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