Biomechanics Lesson 8 Wrist and Hand with practice questions

Boxer's fracture

5th metacarpal fracture from punching wall or person

Wolff's Law

A bone grows or remodels in response to forces or demands placed upon it

compacted fracture

A fracture when the bones are driven into each other

Crepitus

A grating or grinding sensation caused by fractured bone ends or joints rubbing together; also air bubbles under the skin that produce a crackling sound or crinkly feeling.

articular changes of RA fall into 2 categories: reversable and irreversable

Are the articular changes that occur with RA reversible? Explain.

carpometacarpal joint (CMC)

Articulate the distal row of carpal bones and the proximal bases of the five metacarpal bones

hard end feel

Bone against bone feeling

no there is no way to reverse ankylosis but you can reduce symptoms

Can you reverse ankylosis in therapy? Explain.

dynamometer

Device that measures the amount of force produced by a muscle or group of muscles -measures strength through use of a load cell or spring loaded gauge. (ex: grip strength-pounds) -usually used to measure grip strength

Ulnar Drift Splint

If a client is experiencing ulnar drift, what orthosis is indicated?

?

If arthritis is inflammatory, and heat increases inflammation, is it contraindicated with a diagnosis of arthritis?

splint that limits flexion and rests the finger oval-8 is often used

If someone presents with a trigger finger & is declining surgery, what orthotic would you fabricate to assist with decreasing inflammation & pain?

gel phenomenon

Inability to move joints after prolonged rest often seen in patients with arthritis

Heberden's nodes

Osteoarthritis (DIP swelling 2° to osteophytes)

Bouchard's nodes

Osteoarthritis (PIP swelling 2° to osteophytes)

DeQuervain's Syndrome

Painful condition at the wrist on the side closer to the thumb resulting from tendons (extensor pollicis brevis and abductor pollicis longus) trapped beneath a ligament as they travel to the thumb

anklyosis

Stiffening of the joints and the movement of the arytenoids; caused by arthritis or cancer

Dupuytren's contracture

Thickening and shrinking of the fascia (palmar aponeurosis) of the palm with fingers being drawn into a flexed position -increases loss of prehension

1. Boutonniere deformity 2. Swan neck deformity 3. volar subluxation 4. ulnar drift

What are 4 common deformities often seen in clients with RA?

autoimmune inflammation (specifically in synovial membrane)

What occurs in the joints of someone with RA?

sleep disturbances, depression, attention span, memory, and problem solving skills may be influenced by medication or by chronic pain from arthritis

Why is it important to include a cognitive and psychosocial screening in an OT evaluation with a client who has RA or OA?

spiral fracture

a fracture in which the bone has been twisted apart

firm end feel

a stretching or springy feeling ex: ankle DF, finger extension, hip medial rotation, forearm supination

avascular necrosis

an area of bone tissue death caused by insufficient blood flow

rheumatoid arthritis (RA)

arthritis with swelling, stiffness, pain, and degeneration of cartilage in joints caused by chronic soft tissue inflammation; may result in crippling deformities; an autoimmune disease

midcarpal joint

articulation between the proximal and distal rows of the carpal bones; contributes to movements of the hand at the wrist

mallet finger

avulsion of the terminal tendon and is splinted in full extension for 6 weeks

complete fracture

bone is broken all the way through

simple fracture

bone is broken cleanly; the ends do not penetrate the skin

incomplete fracture

bone is not broken all the way through

communited fracture

bone is splintered or crushed into several pieces

closed fracture

broken bone with no open wound

transverse fracture

complete fracture that is straight across the bone at right angles to the long axis of the bone

open fracture

compound fracture; broken bone with an open wound

avascular necrosis in proximal pole

displaced scaphoid fractures put the client at a risk for what condition?

Colles fracture

distal radius is broken by falling onto an outstretched hand

Colles fracture

distal radius is broken by usually caused by falling onto an outstretched hand

Mallet Finger

flexion of DIP due to an avulsion of the terminal tendon and is splinted in full extension for 6 weeks

Boutonniere deformity

flexion of PIP joint and hyperextension of DIP joint -rupture of central slip -lateral bands slip volarly

arthritis is variable so you should approach MMT based on the client's pain, joint stiffness, fatigue and limitations

how can you vary your technique for performing MMT with an individual with arthritis?

3 trials

how many trials when testing pinch?

3 trials

how many trials when using a dynamometer?

