notes from lecture
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| joints of wrist | radiocarpal (wrist flex), midcarpal (somewhat flex/ext but mostly hand function)
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| length-tension relationships | position of wrist controls length of mm. wrist & finger ext contract to stabilize during gripping w/finger flexors
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| most powerful grip... | in a little bit of flex
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| stretching of ECR longus & brevis/ECU | elbow straight, wrist flex, fingers relaxed
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| stretching of FCU/FCR | elbow ext & in supination, wrist ext, fingers relaxed
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| to stretch superficialis | let DIP relax
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| cylindrical grip (power) | holding coke can
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| conical grip (power) | holding ice cream
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| key grip (power) | thumb & side of 1st finger
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| pincher (precision) | thumb & 1st finger tip to tip
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| tip to tip (precision) | thumb & other fingers
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| 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
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| 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
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| 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
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| 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
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| carpal fx-scaphoid | most common carpal fx, can get avascular necrosis usually not initially seen on xray
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| carpal fx-scaphoid S&S | pain & edema in snuffbox, malunion common, often dismissed as sprain
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| carpal fx-scaphoid rx | cast up to 12 wks due to poor blood supply
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| metacarpal fx | occurs from falls, jammed fingers, direct blows (bruising)
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| 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
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| 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
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| skier's thumb | sprain ulnar collateral
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| de quervain dx/tenosynovitis | abd pollicus longus & extensor pollicis brevis tendons & sheaths, pn on the RADIAL side of the wrist, cause often not clear
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| 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)
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| 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
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| carpal tunnel syndrome (CTS) | compression neuropathy-structures constrict MEDIAN nerve & blood supply resulting in impaired nerve conduction-decreased sensation, pn & tingling
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| 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
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| 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
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| structures located w/in carpal tunnel | flexor poll longus tendon, 4 tendons of flex digitorum superficialis, 4 tendons of profundus, median nerve
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| 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
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| 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
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| 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
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| carpal tunnel syndrome (CTS)PT | modalities for pn, ROM/jt mob to carpals, cock-up splinting esp @ night, pt edu.
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| carpal tunnel syndrome (CTS) sx | transection of transverse ligament
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| carpal tunnel syndrome (CTS)special tests | phalens-wrist flex 60 seconds, reproduce symptoms. tinnels sign-tapping on CT reproduces symptoms
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| 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
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| ulnar neuropathy motor loss | lumbricales 1/2, interossei (abd & add), hypothenar (abd, digiti minimi, opponens digiti minimi, flex digiti minimi), add poll
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| 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
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| radial motor loss | none in hand, may have wrist drop if higher lesion.
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| radial sensory loss | dorsal radial hand to 1/2 4th finger
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| radial functional loss | decreased grasp due to inability to stabilize wrist if wrist drop
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| tendonitis | overuse syndrom, can occur anywhere in wrist, usually occurs as tenosynovitis since most tendons have sheaths
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| tendonitis S&S | pn w/active contraction, stretch, or overactivity, may have edema
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| tendonitis rx | usually acute so rx w/rest, painfree motion, anti-inflammatories
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