AT304_Wrist_Hand

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Author:
itzlinds
ID:
259183
Filename:
AT304_Wrist_Hand
Updated:
2014-02-03 20:21:43
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Chapter 18 wrist hand finger pathologies
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wrist hand finger pathologies
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  1. because of the # of pathologies involving the _______, suspected trauma to this bone should be referred for further examination.
    because of the # of pathologies involving the scaphoid, suspected trauma to this bone should be referred for further examination.
  2. trauma to the triangular fibrocartilage complex (TFCC) should be suspected with the following 3 motions:

    diffuse pain with TFCC trauma will be located at:
    • motions that cause TFCC trauma
    • forced hyperextension
    • radial deviation
    • ulnar deviation

    diffuse pain with TFCC trauma will be located at: distal ulna
  3. the signs and symptoms of carpal tunnel syndrome and other neuropathies of the hand can be cuase by nerve insult anywhere from the _________________ distally to the hand.
    the signs and symptoms of carpal tunnel syndrome and other neuropathies of the hand can be cuase by nerve insult anywhere from the cervical spine distally to the hand.
  4. the disposition of metacarpal and carpal fx depends on the location, direction, and displacement of the fx.

    _______________  fxs that involve the articlar surface will result in more time being lost (and possibly surgery) than ___________ fxs that do not involve the articular surface.
    displacedcfxs that involve the articlar surface will result in more time being lost (and possibly surgery) than nondisplaced fxs that do not involve the articular surface.
  5. the _________ is an inherently weak and unstable joint. unresolved or unrecognized trauma can lead to instability that alters even the most fundamental ADL's
    thumb
  6. the distal radius broadens to form a small _________ on its medial surface to accept the ulnar head
    the distal radius broadens to form a small ulnar notch on its medial surface to accept the ulnar head
  7. from the radial to the ulnar side, list the the proximal row of carpal bones in the hand:
    proximal row: scaphoid, lunate, triquetrum, and pisiform
  8. from the radial to the ulnar side, list the distal row of carpal bones in the hand:
    • trapezium
    • trapezoid
    • capitate
    • hammate
  9. which bone in the hand "floats" on the triquetrum, acting as a sesamoid bone to improve the mechanical efficiency of the flexor carpi ulnaris muscle:
    pisiform
  10. which bone of the hand is the most commonly fxed of the carpals:

    which bone of the hand is the most commonly dislocated of the carpals:
    • commonly fxed: scaphoid
    • commonly dislocated: lunate
  11. what are the 2 main articulations of the wrist:

    list the degrees of freedom for each joing:
    list the movements that occur around the joint:
    • radiocarpal joint:
    • degree of freedom: 2
    • movements: flexion/extension and radial/ulnar deviation
    • distal end of the radius with the scaphoid and  lunate

    • midcarpal joint
    • the articulations between the proximal and distal carpals
    • movements: limited gliding in flexion/extension and radial/ulnar deviation
  12. list the 3 joints of the hand:
    • carpometacarpal joint
    • metacarpophalangeal 
    • interphalageal joint: common site for dislocations
  13. the structure composed of the articular disk (or fibrocartilage), the radioulnar ligaments, and the ulnar collateral ligament attached to the triquetrum is called:
    triangular frbrocartilaginous complex
  14. list 3 fxns of the TFCC:
    • dissipates stresses imposed on the forearm during loading
    • stabilizes the distal radioulnar joint
    • extends the radiocarpal articulation by stabilizing the ulnar side carpals
  15. list the 3 peripheral neves that provide input to the wrist and hand:
    ulnar nerve

    • median nerve
    • radial nerve
  16. what structure does the ulnar nerve pass thru:

    which branch of the ulnar nerve provides to the little finger and the ring finger:
    • ulnar never passes thru: tunnel of Guyon, formed by the hammate and pisiform
    • little finger and ring finger innervated by: superficial branch of the ulnar nerve
  17. what structure does the median nerve pass thru:

    what are the structures innervated by the palmar digital branch:
    median nerve passes thru: carpal tunnel lateral

    • palmar digital branch
    • thumb
    • index finger
    • middle finger
    • index finger
    • lateral 2 lumbricals
  18. list the structures that form the carpal tunnel's floor and roof:

    list the 10 structures that pass thru the carpal tunnle:

    impairment found from inflammation of the carpal tunnel:
    • carpal tunnel floor: proximal carpal bones
    • carpal tunnel roof: transverse carpal ligament

