Wrist > Pathology, Scanning, & Tests > Flashcards

Pathology, Scanning, & Tests Flashcards

(52 cards)

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1
Q

Pathology General Considerations: Visceral

A

Heart
Apical Lung
Bronchus Breast

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2
Q

Pathology General Considerations: Vascular

A

Scaphoid & Lunate vulnerable to AVN

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3
Q

Pathology General Considerations: Neurogenic

A

UMN
Tumors
Spinal Stenosis
Peripheral nerve: median, ulna

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4
Q

Pathology General Considerations: Spondylogenic

A 
C5-T2 Radiculopathy 
Referred pain & symptoms
Tumors
Fractures
Spinal Dysfunctions
Brachial Plexus Lesions
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5
Q

Pathology General Considerations: Systemic

A 
RA
AS
OA
Reiter's
Hemophilia
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6
Q

Pathology General Considerations: Other Joints

A 
Elbow
Shoulder
Shoulder girdle
C-spine
T-spine
Referred pain or signs
Facilitated segments
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7
Q

Pathology - Local MS Disorders: Bone

A

Fracture - scaphoid, lunate, radial/ulnar styloid, Colles Fx, Bennett fx, Diloc Tumor, deformity, dislocation

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8
Q

Pathology - MS Disorders: Articular

A

Capsular- traumatic arthritis, immobilization arthritis, OA, RA, AS, Reiter’s

Non-capsular- subluxation (carpals or TFCC), inferior R-U joint, dislocation, instability, loose body, scaphoid fx, lunate fx

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9
Q

Pathology - MS Disorders: Ligamentous

A

1st, 2nd, 3rd degree tears
Strains
Sprains

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10
Q

Pathology - MS Disorders: Muscular

A
  • Muscle tear
  • Tendon tear
  • Ruptures
  • Strains
  • Myositis Ossificans
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11
Q

Pathology - MS Disorders: Tendons

A
  • Tendinitis
  • Tendinosis
  • Tenosynovitis (DeQuervain’s)
  • Primary or Secondary
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12
Q

Pathology - MS Disorders: Soft Tissue

A
  • Contractures

- Trigger Points

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13
Q

Pathology - MS Disorders: Nerve

A
  • Neuritis
  • Impingement
  • Neuroma
  • Thoracic Outlet
  • Peripheral Neuropathy
  • Brachial Plexus Injury
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14
Q

Colle’s Fracture

A
  • Fx of distal radius with dorsal & radial displacement of wrist and hand
  • Dinner fork or Bayonet deformity
  • FOOSH with wrist extended
  • Dorsal angulation
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15
Q

Smith’s Fx (Reverse Colle’s)

A

Fx of distal radius with volar displacement

  • FOOSH with wrist flexed
  • Volar angulation
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16
Q

Monteggia Fx

A

Fx of proximal ulna with dislocation of radial head anteriorly

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17
Q

Galeazzi Fx

A

Fx of distal 1/3 of radius with dislocation of distal radioulnar joint

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18
Q

Bennett’s Fx

A

Fx of base of 1st metacarpal bone which extends into CMC joint

  • intra-articular fx; most common type of fx of thumb
  • instability of CMC joint accompanied by pain & weak pincer grasp
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19
Q

Most commonly fractured carpal bone: _______________

A

Scaphoid

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20
Q

Scanning Exam of Wrist

A
  • Hx: trauma vs insidious
  • Behavior of symptoms
  • Area of symptoms
  • PMHx
  • Special Q’s: imaging, meds, osteoporosis, systemic dx
  • Observation: posture, swelling, color, size, skin/nail condition
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21
Q

Plan of Wrist Exam

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A
  • Scan: C-spine, T-spine, Shoulder-girdle complex, Elbow as indicated
  • Joint mobility: active, passive, resisted
  • Neurological conduction: LMN, UMN
  • Neurological Mobility Tests
  • Circulatory System
22
Q

Objective Wrist Tests - Observation

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A
  • Temperature
  • Swelling
  • Moisture
  • Sensitivity to touch
  • +/- detailed sensation testing (2-pt discrimination)
23
Q

Objective Wrist Tests - ROM (active, passive, resisted)

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A

Wrist: flex/ext, ulnar/radial deviation
Elbow: pronation/supination
Hand: cupping, flattening Palm
Thumb: 1st CMC - add/abd, flex/ext, oppos 1st MCP, IP-flex/ext
Fingers: MCP-flex/ext, abd/add, IP-flex/ext
Functional Motion: opposition- pad to pad mobility, Tips to MCP, Fist

