Exam

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jessiekate22
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158407
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Exam
Updated:
2012-06-12 19:31:01
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Sixth Week
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2020
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  1. What are the functions of the wrist?
    • - to position hand in space
    • - wrist transmits forces to and from hand
    • - requires great mobility and stability
    • - tactile organ
    • - means of expression
    • - weapon
    • - placement of digits
    • - grip (prehension)- precision + power
  2. What is the precision grip?
    • - pick upand manipulate object between fingers and thumb
    • - radial- sided movement
  3. What is power grip?
    • -objects picked up and held tightly: hand stable
    • - ulnar 2 fingers flex toward thenar eminence
  4. What is the anatomy of the hand?
    • - radiocarpal jt between distal radius and scaphoid, lunate , lunate, triquetrum
  5. Radiocarpal joint
    • - between carpals and radius/ ulnar
    • - synovial, ellipsoid
    • - biaxial
    • - radial and ulnar collateral ligaments
    • - palmar and dorsal radiocarpal ligaments
  6. What ligaments link carpal rows?
    • scaphoid
    • interosseous ligaments
  7. Midcarpal joint
    • - compund joint
    • - synovial, ellipsoid medially
    • - synovial plane laterally
    • - short capsule
    • - radiate ligament
    • - intercarpal ligaments
    • - acts as a hinge- flexion/ ext
    • - aids wrist
  8. Carpometacarpal joint
    • - synovial plane- at digits- gliding
    • - synovial saddle- at thumb, angular movements
    • - radial and ulnar collateral ligaments
    • - palmar and dorsal radiocarpal ligaments
  9. Carpometacarpal jt
  10. What movements are availble at the wrist
    • - abd/ adduction (15- 45 respectively)
    • - flexion/ extension 85*
  11. What are the movements at the thumb?
  12. Bones of the hand
  13. Where does flexion of the wrist take place?
    - mainly in the midcarpal jt
  14. Where does ext of the wrist take place?
    - mainly in the radiocarpal jt
  15. What is the usual plane of movement of the wrist from?
    • - ext/ radial devn
    • - flex/ ulnar devn
  16. Where does sup/pron take place in the wrist?
    - radius rotates around ulna head (inferior radioulnar jt)
  17. Where does radial dev ocur in the wrist?
    • - radiocarpal jt
    • - proimal carpal row slides in ulnar direction
  18. Where does ulnar deviation occur in the wrist?
    • - radiocarpal jt
    • - proximal carpal row slides in radial direction
  19. What movements are available at the thumb CMC jt?
    • - flexion
    • - ext
    • - abd
    • - add
    • - rot
    • - circumduction
  20. What movements occour at the 2-5 CMC jts?
    • - rot which alows horizontal flexion (cupping)
    • - horizontal ext (flattening palm)
  21. What movements are available at MCP jts?
    - adb/ add- limited by collateral ligaments and capsule
  22. What type of jts are IP jts?
    - hinge jts
  23. What is the lose packed position of the wrist?
    • - Radiocarpal- slight flex, slight lnar deviation
    • Midcarpal- slight flex
    • Distal radioulnar- 10-35* supination
    • Carpometacarpal 1- neutral
  24. What is the closed packed position of the wrist?
    • - Radiocarpal: full ext and radial deviation
    • Midcarpal- full ext
    • Distal radioulnar: 0-5* supination
    • Carpometacarpal 1: full opposition
  25. What are the capsular patterns of the wrist?
    • - radiocarpal: equal dgree of limitation of flexion and ext
    • -midcarpal: equal degree of limitaion of flex, etx
    • - distal or inf radioulnar: pain at both extremes of rot
    • - CMC 1: limitation abd, ext
    • - thumb and fingers: more F than E
  26. Extrinsic wrist/hand disorders
    • - referred pain from elbow, shoulder, radiculopathy, and somatic cervical spine dysfunction/ arthritis
    • -vascular, neurological, metabolic and skin disorders
  27. What are some intrinsic wrist/ hand disorders?
    • - peripheral nerve entrapment (carpal tunnel syndrome)
    • - tendinopathy/ tendon rupture
    • - tenosynovitis (de Quervain's disease)
    • - trigger finger
    • - dupuytren's contracture
    • - finger deformities
  28. Nerves
  29. Carpal tunnel syndrome
    • - compression of median nerve
    • - usually dominant hand
    • - paraesthesia/ anaesthesia/ pain in median nerve
    • - may disrupt sleep, radiate
    • - atrophy of thenar eminence
    • - weak APB
    • - poisitve tinels and phalen's teswts
    • - nerve conduction studies
    • - occurs between proxiaml and distal row of carpal bones
  30. How do you manage Carpal tunel syndrome?
    • - depends on cause: wrist #, haematoma, hypothyroidism, pregnancy, diabetes, flexor tenosynovitis, ganglion cysts, OA, oedema
    • - rest, night splint
    • - passive mobilise flexor retinaculum, intercarpal jts, median nerve
    • - cortisone injection, NSAIDs
    • -decompressive surgery
  31. Tendinopathy
    • - common ECR, ECU, FCU, FCR
    • - follows trauma or overuse
    • - tender just proximal to insertion or at tenoperiosteal junction
    • - pain on isometric contraction and stretching
    • - extensor tendon rupture: digit heald in fex, no active ext, normal passive ext, wweak and painless resisted ext
  32. How do you manage tendinopathy?
    • - avoid aggravating ADL
    • - EPA
    • - Deep friction masage
    • - stretching exercises
    • - carpal jt mobs
    • - NSAIDs
    • -cortisone injection
  33. Tenosynovitis (infalm of the lining of the sheath that surrounds a tendon)
    • - usually pain felt over dorsal aspect of hand
    • - locally tender, swollen synovium over extensor tendons
    • - pain on resisted finger ext through range- crepitus
    • - pain on stretching mm
  34. What is De Quervian's disease?
    • - type of tenosynovitis of EPB + APL over radial styloid
    • - inflammation of common synovial sheath
    • - radial rain on thum ext, abd, pinch grip
    • - tender swollen at styloid
    • - positive finkelstein's test (careful of OA)
    • - may need to splint or decompreeive surgery
  35. What is trigger finger?
    • - nodular thickening of flexor tendon
    • - after flexion, ext limited as nodule isunable to pass under MCP ligament
    • -MCP jt pain, sweling, inflammation
    • - clinking sensation palpable on ext
    • - inability to actively ext finger
    • - RX: rest, cortisone injection, surgery
  36. What is dupuytren's contracture?
    • - fibrous proliferation of palmar fascia
    • - flexion deformity of MCP, prox IP jt
    • - expanding fibrous, nodular thickening
    • - becomes cord- like band
    • - skin dimples
    • - elderly, caucasian males
    • - commonly bilateral; aetiology unknown
  37. How do you treat dupuytren's contracture?
    • - US, moist heat, extension splints, stretching in early stage disease
    • - surgery- fasciectomy
    • - post surgery- scar tissue massage lanolin, splints, passive jt mobs, active tendon gliding exercises
  38. Conditions
  39. Tedons of the digits
  40. # of the wrist
    • - schaphoid #
    • - skiers thub

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