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O wrist & hand

notes from lecture

joints of wrist radiocarpal (wrist flex), midcarpal (somewhat flex/ext but mostly hand function)
length-tension relationships position of wrist controls length of mm. wrist & finger ext contract to stabilize during gripping w/finger flexors
most powerful grip... in a little bit of flex
stretching of ECR longus & brevis/ECU elbow straight, wrist flex, fingers relaxed
stretching of FCU/FCR elbow ext & in supination, wrist ext, fingers relaxed
to stretch superficialis let DIP relax
cylindrical grip (power) holding coke can
conical grip (power) holding ice cream
key grip (power) thumb & side of 1st finger
pincher (precision) thumb & 1st finger tip to tip
tip to tip (precision) thumb & other fingers
zone II is called "no mans land" because... injury/sx to this area is associated w/very poor outcomes (infection, contracture, scarring) bc of the complex interweave of the finger flexor tendons
post op tendon repairs usually immobilized in shortened position, use gentle mm setting & PROM up to 4 wks then AROM, avoid stretching & resistive ex for 6-8 wks post op, ALWAYS under MD protocol
colles fx radius fx w/in 2.5 cm of the wrist in which the distal fragment is displaced in a dorsal direction. may involve ulna fx also. most common fx in adults, fall on palm, fork deformity, often permanent loss of motion
rehabilitation for radius fx starts as soon as stable immobilization has been achieved, goals:reduce edema, maintain digit ROM. light gripping, pinching & use of fingers encouraged (painfree), active forearm rot w/in limit of cast
carpal fx-scaphoid most common carpal fx, can get avascular necrosis usually not initially seen on xray
carpal fx-scaphoid S&S pain & edema in snuffbox, malunion common, often dismissed as sprain
carpal fx-scaphoid rx cast up to 12 wks due to poor blood supply
metacarpal fx occurs from falls, jammed fingers, direct blows (bruising)
boxers's fx fx of the neck of the 4th or 5th metacarpal- occur when the pt strikes a hard object w/a clenched fist
ligament injuries of the wrist & hand lig sprains w/varying degrees of carpal instab, usually from a fall with the wrist hyperext, immobilized in a short arm cast or splint for 3 or 4 wks, if severe, opt include rigid cast immob, closed reduction w/percutaneous pinnning & ORIF
skier's thumb sprain ulnar collateral
de quervain dx/tenosynovitis abd pollicus longus & extensor pollicis brevis tendons & sheaths, pn on the RADIAL side of the wrist, cause often not clear
de quervain dx/tenosynovitis S&S tender radial styloid, pn w/active abd of thumb, + Finkelsteins test (pain w/passive thumb flex/abd & wrist ulnar deviation)
dupuytren dx formation of pits & firm nodules that lie just below the skin of the palm. mostly white men of N European descent. may require sx. rx centered on pt reassurance & edu (stretching & heat doesn't work great), steroids or collagenases, tendons stick out
carpal tunnel syndrome (CTS) compression neuropathy-structures constrict MEDIAN nerve & blood supply resulting in impaired nerve conduction-decreased sensation, pn & tingling
carpal tunnel syndrome (CTS) motor probs including mm loss thenar intrinsic mm (flexor pollicis brevis), abductor pollicis brevis, & opponens pollicis, loss of the 1st 2 lumbrical mm
carpal tunnel syndrome (CTS)-tunnel defined by pisiform side-ulnar/scaphoid side-radial/hook of hamate side-radial/tubercle of trapezium side-ulnar/transverse carpal lig-roof
structures located w/in carpal tunnel flexor poll longus tendon, 4 tendons of flex digitorum superficialis, 4 tendons of profundus, median nerve
carpal tunnel syndrome (CTS) etiology swelling of long flexor tendons or w/in tunnel due to repetitive wrist motion of finger activity or trauma/cause is often activity related, end result is medial nerve compressed, worse if pt obese
carpal tunnel syndrome (CTS)S&S pain in hand that increases w/activity esp writing, gripping/numbness in median nerve distribution, early symptoms of pn & numbness worse @ night, atrophy of thenar eminence, ape hand deformity
carpal tunnel syndrome (CTS) functional loss grip awkward, flex & opposition of thumb is lost & thumb is pulled dorsally/index & middle finger lose flexion of IPs-sensory loss-palmar side of thumb & digits 1,2,3, 1/2 of 4, all finger tips
carpal tunnel syndrome (CTS)PT modalities for pn, ROM/jt mob to carpals, cock-up splinting esp @ night, pt edu.
carpal tunnel syndrome (CTS) sx transection of transverse ligament
carpal tunnel syndrome (CTS)special tests phalens-wrist flex 60 seconds, reproduce symptoms. tinnels sign-tapping on CT reproduces symptoms
ulnar neuropathy often entrapped in tunnel of Guyon (pisiform & hook of hamate), claw hand deformity, loss of sensation-ulnar hand, volar & dorsal, so loss of thumb & lat pinch
ulnar neuropathy motor loss lumbricales 1/2, interossei (abd & add), hypothenar (abd, digiti minimi, opponens digiti minimi, flex digiti minimi), add poll
ulnar neuropathy functional loss ext digitorum keeps last 2 MPs hyper ext bc of loss of lumbricales & interossei, can't abd or add fingers due to loss of interossei, can abd 5th finger bc of ext digit minimi but not add
radial motor loss none in hand, may have wrist drop if higher lesion.
radial sensory loss dorsal radial hand to 1/2 4th finger
radial functional loss decreased grasp due to inability to stabilize wrist if wrist drop
tendonitis overuse syndrom, can occur anywhere in wrist, usually occurs as tenosynovitis since most tendons have sheaths
tendonitis S&S pn w/active contraction, stretch, or overactivity, may have edema
tendonitis rx usually acute so rx w/rest, painfree motion, anti-inflammatories
Created by: jessigirrl4



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