    • structures passing thru the carpal tunnel
    • median nerve
    • flexor pollicis longus tendon
    • the 4 tendons of the flexor digitorum superficialis
    • the 4 tendons of the flexor digitorum profundus tendons

    • impairments
    • paresthesia of the 2nd, 3rd, and 4th fingers
    • decreased grip strength
  19. vascular insufficiencies that may result in a sensation of coolness and thickness in the hand from:
    peripheral vascular disease (PVD) or Raynaud's phenomenon
  20. a "clicking" on the ulnar side of the wrist is often associated with which pathology:
    TFCC tears
  21. Nagging wrist pain that does not decrease in severity may indicated:
    • scaphoid fx
    • tears of the TFCC
    • carpal instability
  22. pain that is described as "aching" or throbbing" is often associated with:

    pain that is described as "burning" or "tingling" is associated with:
    • aching/throbbing pain: bony or soft tissue
    • burning/tingling: neurological or vascular
  23. a formation of a nodule in the flexor tendon, causing the finger to hesitate and then "snap" during flexion,  as the nodule is wedged beneath the pulley resulting in an audible pop as it passes thru the opening is called:
    trigger finger
  24. overemphasis of the extensor muscles which pull the thumb parallel with the fingers is called:
    ape hand
  25. flexion of the MCP and the DIP joints and hyperextension of the PIP joint is called:
    swan neck deformity
  26. inhibition of the radial nerve may result in paralysis of the wrist and finger extensors, caused by the inability to extend the wrist, called:
    drop wrist
  27. a benign collection of thick fluid within a tendinous sheath or joint capsule is called:
    ganglion cyst
  28. the formation of hematoma, characterized by discoloration beneath the finger nail is called:
    subungual hematoma
  29. an infection or abscess at or distal to the DIP joint, this pathology arises scondary to contusions or lacerations:
    felons
  30. an infection around the periphery of the fingernail, resulting in redness, swelling, and possible drainage around the nail bed is called:
    paronychia
  31. an avulsion of the flexor digitorum profundus tendon, that leads to an impairment of the inability to actively flex the DIP joint is called:
    jersey finger
  32. an avulsion of the extensor digitorum longus tendon that results in the inability to actively extend the distal phalanx, which assumes the posture of 25-30 degrees of flexion is called:
    mallet finger
  33. a rupture of the central extensor tendon, that results in the extension of the MCP and DIP joints and flexion of the PIP joint, but active PIP extension is absent is called:
    Boutonniere deformity
  34. the small but prominent mass on the palmar surface of the hand near the base of the thumb is called:
    thenar compartment
  35. the mass along the ulnar boarder of the hand is called the:
    hypothenar compartment
  36. describe the end feels obtained during passive ROM for wrist:

    Flexion:
    Extension:
    Radial deviation:
    ulnar deviation:
    • Flexion: firm; dorsal radiocarpal ligaments and joint capsule
    • extension: firm; palmar raidiocarpal ligament and the joint capsule
    • radial deviation: hard; scaphoid striking the styloid process of the radius
    • ulnar deviation: firm; radiocarpal ligaments and tendons
  37. describe the end feels obtained during passive ROM of the thumb (CMC) joint:

    flexion:
    extension:
    abduction: 
    adduction:
    • flexion: soft; approximation of the thenar eminence and the palm
    • extension: firm; muscles
    • abduction: firm; stretching of the webspace
    • adduction: soft; approximation of the thenar eminence and palm
  38. describe the following end feels obtained during passive ROM of the fingers and thumb (MCP):

    Flexion:
    Extension:
    abduction:
    adduction:
    • Flexion: hard; proximal phalanx contacts the metacarpal
    • extension: firm; tension in the volar plate
    • abduction: firm; stretching of the collateral ligaments and webspace
    • adduction: firm; stretching of the collateral ligaments and webspace
  39. describe the following end feels obtained during passive ROM of the fingers (PIP) joint:

    flexion:
    extension:
    • Flexion: hard; proximal and middle phalanges contact
    • extension: firm; stretching of the volar plate
  40. describe the following end feels obtained during passive ROM of the Fingers and thumb (DIP)

    Flexion:
    extension:
    • flexion: firm; tension in dorsal joint capsule and collateral ligaments
    • extension: firm; stretching of palmer joint capsule and volar plate
  41. wrist joint active ROM...

