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101 Cards in this Set
- Front
- Back
Name all of the carpal bones starting with the scaphoid.
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1) scaphoid
2) lunate 3) triquetrum 4) hamate 5) pisiform 6) capitate 7) trapezoid 8) trapezium |
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What is the closed pack position of the wrist?
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* full extension with supination
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In full extension of the wrist, describe the motion of the scaphoid on the radius.
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during full extension, the scaphoid supinates on the radius
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During radial deviation, what does the scaphoid do?
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Radial deviation -- the scaphoid flexes
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During ulnar deviation, what does the scaphoid do?
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ulnar deviation -- the scaphoid extends
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What is the importance of the scaphoid supinating?
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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 |
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Which digits are considered the stable ones?
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2, 3
** we want stablility proximally in order to move distally |
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Which digits have plane joints at their CMC?
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2, 3, 4 are all plane joints
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What motion do palmar/volar plates limit?
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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 |
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In what motion do the collateral ligaments which support the joint get taut?
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in flexion at the MCP due to the shape of the proximal joint which stretches the ligament
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What is the difference between the radial and ulnar collateral ligaments at the MCP joints?
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the radial collateral is longer and more lax than the ulnar
** in rheumatoid arthritis, this is seen -- MCP drifts ulnarly |
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Dorsal interossei innervation and function
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ulnar nerve
abduction |
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Palmar interossei innervation and function
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ulnar nerve
adduction |
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The lumbricals come off of the tendons of which muscles?
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The tendons of FDP -- we need tension in these tendons for the lumbricals to work (they provide stability for muscle contractions)
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How can a person distinguish between the dorsal and palmar surface of the hand by only looking at the interossei?
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*Dorsal --> there are 2 interossei for the 3rd digit
*Palmar --> there are 3 main interossei that abduct (2, 3, 5th) |
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In rheumatoid arthritis, which set of ligaments is lax?
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radial collateral ligaments
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What is the purpose of the extensor hood?
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It allows the fingers to extend while maintaining a good moment arm
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Why is an extensor mechanism necessary? Why can't we just have one extensor tendon?
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They are geared toward getting the fingers to extend. They allow the fingers to have a small moment arm (NO BOWSTRINGING!)
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Describe how the lateral bands get to the DIPs?
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they split around the PIP and come back together at the DIP
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What do the interossei do as a whole?
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1) adduct toward middle finger
2) MCP flexion 3) extend the IPs (assisting the lumbricals) when the MCP is extended |
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What do the lumbricals do?
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1) MCP flexion
2) extend the IPs -- they will do this in extension OR flexion of the MCP |
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What are the conditions under which the lumbricals and interossei will extend the IPs?
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The lumbricals extend in either MCP flexion or extension while the interossei only extend if the MCP is already extended
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What does the oblique retinacular ligament do?
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it assists in MCP extension, this limits the ability to flex the DIP (when PIP is extended)
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When going from flexion to extension, what happens to the oblique retinacular ligament?
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the PIP makes the ORL taut -- as we flex, it gets taut and pulls the DIP into extension
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How does the extensor mechanism relate to the movement of finger flexion?
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if the extensor tendons come around with the lateral bands, there would be a very large excursrion
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If the lateral bands get scarred, what happens to mobility?
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there is a huge effect, mobility is greatly decreased
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Which muscle has a longer excursion? FDP or FDS?
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FDP at 5 cm vs. FDS at 4 cm.
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What is the point of having cruciate ligaments in the hand? What joints are they at?
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They are at the PIP and DIPs. X shaped and they hold down the flexor tendons...no bowstringing
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If scarring occurs between the FDS and FDP what happens?
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You will lose function of the FDP
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Where is a Colles fracture?
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at the distal radius
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What age group generally suffers from Colles fractures?
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elderly (younger people break their scaphoids)
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What direction is a Colles fracture often displaced?
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posterior/dorsal with some supination
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What is a MOI for a Colles fracture?
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FOOSH
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What position might a physician cast a person in if they have a Colles fracture?
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slight flexion, ulnar deviation, and supination
** above is the tradition position for immobilization, but some chose extension instead of flexion |
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What is another name for a Colles fracture?
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dinner fork deformity
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Where are the pins in an external fixation device for the Colles fracture
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2 in the 2nd MC and 2 in the radius
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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 |
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Name some "tissue issues" after a Colles fracture immobilization.
