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22 Cards in this Set
- Front
- Back
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Hand and wrist intro |
Vulnerable b/c - little muscle or fat padding to protect underlying bony structures. Easy to assess, most have local pt tenderness, swelling, reduced function. 19 intrinsic, 20 extrinsic muscles Espressive, protective, motor & sensory roles. Joints in functional groups |
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Anatomy of the hand/wrist |
Proximal row: Scaphoid, lunate, triquetrum, pisiform Distal row: trapezium, trapezoid, capitate, hamate. Phalanges, metacarpals, carpals. |
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Anatomy articulations of the hand/wrist |
Radiocarpal joint, distal radioulnar joint |
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Neurovascular anatomy of hand/wrist |
Most flex are supplied by median nerve Most ext supplied by radial nerve Blood supplied by radial and ulnar arteries. Two arterial arches superficial and deep. |
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Injury prevention |
Protective equipment - pads/gloves Physical conditioning - strenght and flexibility, exercises for wrist and elbow. Proper skill technique - falling. |
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Common injuries |
Acute - contusion, sprain, strain, fracture, dislocation. Chronic - wrist ganglion. |
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Wrist sprain |
E: Most common wrist injury - falling on hyperextended wrist, violent flex/torsion, FOOSH. Multiple incidents may disrupt blood supply. S&S: Pain, swelling, difficulty w/mvmt M: Refer for xray, RICE, splint, analgesics, tape. Note - if difficulty moving thumb, scaphoid fracture! |
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Phalangeal sprain |
E: Direct blow to finger tip, or valgus/varus stress. Damage joint capsule, ligaments. S&S: Pain, swelling, pt tenderness, instability, loss of ROM M: RICE, splint, refer if suspect fracture. |
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Thumb sprrain |
E: Thumb MCP forced into abduction and hyperextension S&S: pain, swelling, instability, loss of function, cannot pinch or grip. M: RICE, NSAIDS, splint/tape, refer if suspect fracture. |
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Strains - Mallet finger |
E: Direct blow to finger tip (axial) w/ forced hyperflexion of DIP avulsing extensor tendon. S&S: Pain & swelling soon after at DIP, pt tenderness, instability, loss of ROM, cannot extend. M: RICE, splint, refer if suspect #. |
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Strains Boutonniere deformity |
E: Rupture of extensor tendon at middle phalanx S&S: Extensor slides below axis of PIP causing DIP to extend and PIP to flex. Oain swelling pt tenderness instability deformity loss of ROM, cannot extend M: RICE, splint, refer. Surgery. |
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Strains - jersey finger |
E: Rupture of flexor digitorum profundus tendon from distal phalanx. MOI is rapid ext from active flexion. S&S: loss of ROM, cannot flex. M: RICE, splint, refer. Flexor being torn. |
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Strains - trigger finger |
E: Tensynovitis of extensor tendonds of wrist fingers, thumb, abductor pollicis. Formed nodule or thickened sheath cannot glide uninterrupted. S&S: Locking, painful popping sensation that is palpable and audible. M: RICE, nsaids, immobilization. |
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Strains - Dequervain's tenosynovitis |
E: Stenosing tenosynovitis in thumb extensor and abductor. S&S: Pt tenderness over tendons, aching pain over radial stylus, with increased thumb and wrist motion. Pain with thumb abduction. M: RICE, nsaids, immobilization. Bursal sac surrounding tendon is inflamed. |
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Carpal tunnel syndrome |
E: Compression of median nerve in tunnel due to inflammation. Compounded by overuse, anatomic anomalies, direct trauma. S&S: Sensory and motor deficits in first three digits, thumb weakness, awakening pain. M: RICE, nsaids, may require further medical intervention. May come from somewhere else. |
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Fractures - distal ulna/radius |
E: FOOSH, axial loading forcing radius and ulna into hyperextension. Types: Colles (up) & smith's (down) both occur in distal radius. S&S: fork deformity, conserns for neurovascular dammage. Fracture without deformity may be confused w/ severe sprain. M: Immobilize and refer to physician. In child injury may cause lower epiphyseal separation (disrupt growth plate and seal it) |
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Fractures - scaphhoid |
E: FOOSH, MVA, concern is poor healing. S&S: Pain, swelling, pt tenderness in snuff box, increased pain with wrist ext and radial deviation. M: RICE, splint, refer. Note - ensure blood flow! |
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Fractures - metacarpals |
E: Direct axial or compressive force. Boxers - 4th or 5th, Bennets - 1st MC or CMC S&S: Pain, swelling, inability to grip, Pt tenderness & crepitus. M: RICE, splint, refer. |
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Dislocation - finger |
E: damage to collateral ligs and plate MCP - rarw twist or shear PIP - Hyperextension and axial load DIP - usually dorsal S&S: Pain, swelling over joint, pt tenderness, obv deformity. M: RICE, splint, refer. Buddy taping post splint. |
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Subungal Hematoma |
E: Direct trauma to nail, compressive force S&S Pain, swelling bleeding M: Ice via compression or ice bath Refer if suspect # May release pressure by draining. But manage wound after. |
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Wrist ganglion |
E: Synovial cyst (herniation of joint capsule) may appear following wrist strain or repetitive injury. S&S: Generally appear on back of wrist, palpable, soft, rubbery or hard mass. May be painful. M: May be self-limiting, aspiration or surgical removal. |
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Rehab for hand and wrist |
Restore rom/flexibility. restore proprioception and balance NMC Muscular strength, endurance, power, cv fitness. Protect in RTP. |