24
Q

Objective Wrist Tests - Stress Tests

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A
  • Ligamentous: ulnar/radial collateral, inferior radio-ulnar, specific for each carpus joint or finger joint
  • Articular: dorsal shear, ventral shear, specific for each carpus joint or finger joint
25
Objective Wrist Tests - Palpation
- Muscle - Tendon - Insertion - Ligaments - Capsules - Bones
26
Radio-Carpal Joint Play - Radius
- Radius - Scaphoid | - Radius - Lunate
27
Radio-Carpal Joint Play - Triquetral
- Triquetral-Ulna - Triquetral-Pisiform - Triquetral-Lunate
28
Radio Carpal Joint Play - Scaphoid
- Scaphoid-lunate
29
Mid-Carpal Joint Play - Capitate
- Capitate-Trapezoid - Capitate-Scaphoid - Capitate-Lunate - Capitate-Hamate
30
Mid-Carpal Joint Play - Scaphoid
- Scaphoid - Trapezii
31
Mid-Carpal Joint Play - Trapezoid
Trapezoid-Trapezium
32
Mid-Carpal Joint Play - Hamate
Hamate-Triquetral
33
Special Test's - Phalen's
Forced flexion --> compression of median nerve - Exam: Pt elbows resting on table & asked to hold wrists in flexion for 30-60 sec - (+) = numbness/tingling into 1st - 3rd digits - CTS - SNout 77%, SPin 40%
34
Special Test's - Allen's Test
Determine's whether patency of radial or ulnar artery is normal - condition of being open/expanded or obstructed - Exam: pt opens/closes hands several times then asked to squeeze hand tightly. Examiner places thumbs over radial & ulnar arteries to compress them. Pt opens hand while pressure is maintained. Examiner releases pressure over 1 artery to see if hand flushes - 97%SPin, 73%SNout - Arterial blood flow, TOS
35
Special Test's - Finkelstein's Test
- Exam: Pt creates fist around them and ulnarly deviates hand - (+) = pain radiating up the inside of arm from the thumb - De Quevain's - Reliability ??? Research limited
36
Special Tests - Tinel's Test
- Exam: tapping on median nerve to elicit N/T sensation - (+) = when nerve is entrapped, will reproduce N/T - SNout 43%, SPin 56%
37
Special Tests - Durkan's Carpal Compression Test
- Exam: examiner applies pressure directly over carpal tunnel - (+) = elicits typical CTS symptoms while pressure is applied - SNout 77%, SPin 18%
38
TFCC Pathology
- FOOSH-->tearing or displacement of ulnar meniscus - Light, but prolonged compression d/t adducted ulna-->tearing or displacement of ulnar meniscus - Commonly displaces DORSALLY--> springy block c ext/sup - S/S Tear = Painful loading of wrist (esp. with ulnar deviation), pain (+/-) extreme play at end of sup/pron
39
Palmer Classification of TFCC Traumatic Lesions
1A: Central Perforation 1B: Ulnar Avulsion (with or without distal ulnar fx) 1C: Distal Avulsion 1D: Radial Avulsion (with or without sigmoid notch fx) **Traumatic tears can be repaired** - Class 2: Degenerative
40
Carpal HVLAT - Indication
- Subluxation carpus (anterior or posterior) - Chronic tightness secondary to adhesion - Unresponsive to mobilization
41
Carpal HVLAT - Contraindications
General contraindications - unable to protect sensitive joints - cold/sweaty hand if other is warm
42
Carpal HVLAT Technique
Patient: seated or supine, elbow, shoulder, neck protected - wrist in slight Flexion PT: 2 hands hold wrist - stand in walk stance facing patient - direction= in line of joint, fine tuned to plane where resistance or joint line is felt - pre-manip hold: traction and glide to a larger amplitude than technique and hold - HVLAT= rapid motion utilizing static rapid motion or flick (AVOID EXTENSION OF CARPUS)
43
Trapezoid-Trapezium Manip
Planar joint Pain in dorsum of hand, particularly during pinch or grip Manip= stabilize trapezoid (base of 2nd metacarpal) - grasp trapezium (base of 1st metacarpal) - slightly flex - thrust is PALMER on trapezium
44
Scaphoid-Radius Dorsal Manip
Scaphoid often subluxes ventral & into IR - Stabilize scaphoid on palmar aspect - Thumbs over radius - Thrust= ventral on radius with the conjunct rotation joint plane
45
Lunate-Radius: Ventral
Move Lunate VENTRAL - stabilize lunate on dorsal aspect with finger - thumbs over radius palmarly - wrist in slight Flexion - Thrust = on radius dorsally
46
Lunate-Radius Dorsal
Move Lunate Dorsal - Stabilize lunate on palmar aspect with fingers - thumbs over radius dorsally - Thrust = on radius palmarly over a fixed lunate-relative dorsal lunate
47
TFCC Manip - Dorsal/Ventral
Similar to Dorsal/Ventral Carpal Manips - Stabilize ulna - Move TFCC in direction to correct displacement - **remember conjunct rotation with dorsal/ventral thrust**
48
TFCC Manip - Lateral Displacement
- Ulnar deviation lost & springy end-feel; often palpable lateral subluxation present - Pt prone with arm OH and internally rotated (IR) - Plinth fixes radius/ulna - Wrist held in slight radial deviation - Thumbs over TFCC on ulnar aspect - Thrust = medial on TFCC - Retest mobility post & often needs to be stabilized (taped) and anti-inflammatory modalities (indicative of a tear) - Recheck stability & mobility of inferior radio-ulnar joint
49
1st CMC Joint & Scapoid/Trapezium Manip
- Proximal hand fixes Trapezium & induces traction - Distal hand grasps 1st CMC & induces traction/conjunct rot - Use hypo thenar over palmar aspect of trapezium/scaphoid & other hypothecate over 1st CMC - Apply circumduction moment to find barrier & apply short sharp squeeze - **For Scapoid-Trapezium, thrust is similar, fixation is on correct bones**
50
MCP Manipulation
- Stabilize MCP with proximal hand - Grasp phalanx with distal hand - Find barrier & thrust with distraction
51
CMC Manipulation
- Stabilize hand on table - Fingers in semi-Flexion - Fix proximal carpal - Distract metacarpal
52
IP Joint Manip
- Hold dorsum of pt hand against or towards therapist's stomach or on table or on wedge - Thrust = distraction or medial/lateral gapping
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