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1) CT -- capsule, ligaments, nerve, muscles
2) atrophy of muscles 3) articular cartilage (thickness) |
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Name some impairments seen after a Colles fracture.
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1) decreased ROM (all throughout UE)
2) decreased strength |
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How long is a person generally casted after a Colles fracture?
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6 - 8 weeks
** STIFFNESS |
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What are some things that can be done as rehab for after removal of a cast for a Colles fracture?
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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 |
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Why don't we use PROM as an exercise soon after a person gets uncasted after a Colles fracture?
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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
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Is the radius healed 6-8 weeks after injury?
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negative. It is not
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What are the precautions after a Colles fracture?
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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) |
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Scaphoid fracture MOI
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FOOSH with elbow/wrist extension
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What age group generally gets scaphoid fractures?
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younger people break their scaphoids while older ones have Colles fractures
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What is the most common bone in the wrist to get broken?
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scaphoid
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TRUE or FALSE
A scaphoid fracture takes 2 - 3 weeks to show up on an x ray. |
TRUE
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How can you tell if a person has a scaphoid fracture if it hasn't shown up on an x-ray yet?
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1) pain with palpation
Cast it and then re-Xray later |
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How far does a cast for a scapoid fracture extend?
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past the elbow so that you don't get any pronation or supination that might move the scaphoid
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Why don't you want any motion in the wrist with a scapoid fracture?
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the blood supply to the scapoid is at it's distal end and motion can cause the proximal end to die which is bad
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What are 2 ways in which the lunate can dislocate?
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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 |
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What are some Sxs of carpal tunnel?
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1) numbness/paresthesia in a median nerve distribution
2) worse at night 3) clumsiness 4) Sxs increase with finger flexion activities |
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What are some objective findings with carpal tunnel?
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1) ROM WNL
2) weakness -- median nerve distribution (abductor pollicis brevis, opponens, thenar eminence) |
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Does carpal tunnel, which affects the median nerve, affect FDS, FDP?
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no because these are forearm muscles and the carpal tunnel is at the wrist
** low compression, they are innervated higher |
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Why is the carpal tunnel susceptible to compression?
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there is not much room 1.7 cm2 while the wrist is in a neutral position
**flexor tendons, median nerve all pass through there |
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TRUE or FALSE
We want to see an articular line between the lunate and the capitate on images? |
TRUE
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What are specific conditions that cause compression at the carpal tunnel?
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-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 |
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What is a differential diagnosis for carpal tunnel?
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1) C6-7 radiculopathy
2) TOS 3) anterior interosseous syndrome |
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What are 3 things that compress the neurovascular bundle in TOS?
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1) tight scalenes/1st ribs
2) clavicle 3) pec minor --------------------------------------- *global pain while carpal tunnel is only at the wrist |
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What are some ways to non-surgically treat carpal tunnel?
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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 |
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What is the purpose of the retinaculum at the wrist?
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keeps the flexors from bowstringing
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What are specific conditions that cause compression at the carpal tunnel?
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-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 |
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What are specific conditions that cause compression at the carpal tunnel?
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-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 |
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What is a differential diagnosis for carpal tunnel?
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1) C6-7 radiculopathy
2) TOS 3) anterior interosseous syndrome |
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What is a differential diagnosis for carpal tunnel?
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1) C6-7 radiculopathy
2) TOS 3) anterior interosseous syndrome |
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What are 3 things that compress the neurovascular bundle in TOS?
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1) tight scalenes/1st ribs
2) clavicle 3) pec minor --------------------------------------- *global pain while carpal tunnel is only at the wrist |
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What are 3 things that compress the neurovascular bundle in TOS?
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1) tight scalenes/1st ribs
2) clavicle 3) pec minor --------------------------------------- *global pain while carpal tunnel is only at the wrist |
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What are some ways to non-surgically treat carpal tunnel?
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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 |
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What are some ways to non-surgically treat carpal tunnel?
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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 |
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What is the purpose of the retinaculum at the wrist?
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keeps the flexors from bowstringing
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What is the purpose of the retinaculum at the wrist?
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keeps the flexors from bowstringing
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What is a surgical treatment for carpal tunnel?
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endoscopically enter the wrist and cut the transverse retinaculum
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Which is more advantageous: endoscopic or open carpal tunnel surgery?
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endoscopic, not as many structures are damaged and yet it accomplishes the same things
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During the first 3 weeks after carpal tunnel surgery, what are goals for healing of the tissue?
