Exam 7 (Pathologies/Special tests of the Elbow, Wrist, and Hand joints)
C.
All of the following are goals for management of distal radial fractures except: A. reduce edema through positioning B. retrograde massage C. wrist ROM through exercise D. maintain digit ROM through exercise
inability to abduct and oppose the thumb if paralyzed
Anterior museus on the thumb side (motor) of the median nerve innervations results in inability to what?
boxer's fracture
Fractures of the neck of the 4th or 5th metacarpal are called what type of fractures?
pain and swelling management
The tx of CRPS primarily is focused on what
broken into pieces
What does comminuted mean
increase the speed of movement
With progressing a patient with a ligament sprain, what would be the next step after closed-chain exercises of the wrist
fall on an outstretched hand
carpal fractures are caused by what
middle-aged and elderly women
colles fracture also known as dinner fork deformity occurs frequently in what
fall on the palm of an outstretched hand
colles fracture occurs due to what
medial epicondylitis/ golfers elbow
common in patients who repeatedly use their writs, or clench their fingers (swinging of a golf club, pitching a ball, work-related grasping, shuffling papers, and lifting heavy objects)
lateral epicondylitis/tennis elbow
common precipitating activities include backhand stroke in tennis, computer keyboarding, pulling weeds, ex...
30 to 55 year old women who smoke
complex regional pain syndrome is more prevalent in who
distal radius and ulna
complex regional pain syndrome is most commonly associated with a fracture to what
cubital tunnel syndrome
compression or irritation of the ulnar nerve in the cubital tunnel, which runs posterior to the medial epicondyle of the humerus (most common)
extensor pollicis braves and abductor policies longus
de quervain's tenosynovitis causes inflammation of the tendon sheath around what 2 muscles
overuse and repetitive motions of the thumb
de quervain's tenosynovitis is idiopathic cause but theorized due to what
with distal radial fractures
distal ulna fractures typically do not occur in isolation but occur with what
capitate
dorsal radoiocarpal lig attaches to the radius and all of the following except what?
limit in elbow extension and resulted elbow flexion is painful
how is myositis ossification different from traumatic arthritis
causes more limitations in elbow extension and resisted elbow flexion causes pain
how is mystics ossifcans differentiated from traumatic arthritis of the humeroulnar joint
5-24 weeks
immobilization for scaphoid fracture lasts for how long depending on vascularization of the region fractured
tenosynovitis and tendonitis
inflammation caused by repetitive use of the muscle, from the effects of RA, from a stress overload or roughening of the surface of the tendon or its sheath
falling on the palm with the forearm pronated or during gripping activities
injury to the triangular fibrocartilage complex can occur from what force
no
is the severity of CRPS related to the tissue injury?
near the musculotendinous junction
lateral epicondylitis also known as tennis elbow is causes from micro-tears near the what
carpal tunnel
most common site for compression of the median nerve is where
ulnar tunnel (guyon's canal)
most common site for compression of the ulnar nerve is where
wrist and finger flexion, ulnar deviation, elbow extension, and pronation
most effective stretch for lateral epicondylitis is a combination of what
wrist and finger extension, radial deviation, elbow extension and supination
most effective stretch for the medial epicondylitis is a combination of what?
ulnar nerve
muscle innervation of the forearm includes anterior muscles on the ulnar side which is what nerve
median nerve
muscle innervation of the forearm includes anterior muscles on thumb side which is what nerve
radial nerve
muscle innervation of the forearm includes posterior muscles which is what nerve
elbow region or thigh
myositis ossifcans is not common but a potential complication in what regions
symptoms of carpal tunnel syndrome
numbness or pain where the median nerve is innervated
smith fracture
occurs with a fall on the dorm of the hand with a resultant distal radial fragment displacement in a palmar direction
smith fracture
referred to as a reverse colles fracture
extended and radially deviated
scaphoid fracture occurs with a fall when the wrist is what
"flexion fracture of radius"
smiths fracture is considered what?
