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22 Cards in this Set
- Front
- Back
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What occupational performance areas do you assess with hand/wrist dysfunction? |
ADLs/IADLs, work/leisure, health history/diagnostic imaging, A/PROM, MMT, posture, sensation |
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What are the 7 overall treatments for UE dysfunction? |
manual therapy, therapeutic activity, therapeutic exercise, neuromuscular re-education, self-care retraining, splinting, modalities |
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What are the 8 carpal bones in the wrist? What is the DRUJ? What is the TFCC? |
scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate distal radio-ulnar junction (carpals articulate here) triangulofibrocartilage complex (controls movement on ulnar side of wrist) |
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What causes carpal tunnel syndrome? What is the etiology of CTS? How is it identified? How is CTS treated? |
- injury to median nerve at the carpal tunnel, usually due to inflammation & compression - mostly structural, genetic, biological - Phalen's, reverse Phalen's, Tinel's sign - reduce inflammation (ice, contrast baths, iontophoresis, high voltage galvanic stimulation, manual edema mobilization)- neutral position wrist splint, tendon gliding exercises, median nerve glides - after acute phase: soft tissue & tendon mobilization, isometrics, patient education - cortisone shots |
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-What causes pronator teres syndrome? What is the etiology? How is it identified? -How is pronator teres syndrom treated? |
- median nerve compression between 2 heads of pronator teres - repetitive pronation/supination and excessive pressure on proximal forearm by the elbow - positive Tinel's sign, tingling and numbness in palm, thumb, 3rd fingers, & aching in proximal volar forearm - elbow splint at 90 degrees w/ forearm in neutral - avoid activities that include repetitive and forceful pronation/supination |
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What is the etiology of Guyon's Canal Syndrome? How is it identified? How is Guyon's Canal Syndrome treated? |
- repetitive strain, ganglion, pressure, fascial thickening causing compression of ulnar nerve through the canal - positive Tinel's sign at canal, positive Wartenberg's sign, numbness/tingling on ulnar side, motor weakness, can lead to atrophy of ulnar innervated muscles - wrist splint in neutral, nerve glides, activity modification, edema control, AROM, strengthening, sensory re-education, cortisone shots |
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What is the etiology of DeQuervain's tenosynovitis? How is it identified? How is it treated? |
- overuse of extensor pollicis brevis and abductor pollicis longus under stress, ulnar wrist deviation, or grasp requiring grip and thumb adduction - Finkelstein's test, pain and swelling at radial styloid, worse with thumb or wrist motion, weak pinch, weak grip - thumb spica splint w/ IP free full time wear for 2-4 weeks; soft tissue and joint mobilization, stretching, tendon glides, iontophoresis and ultrasound for inflammation, strengthening when pain is reduced, cortisone, surgery |
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What is the etiology of radial tunnel syndrome? How is it identified? How is it treated? |
- radial nerve compression in the radial tunnel (fibrous edge of the supinator muscle) from an external force or repetitive forceful supination + wrist extension - positive Tinel's sign at extensor wad, dull aching or burning pain - long arm orthosis w/ wrist in extension, elbow in flexion, forearm in supination; activity modification, nerve gliding, anti-inflammatory meds; cortisone |
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Why is the thumb prone to injuries and arthritis? |
Its wide range of motion (including palmar abduction, radial abduction, and opposition) makes the thumb more prone to injury/arthritis |
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What is the etiology of trigger finger? How is it identified? How is it treated? |
- overuse of flexor tendons of the hand, chronic synovitis such as RA or diabetes; swelling causes the tendons to get stuck - test for snapping-back movement, palpate nodule on tendon, patient feels painful catching of the tendon - trigger-finger splint (MCP extended, IP free); scar/soft tissue massage, edema control, tendon glide, activity/work modification, cortisone, surgery |
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What is the etiology of Skier's or Gamekeeper's Thumb? How is it identified? How is it treated? |
- rupture of the UCL - often from falling while skiing w/ thumb in ski pole - thumb splint 4-6 weeks, AROM & pinch strengthening at week 6, focus on ADL requiring opposition & pinching, surgical |
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What is the etiology of Ganglion Cysts? How are they identified? How are they treated? |
- exact etiology unknown, soft tissue tumor arises from synovial lining of either a joint or a tendon sheath - palpation will identify cyst - anti-inflammatory modalities: ionto, ultrasound; soft tissue and joint mobilization; edema management; strengthening, cortisone, cyst removal |
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What is the etiology of Rheumatoid Arthritis? How is it identified? How is it treated? |
- immune system response in synovial tissues - rheumatoid factor must be found in the blood; swollen red hot painful joints; deformities - splinting, ring splints, patient education, minimal soft tissue mobilization, gentle exercise |
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Swan neck deformity and boutonniere deformity are the results of what disease? |
rheumatoid arthritis |
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What can nerve lacerations lead to? |
sensory/motor loss, deformity, muscle wasting, functional loss |
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What is Phalen's test? What is Reverse Phalen's? How are they performed? What indicates a positive test? What does a positive test mean? |
top: Phalen's; bottom: reverse flex (or extend) wrist maximally and hold for one minute + Phalen's = paresthesia/tingling on thumb, index, middle, and half of ring finger - carpal tunnel or median nerve impingement |
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What is Tinel's sign? How is it performed? What indicates a positive test? What does a positive test mean? |
detects irritated nerves lightly tap over nerve + test = pins and needles sensation can indicate radial tunnel syndrome, Guyon's canal, syndrome, pronator teres syndrome, CTS |
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What is Wartenberg's sign? What does it indicate? |
Weak ulnar nerve/Guyon's canal syndrome |
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What is Finkelstein's test? What does it indicate? |
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Describe the post-surgical treatment: carpal tunnel release |
edema control, AROM, nerve/tendon glide exercises, sensory re-education, strengthening of thenar muscles at 6 weeks, work/activity modification |
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What is the etiology of Duptryen's Contracture? What are the symptoms? What is the treatment? |
- genetic, fingers flex into the palm due to thickening of palmar aponeurosis - tendon-like cords in palm and fingers -surgery necessary to remove aponeurosis; wound care, edema control, extension splint, A/PROM, strengthening, scar management, grasp/release tasks |
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In the tricky process of tendon repair, is it generally preferable to use a wrist cock-up splint or a neutral position splint? |
neutral position splint |
