -- can be the start of complex regional pain syndrome (CRPS) if they avoid movement
Is the radius healed 6-8 weeks after injury?
negative. It is not
What are the precautions after a Colles fracture?
1) extensor tendons rub on bone fragments
2) osteoporosis -- after immobilization will be worse
3) anatomical block -- not perfectly aligned, don't push through
4) complex regional pain syndrome (CRPS) -- pain that is out of proportion
5) carpal tunnel (median nerve)
Scaphoid fracture MOI
FOOSH with elbow/wrist extension
What age group generally gets scaphoid fractures?
younger people break their scaphoids while older ones have Colles fractures
What is the most common bone in the wrist to get broken?
scaphoid
TRUE or FALSE
A scaphoid fracture takes 2 - 3 weeks to show up on an x ray.
TRUE
How can you tell if a person has a scaphoid fracture if it hasn't shown up on an x-ray yet?
1) pain with palpation

Cast it and then re-Xray later
How far does a cast for a scapoid fracture extend?
past the elbow so that you don't get any pronation or supination that might move the scaphoid
Why don't you want any motion in the wrist with a scapoid fracture?
the blood supply to the scapoid is at it's distal end and motion can cause the proximal end to die which is bad
What are 2 ways in which the lunate can dislocate?
1) palmar dislocation -- completely dislocated from the rest of the carpal bones
2) perilunar dislocation -- partially dislocated so capitate can't rest on it anymore
What are some Sxs of carpal tunnel?
1) numbness/paresthesia in a median nerve distribution
2) worse at night
3) clumsiness
4) Sxs increase with finger flexion activities
What are some objective findings with carpal tunnel?
1) ROM WNL
2) weakness -- median nerve distribution (abductor pollicis brevis, opponens, thenar eminence)
Does carpal tunnel, which affects the median nerve, affect FDS, FDP?
no because these are forearm muscles and the carpal tunnel is at the wrist

** low compression, they are innervated higher
Why is the carpal tunnel susceptible to compression?
there is not much room 1.7 cm2 while the wrist is in a neutral position

**flexor tendons, median nerve all pass through there
TRUE or FALSE
We want to see an articular line between the lunate and the capitate on images?
TRUE
What are specific conditions that cause compression at the carpal tunnel?
-flexion/extension
-flexor tendon inflammation
-external pressure
-lunate dislocation
-Colles fracture scarring at transverse ligament
-tendon sheath inflammation
-pregnancy (fluid retention)
-females have smaller tunnel
-menopause
-females 3x more likely to get
What is a differential diagnosis for carpal tunnel?
1) C6-7 radiculopathy
2) TOS
3) anterior interosseous syndrome
What are 3 things that compress the neurovascular bundle in TOS?
1) tight scalenes/1st ribs
2) clavicle
3) pec minor
---------------------------------------
*global pain while carpal tunnel is only at the wrist
What are some ways to non-surgically treat carpal tunnel?
1) with straps -- ineffective, uses straps to pull on skin to open carpal tunnel
2) adapt/change patterns -- sleeping, use brace, stop overuse
3) NSAIDs to decrease inflammation
4) nerve and tendon glides
What is the purpose of the retinaculum at the wrist?
keeps the flexors from bowstringing
What are specific conditions that cause compression at the carpal tunnel?
-flexion/extension
-flexor tendon inflammation
-external pressure
-lunate dislocation
-Colles fracture scarring at transverse ligament
-tendon sheath inflammation
-pregnancy (fluid retention)
-females have smaller tunnel
-menopause
-females 3x more likely to get
What are specific conditions that cause compression at the carpal tunnel?
-flexion/extension
-flexor tendon inflammation
-external pressure
-lunate dislocation
-Colles fracture scarring at transverse ligament
-tendon sheath inflammation
-pregnancy (fluid retention)
-females have smaller tunnel
-menopause
-females 3x more likely to get
What is a differential diagnosis for carpal tunnel?
1) C6-7 radiculopathy
2) TOS
3) anterior interosseous syndrome
What is a differential diagnosis for carpal tunnel?
1) C6-7 radiculopathy
2) TOS
3) anterior interosseous syndrome
What are 3 things that compress the neurovascular bundle in TOS?
1) tight scalenes/1st ribs
2) clavicle
3) pec minor
---------------------------------------
*global pain while carpal tunnel is only at the wrist
What are 3 things that compress the neurovascular bundle in TOS?
1) tight scalenes/1st ribs
2) clavicle
3) pec minor
---------------------------------------
*global pain while carpal tunnel is only at the wrist
What are some ways to non-surgically treat carpal tunnel?
1) with straps -- ineffective, uses straps to pull on skin to open carpal tunnel
2) adapt/change patterns -- sleeping, use brace, stop overuse
3) NSAIDs to decrease inflammation
4) nerve and tendon glides
What are some ways to non-surgically treat carpal tunnel?
1) with straps -- ineffective, uses straps to pull on skin to open carpal tunnel
2) adapt/change patterns -- sleeping, use brace, stop overuse
3) NSAIDs to decrease inflammation
4) nerve and tendon glides
What is the purpose of the retinaculum at the wrist?
keeps the flexors from bowstringing
What is the purpose of the retinaculum at the wrist?
keeps the flexors from bowstringing
What is a surgical treatment for carpal tunnel?
endoscopically enter the wrist and cut the transverse retinaculum
Which is more advantageous: endoscopic or open carpal tunnel surgery?
endoscopic, not as many structures are damaged and yet it accomplishes the same things
During the first 3 weeks after carpal tunnel surgery, what are goals for healing of the tissue?
1) allow healing to occur
2) flexion, active contraction of the wrist and finger flexors -- NONE for 3 weeks post op
3) limit extension to 45 degrees (to let scarring hold down flexor tendons)
During the first 3 weeks after carpal tunnel surgery, what are goals for scar desensitization?
(after the stitches are removed) textures, H2O temperatures (1 - 3 minutes) several times a day
During the first 3 weeks after carpal tunnel surgery, what are goals for scar care?
1) silicon pad for scarring
2) tendon glides (around 3 weeks) -- not in flexion/in neutral and slight extension is allowed
3) nerve gliding but no extremes of extension
4) UE ROM/strength
5) wrist flexion slightly at 3 weeks
What are the three progressive ways to do tendon gliding exercises?
1) hook grip -- profundus
2) straight fist -- superficialis
3) full fist -- both
How do nerve gliding exercises work?
pt goes through the exercises until they feel the sxs, then hold 10-30 seconds to glide the nerves
What are the goals 4-6 weeks after carpal tunnel surgery?
return to function: wrist flexion, move in all directions, strengthen hand muscles(abductor pollicis/opponens)
What activities might a PT prescribe for a patient 4-6 weeks after carpal tunnel surgery?
-gripping -- pinch to each finger
-daily activities such as putty, tools, keyboards --> this is where we can use creativity!
Describe the arthrokinematics at the distal radio-ulnar joint. Pronation/supination.
(Concave radius on the convex ulna)