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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) |
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During the first 3 weeks after carpal tunnel surgery, what are goals for scar desensitization?
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(after the stitches are removed) textures, H2O temperatures (1 - 3 minutes) several times a day
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During the first 3 weeks after carpal tunnel surgery, what are goals for scar care?
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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 |
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What are the three progressive ways to do tendon gliding exercises?
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1) hook grip -- profundus
2) straight fist -- superficialis 3) full fist -- both |
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How do nerve gliding exercises work?
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pt goes through the exercises until they feel the sxs, then hold 10-30 seconds to glide the nerves
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What are the goals 4-6 weeks after carpal tunnel surgery?
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return to function: wrist flexion, move in all directions, strengthen hand muscles(abductor pollicis/opponens)
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What activities might a PT prescribe for a patient 4-6 weeks after carpal tunnel surgery?
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-gripping -- pinch to each finger
-daily activities such as putty, tools, keyboards --> this is where we can use creativity! |
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Describe the arthrokinematics at the distal radio-ulnar joint. Pronation/supination.
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(Concave radius on the convex ulna)
Pronation -- roll/glide medial Supination -- roll/glide lateral |
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Describe the arthrokinematics at the radio-carpal joint. Flexion/extension.
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(Convex lunate on concave radius)
Flexion -- roll anterior, glide posterior Extension -- roll posterior, glide anterior **scaphoid supinates on the radius in full extension |
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Describe the arthrokinematics at the mid-carpal joint. Flexion/extension.
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(Convex capitate on concave lunate)
Flexion -- roll anterior, glide posterior Extension -- roll posterior, glide anterior |
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Describe the arthrokinematics at the radio-carpal joint. Radial/ulnar deviation.
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(Convex proximal carpal row on concave radius)
Radial deviation -- roll radial, glide ulnar Ulnar deviation -- roll ulnar, glide radial |
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Describe the arthrokinematics at the mid-carpal joint. Radial/ulnar deviation.
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(convex mid-carpals on concave proximal carpals)
Radial deviation -- roll radial, glide ulnar Ulnar deviation -- roll ulnar, glide radial |
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During radial deviation, which row of carpal bones moves the most and why?
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the mid-carpal row of bones moves the most in radial deviation because the radius stops the proximal row of carpals
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Describe the arthrokinematics at the first CMC. Abduction/adduction.
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(convex MCP on concave-longitudinal-trapezium)
Abduction -- roll palmar, glide dorsal Adduction -- roll dorsal, glide palmar |
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Describe the arthrokinematics at the first CMC. Flexion/extension.
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(concave MCP on convex-transverse-trapezium)
Flexion -- roll/glide ulnar or medial Extension -- roll/glide radial or lateral |
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Describe the arthrokinematics at the first CMC. Opposition.
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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) |
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During opposition at the first CMC how much does the digit rotate and in which direction.
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According to Neumann, the thumb internally (medially) rotates 45-60 degrees. Someone could be lacking this motion at the thumb and need therapy.
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Describe the arthrokinematics at the CMC in digits 2-5. Flexion/extension.
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(concave metacarpals-in general-on convex carpals)
Flexion -- roll/glide anterior Extension -- roll/glide posterior |
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Describe the arthrokinematics at the MCP and IP joints. Flexion/extension.
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(concave distally and convex proximally)
Flexion -- roll/glide anterior Extension -- roll/glide posterior |
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Describe the arthrokinematics at the MCP joint. Abduction/adduction.
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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. :)
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What structures at the wrist might get tendinitis?
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-ECRB and L (where they cross the wrist and insert on the 2nd/3rd MC)
-EPL (around Lister's tubercle) -ECU -FCU |
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How might a PT/pt determine if there is tendinitis at the wrist?
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1) active contraction or passive stretching is painful
2) creptius when the tendon passes through the sheath, a squeaky sound |
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What muscles of the hand are susceptible to tendinitis?
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-abductor pollicis longus
-extensor pollicis brevis (as tested by Finkelstein) |
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What is a differential diagnosis for tendinitis at the hand?
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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 |
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How long might a patient expect to be in rehab for tendinitis at either the wrist or the hand?
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6 - 10 weeks
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What motions/exercises are appropriate in Phase 1 of tendinitis treatment?
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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 |
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What motions/exercises are appropriate in Phase 2 of tendinitis treatment?
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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 |