    Flexion:
    Extension:
    Total:
    • flexion: 80 to 90 degrees
    • extension: 75 to 85 degrees
    • total: 155 to 175 degrees
  42. wrist joint active ROM..

    radial deviation:
    ulnar deviation:
    • radial deviation: 20 degrees
    • ulnar deviation: 35 degrees
    • total: 55 degrees
  43. list the following ligaments stressed during wrist passive ROM..

    extension:
    flexion: 
    radial deviation:
    ulnar deviation:
    • extension
    • primary: palmar ulnocarpal and palmar radiocarpal
    • secondary: radial collateral and ulnar collateral

    • flexion
    • primary: dorsal radiocarpal 
    • secondary: radial collateral and ulnar collateral


    • radial deviation
    • primary: ulnar collateral
    • secondary: palmer ulnocarpal

    ulnar deviation

    • primary: radial collateral
    • secondary: palmer radiocarpal
  44. a fx of the distal radius is called:

    which way is the radius displaced in this fx:
    • a Colles' fx
    • a true Colles is a nonarticular fx of the radius approx. 1.5 inches  proximal to the radiocarpal joint,
    • and the radius is displaced dorsally
  45. when the wirst appears as an upside-down fork, what is this fx called:

    which was is the distal radius displaced in this fx:
    • Smiths fx or reverse colles fx
    • distal radius is displaced palmary
  46. what is the fxn of the scaphoid bone that it accounts for 70% of all carpal fxs:
    fxns as a bony block limiting wrist extension
  47. unresolved fxs of the scaphoid or chronically impaired circulation to the scaphoid may result in:
    periser's disease: osteoporosis of the scaphoid
  48. describe the following of examination findings of a scaphoid fx:


    pain characteristics:
    MOI:
    palpation:
    • pain characteristics: proximal portion of lateral wrist in the anatomic snuffbox  and at the scaphoid tuberical
    • MOI: forceful hyperextension of the wrist that compresses the scaphoid
    • palpation: anatomical snuffbox elicits pain and tenderness; compression of the 1st metacarpal toward the scaphoid may elicit pain
  49. describe the following of examination findings of a hamate fx:

    pain characteristics:
    MOI:
    inspection:
    palpation:
    neurological screen:
    • pain characteristics
    • pain on the ulnar side of the hand, proximal to the 5th MC
    • diffuse pain in the wrist and hand

    • MOI
    • The hook of the hamate may be fxed secondary to a fall on the hand
    • probability of a fx is increased if the pt falls gripping an object such as a bat, club, hammer
    • axial load applied to the 4th or 5th MC
    • direct blow to the hamate

    • inspection
    • often unremarkable
    • swelling may develop in the  hypothenar eminence
    • a callus like projection may develop over the hamate

    • palpation
    • pain during palpation of the hamate
    • hook of hamate fxs will produce pain during palpation of the palmar aspect of the hand

    • neurological screen
    • paresthesia may be present in the 4th and 5th fingers secondary to the ulnar nerve traum
  50. what is the most commonly fx'd carpal bone in the hand?

    lunate
    capitate
    pisiform
    scaphoid
    scaphoid
  51. what is the most commonly dislocated carpal bone in the hand?

    lunate
    capitate
    pisiform
    scaphoid
    lunate
  52. what ligament originates off the styloid process and inserts on the scaphoid and trapezium?

    RCL
    UCL
    palmar radiocarpal ligament
    dorsal radiocarpal ligament
    radial collateral ligament (RCL)
  53. what is the ligament that is responsible for checking radial deviation and becomes taut at the end ranges of flexion and extension?

    RCL
    UCL
    palmar radiocarpal ligament
    dorsal radiocarpal ligament
    ulnar collateral ligament (UCL)
  54. what is the primary extensor of the lateral 4 fingers' interphalangeal (IP) joints and assists in wrist extension?

    extensor carpi radialis longus
    extensor carpi radialis brevis
    extensor carpi ulnaris
    extensor digitorum communis
    extensor digitorum communis

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