scaphoid fracture
symptoms include pain and swelling that do not resolve over a few weeks in the anatomical snuffbox, pain with wrist extension, and decreased grip strength
valgus stress test, laxity or altered pain compared to other elbow
the purpose of this test is to assess integrity of medial collateral ligament, what is the test and what is a positive sign
ulna and carpal bones
the triangular fibrocartilage complex is formed by the ligaments and an articular disk between what
complex regional pain syndrome
these are signs and symptoms of what: pain to light touch, trophic changes, autonomic disturbances, and functional impairments
true
true or false: a compression neuropathy occurs when neighboring structures constrict a peripheral nerve, which limits its blood supply and results in impaired nerve conduction
true
true or false: desensitization programs and sensory reeducation techniques can help patients with CRPS
true
true or false: typically, there is not a direct relationship between the severity of injury and the degree of pain experienced by prone suffering from CRPS
true
true or false: with complex regional pain syndrome there is no relationship between severity of injury and degree of pain
true
true or false: with de quervain's tenosynovitis you want to focus on all movements of the thumb, not just the EPB and APL
true
true or false: with distal ulna fractures you want to follow same guidelines as distal radial fractures
true
true or false: with protection phase of medial and lateral epicondylitis you do not allow the splint to be worn continuously, but to perform the following activities throughout the day
massage, passive stretching, and resistive exercises
what are contraindicated if the brachial muscle is implicated after trauma with myositis ossifcans
pain and swelling on radial side of wrist that worsens with thumb use
what are the symptoms of de quervain's tenosynovitis
pain in wrist extensor tendons with gripping activities
what are the symptoms of lateral epicondylitis/tennis elbow
elbow motion or be reabsorbed over several months with return of motion
what can complication of myositis ossifcans permanently restrict
cubital tunnel syndrome
what disease could result in ulnar nerve transposition
eccentric and concentric motions of the thumb and wrist
what do you want to emphasize with de quervain's tenosynovitis
ulnar nerve palsy
what does a positive fronts sign indicate
means in the joint
what does heterotopic bone formation mean
cross-fiber massage in shortened position
what exercise is NOT recommended with de queveraris tenosynovitis
3 jaw chuck
what grip is most common precision grip
avascular necrosis
what is a major concern with proximal scaphoid fractures
ulnar drift
what is a part of RA deformity of the hand
patients thumb flexes to maintain the grip
what is a positive sign for froment's sign
pain over medial epicondyle
what is a positive sign for medial epicondylitis test
sudden, severe pain in lateral epicondyle
what is a positive sign of lateral epicondylitis test
heterotopic bone formation
what is another name for myositis ossifications
compression of the median nerve, who perform repetitive motions
what is carpal tunnel syndrome, and what people does it occur in
high-intensity stretching of the elbow flexors
what is contraindicated following trauma due to possible development of heteroptopic bone formation (myositis ossifcans)
PROM
what is contraindicated with trauma to brachialis muscle
ergonomic assessment
what is crucial treatment with carpal tunnel syndrome
principles of joint protection
what is crucial with management of rheumatoid arthritis that may include energy conservation techniques and the use of splints to prevent deformity
sleeping with the elbow bent, which puts pressure on the ulnar nerve
what is cubital tunnel syndrome usually caused by
ulnar neuropathy
what is frequently associated with medial epicondylitis
sensitivity to touch
what is hyperesthesia
ligament sprain
what is scaphoid fracture often misdiagnosed as
1st through 3rd fingers plus half of the 4th finger (sensory)
what is the area of sensation in which the median nerve innervates
colles fracture arm in fall position makes a c shape, and smith fracture arm in fall position makes a s shape
what is the falling position difference with collie and smiths fracture
pain and swelling management
what is the focus of treatment with complex regional pain syndrome
formed by the hook of the hamate and the pisiform
what is the guyot's canal (ulnar nerve entrapment) formed by
trapezoid fracture
what is the least common carpal fractures
scaphoid fracture
what is the most common carpal fractures
scaphoid
what is the most common carpal to be fractured
median nerve
what is the most common compression neuropathy nerve in the upper extremity
colles fracture
what is the most common distal radius fracture
colles fracture
what is the most common radial fracture
treating the source of the pain
what is the only effective treatment for the nerves that can be injured or trapped at any point from the cervical spine to their termination? (mainly compression of median and ulnar nerve)
tests for weakness of the adductor policies and ulnar nerve palsy
what is the purpose of froments sign
tests for irritation of extensor policies braves and abductor policies longus
what is the purpose of the finkelstein's test
assesses for median nerve involvement in carpal tunnel
what is the purpose of the phalen's test
assess integrity of medial collateral ligament
what is the purpose of the valgus stress test
assess integrity of the lateral collateral ligament
what is the purpose of the varus stress test