Swan neck deformity

hyperextension of PIP joint and flexion of DIP joint lateral bands slip dorsally at PIP palmar plate is stretched

no

if you suspect someone may be being less than truthful about their injury you can test them with a dynamometer in 5 positions ... a patient that is actually trying would produce a bell-shaped curve regardless of injury... anything other than a bell-shaped curve would indicate abnormal results... can you ALWAYS tell that someone is faking from using a dynamometer?

rest ice stretch splinting

list common treatments of trigger finger?

median nerve

lumbricals for digits 2 and 3 are innervated by?

ulnar nerve

lumbricals for digits 4 and 5 are innervated by?

radial thumb abduction

moving thumb away from index finger (90°)

oblique fracture

occurs at an angle across the bone

compression fracture

occurs when the bone is pressed together on itself

secondary osteoarthritis

osteoarthritis related to an identifiable cause such as trauma, infection, or abnormality

primary osteoarthritis

osteoarthritis with no known cause

lumbrical minus

prehension pattern that a hand may need to be splinted or stretched into

lumbrical plus

prehension pattern that a hand may need to be splinted or stretched into

Osteoarthritis (OA)

progressive, degenerative joint disease with loss of articular cartilage and hypertrophy of bone (formation of osteophytes, or bone spurs) at articular surfaces

radiocarpal joint

radius, scaphoid and lunate make up what joint?

Ulnar drift

results in ulnar deviation of the fingers at the MCP joints

CMC arthroplasty

surgeon removes trapezium and stuffs the FCR tendon in the place because the tendon takes the bone's place there is no longer bone on bone friction

trapezium

surgeon takes out what bone during a CMC arthroplasty?

extension radial deviation with flexion ulnar deviation

the dart throwing motion of the wrist is a combination of what movements?

linear fracture

the fracture is parallel to the long axis of the bone

ankylosis

the loss, or absence, of mobility in a joint due to disease, injury, or a surgical procedure

tigger finger

thickened area on flexor tendon becomes larger than space in the pulley

true

true or false: carpal bones contribute to movement of the wrist through movement themselves

false

true or false: surgery to correct Dupuytren's contracture is usually healed by being sewn closed

true

true or false: wrist surgeries are salvage procedures

rest splinting ice activity modification

what are some treatments for DeQuervain's Syndrome?

-extension -flexion -radial deviation -ulnar deviation -circumduction

what are the movements of the wrist?

1. two-point pinch 2. three-point pinch 3. lateral pinch

what are the the three pinches tested in pinch strength testing. ****define each pinch

ballistic movement use of vibratory tools resistance

what are things that are limited or completely taken away for life after a wrist replacement?

Boutonniere

what diagnosis might this splint be used with?

mallet finger splint

what diagnosis might this splint be used with?

swan neck

what diagnosis might this splint be used with?

4th and 5th

what digits are Dupuytren's contracture most common in?

flex CMP and extend PIP

what do both dorsal and palmar interossei do?

fall on outstretched hand

what does FOOSH stand for?

stage 2 reparative

what fracture healing stage are the following associated with? fibrocartilagionous collus formation capillarie formation

stage 1 inflammation

what fracture healing stage are the following associated with? hematoma formation edema vasodilation osteoclasts reobsorbing dead bone fibroblasts begin forming new matrix

Colles fracture

what fracture might the scaphoid fracture occur with?

2

what is standard position when using a dynamometer?

MCP flexion, PIP/DIP extension

what is the action of lumbricals?

abduction

what is the action of the dorsal interossei?

adduction

what is the action of the palmar interossei?

wrist extension (0-20 degrees) ulnar deviation (10-20 degrees) MCP flexion (20-30 degrres) PIP and DIP flexion (10-30 degrees) slight thumb extension and abduction at CMC slight MCP and IP flexion

what is the recommendation for hand and arm positioning for at rest splinting?

stax splint

what is this splint called?

dart throwing motion

what motion is the normal motion of movement in the wrist?

palmar abduction

what movement is pictured?

wrist flexion and extension supination grip strength full digit closure

what movements are decreased with a colles fracture?

70%

what percentage of carpal fractures are to the scaphoid bone?

synovial / gliding

what type of joint is the midcarpal joint?

synovial ellipsoid/rolling

what type of joint is the radiocarpal joint?

finger

when manual muscle testing the thumb do you use your hand or one finger when applying resistance?

FDP tendon

where do lumbricals orignate?

metacarpals

where do the interossei originate?

Scaphoid fracture

• Pain in the anatomical snuffbox • Plain film x-ray can miss many of them & MRI is more sensitive and specific for occult Fx • Immobilize in thumb spica splint