Pronation -- roll/glide medial
Supination -- roll/glide lateral
Describe the arthrokinematics at the radio-carpal joint. Flexion/extension.
(Convex lunate on concave radius)

Flexion -- roll anterior, glide posterior
Extension -- roll posterior, glide anterior

**scaphoid supinates on the radius in full extension
Describe the arthrokinematics at the mid-carpal joint. Flexion/extension.
(Convex capitate on concave lunate)

Flexion -- roll anterior, glide posterior
Extension -- roll posterior, glide anterior
Describe the arthrokinematics at the radio-carpal joint. Radial/ulnar deviation.
(Convex proximal carpal row on concave radius)

Radial deviation -- roll radial, glide ulnar
Ulnar deviation -- roll ulnar, glide radial
Describe the arthrokinematics at the mid-carpal joint. Radial/ulnar deviation.
(convex mid-carpals on concave proximal carpals)

Radial deviation -- roll radial, glide ulnar
Ulnar deviation -- roll ulnar, glide radial
During radial deviation, which row of carpal bones moves the most and why?
the mid-carpal row of bones moves the most in radial deviation because the radius stops the proximal row of carpals
Describe the arthrokinematics at the first CMC. Abduction/adduction.
(convex MCP on concave-longitudinal-trapezium)

Abduction -- roll palmar, glide dorsal
Adduction -- roll dorsal, glide palmar
Describe the arthrokinematics at the first CMC. Flexion/extension.
(concave MCP on convex-transverse-trapezium)

Flexion -- roll/glide ulnar or medial
Extension -- roll/glide radial or lateral
Describe the arthrokinematics at the first CMC. Opposition.
This is a combination of two previously discussed motions of the thumb.

1) Abduction -- roll palmar, glide dorsal

2) Flexion -- roll/glide ulnar or medial

**reposition is just the opposite of the this (extension followed by adduction)
During opposition at the first CMC how much does the digit rotate and in which direction.
According to Neumann, the thumb internally (medially) rotates 45-60 degrees. Someone could be lacking this motion at the thumb and need therapy.
Describe the arthrokinematics at the CMC in digits 2-5. Flexion/extension.
(concave metacarpals-in general-on convex carpals)

Flexion -- roll/glide anterior
Extension -- roll/glide posterior
Describe the arthrokinematics at the MCP and IP joints. Flexion/extension.
(concave distally and convex proximally)

Flexion -- roll/glide anterior
Extension -- roll/glide posterior
Describe the arthrokinematics at the MCP joint. Abduction/adduction.
These motions depend on which digit we are focusing on (and which side of the 3rd digit or central column it is on). BUT these roll/glide radially or ulnarly in abduction and adduction. Figure it out. You can do it. :)
What structures at the wrist might get tendinitis?
-ECRB and L (where they cross the wrist and insert on the 2nd/3rd MC)
-EPL (around Lister's tubercle)
-ECU
-FCU
How might a PT/pt determine if there is tendinitis at the wrist?
1) active contraction or passive stretching is painful

2) creptius when the tendon passes through the sheath, a squeaky sound
What muscles of the hand are susceptible to tendinitis?
-abductor pollicis longus
-extensor pollicis brevis

(as tested by Finkelstein)
What is a differential diagnosis for tendinitis at the hand?
1) tendinitis at other joints -- at wrist
2) scaphoid fracture -- look for the MOI
3) radial nerve -- superficial cutaneous branch
4) 1st CMC OA -- basilar arthritis
5) Double crush -- compression of the radial nerve proximally and that sensitizes the nerve distally
How long might a patient expect to be in rehab for tendinitis at either the wrist or the hand?
6 - 10 weeks
What motions/exercises are appropriate in Phase 1 of tendinitis treatment?
1) ideally stop working 1 - 2 weeks
2) rest and brace with activities -- brace should have a thumb guard
3) strengthen proximally
4) 5 reps, 5 x 10/day -- basically get pt moving every hour
5) AROM because the thumb is so light, but within pain-free ranges
What motions/exercises are appropriate in Phase 2 of tendinitis treatment?
1) goal is to have patient return to work
2) strengthen -- submax isometric --> max isometric --> dynamic and possibly eccentric
3) work modifications
4) get pt back to activity -- ex: use a light hammer to prepare them to user a heavier one -- fewer reps in therapy for progression