assesses for median nerve involvement in carpel tunnel
what is the purpose of tinel's sign
lateral epicondylitis test
what is the test for tennis elbow also known as cozen's test
tine's sign, tingling or paresthesia into digits 1 through 4
what is the test with the purpose of assessing median nerve involvement with carpal tunnel and what is the positive sign (hand in supination and pt taps over carpal tunnel)
orgomic assessment
what kind of tx is crucial for tx oc CTS
pralen's test, tingling in digits 1 through 4
what test has the purpose of assessing for median nerve involvement in carpal tunnel and what is the positive sign (looks almost opposite of praying hands)
finkelstein's test, pain over tendons
what test is for de quervain's sign and what is a positive sign
varus stress test, laxity or altered pain compared to other elbow
what test is the purpose to asses integrity of the lateral collateral ligament and what is the positive sign
brachalis muscle or joint capsule
where does myositis ossificans most often develop
pain in wrist flexion
where is the sx pain at for medial epicondylitis
medial
which epicondilits is associated with ulnar neuropathy
colles fracture
which fracture occurs with a fall on the palm of an outstretched hand
because adhesive capsulitis frequently occurs with CRPS
why should the entire limb be treated in dealing with patients who have CRPS
forceful grip
with MCP joint deformity in RA what exercise is contraindicated
vigorous stretching techniques
with controlled motion phase of myositis ossificans stretching in ranges tolerated but you do not want to apply what due to risk of myositis ossificans
cross fiber massage in an elongated position
with de queervains tenosynovitis in protection phase what is an important intervention
wrist and thumb
with de quervain's tenosynovitis you want daily passive ROM of what in pain free ranges
extensor pollicis braves and abductor pollicis longs
with de quervo tenosynovitis, inflammation of tendon sheath occurs around what 2 muscles?
3 weeks
with distal radial fractures how long is patient immobilized in a cast preventing pronation and supination
resisted elbow flexion
with distal radial fractures there is caution of performing what due to attachment of brachioradialis on styloid process of radius until cleared by surgeon
as soon as immobilization is achieved
with distal radial fractures when may rehabilitation begin
forceful pinch and grip exercises
with management of RA with any MCP joint deformity what is contraindicated?
active, pain-free ROM
with mystics ossifcans the elbow should be kept at rest in a splint with removal only for what
posterior muscles which results in wrist drop if paralyzed
with nerve palsies radial nerve innovates with what
proximal to the elbow
with protection phase of medial and lateral epicondylitis from and restive exercises should provide resistance to where?
thumb spica splint
with scaphoid fracture what is used between exercise sessions
exercise putty, sustained grip activities, and gradual closed--chain execises
with scaphoid fractures strengthen with what?
12 weeks after cast removal
with scaphoid fractures the patient is full activate allowed after how long
the articular disk has a poor blood supply
with triangular fibrocartilage complex healing is difficult why?
supination
In a patient with an injury to the triangular fibrocartilage complex, what position should exercises begin in?
corticosteroids
In patients with RA what are they taking that can cause damage
mallet finger
Interruption of the extensor tendon mechanism over the DIP joint is referred to as what type of deformity?
D.
Ligament sprains of the wrist with carpal instability are managed with which of the following? A. percutaneous pinning B. immobilization C. open reduction with internal fixation D. all of the above
result from a fall with the wrist hyperextended
Ligament sprains with varying degrees of carpal instability usually result from what?
true
True or false: another name for external fixation is percutaneous fixation
false
True or false: in treating a patient with carpal tunnel syndrome, extreme flexion and extension are encouraged for increasing flexibility
true
True or false: you should include ROM and strengthening to the unaffected joints of the injured extremity
bennett fracture
What is a fracture of the palmar base of the proximal first metacarpal called?
head and neck of the radius
What is the most common fracture of adults in the elbow is a fracture of what
extensor carpi radialis brevis
What muscle is affected in lateral epicondylitis
D.
Which of the following are not a thenar intrinsic muscle? A. flexor pollicis brevis B. abductor pollicis brevis C. opponens pollicis D. abductor pollicis longus
D.
Which of the following is a characteristic of CRPS? A. loss of function B. pain C. hypesthesia D. all of the above
ORIF or excision of the radial head
With joint surgery if proximal radius is displaces or comminuted what can be performed
wrist extension, radial deviation, and ulnar drift
With management of RA during an acute flareup you want to have the patient avoid strong gripping motions that require what 3 motions
PRE's
With management of RA what are contraindicated with any signs of inflammation
anterior muscles on the ulnar side and results in claw hand of the 4th and 5th fingers if paralyzed
With nerve palsies the ulnar nerve innervates with what
true
Your patient has a diagnosis of de Quervain's tenosynovitis. IT is appropriate for her to receive a corticosteroid injection in the first dorsal compartment if conservative treatment has failed. True or false