Ther-ex UE portion of final

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Ther-ex UE portion of final
2015-05-05 17:24:04
shoulder elbow wrist TMJ

shoulder elbow wrist TMJ
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  1. the liver, stomach, and pancreas all refer pain to which shoulder?
  2. the myocardium and spleen refer pain to which shoulder?
  3. which shoulder do pancoasts tumors refer to?
  4. kidney inflammation and GI inflammation due to GI bleeds can cause irritation to what?
  5. originating from an organ system or structure different from the structure perceived as causing the pain
    referred pain
  6. originating from a nerve root
    radicular pain
  7. function of the shoulder is dependent upon?
    • c-spine/c-t junction
    • upper thoracic spine
    • upper ribs
    • core stability
  8. T/F: just because they dont report pain in a specific location it does not mean there is not a dysfunction there.
  9. T/F: the scapulothoracic articulation is a true joint.
  10. what are the synovial joints of the shoulder?
    • GH
    • SC
    • AC
  11. the glenohumeral, coracohumeral ligaments and the labrum are the ____________ for the GH joint.
    passive stabilizers
  12. what are the passive stabilizers of the AC joint?
    superior and inferior AC ligaments
  13. which of the shoulder joints has a disc
  14. what is the force couple muscles of the scapula?
    • UT
    • SA
    • LT
  15. what stabilizes the GH joint?
    rotator cuff muscles
  16. inhibition or disorganization of activation patterns in scapular stabilizing muscles
    scapular dyskinesia
  17. what does scapular dyskinesia do to the scapula?
    alters the normal motion that should be generated by the force couples
  18. which 2 muscles are susceptible to inhibition secondary to pain in the shoulder as an early non specific response?
    • SA
    • LT
  19. what is more important within the force couples than isolated strength of the individual muscles of the scapula?
    balancing the muscle activity
  20. 55 degrees abduction
    30 degrees horiz adduction

    this is what position for the GH jt?
  21. which muscle "sucks" the scapula against the thorax?
  22. what are the first two muscles to initiate during shoulder abduction?
    • deltoid 
    • supraspinatus
  23. at the start of shoulder abduction, does the deltoid have a whole lot of involvement?
  24. at how many degrees of GH motion during shoulder abduction does it take for the scapula to start to rotate?
    45 degrees
  25. at what degrees does the head of the humerus start to glide inferiorly?
    45-60 degrees
  26. when does external rotation of the humerus take place during shoulder abduction?
    75 degrees
  27. when do the corococlavicular ligaments tighten?
    110 degrees
  28. T/F: to reach full elevation, the thoracic spine sidebends. if both arms are raised the spine will extend to accommodate for full elevation
  29. what is the closed packed postion for the GH jt?
    full abduction and external rotation
  30. what is the closed packed postion for the SC jt?
    full elevation
  31. what is the closed packed postion for the AC jt?
    abduction 90 degrees
  32. what is the capsular pattern for the GH jt?
    external rotation, abduction, internal rotation
  33. what is the capsular pattern for the AC and SC joints?
    pain at end range
  34. what is the most common injured "nervy" area for the shoulder?
    brachial plexus
  35. what are the 3 most commonly injured nerves from shoulder injuries?
    • suprascapular 
    • radial (in axilla or radial groove)
    • axillary nerve
  36. what is the most common cause of shoulder pain in laborers, athletes and people who perform repetitive overhead lifting
    shoulder impingement syndrome
  37. what are the 3 most common causes for shoulder impingment syndrome?
    • instability
    • lacking mobility
    • improper recruitment or lack of coordination
  38. what are some of the secondary issues to shoulder impingement syndrome?
    • RC tears
    • bursitis
    • labral tears
    • bone spurs
  39. what are the three classifications for shoulder impingement?
    • primary
    • secondary
    • internal
  40. what type of shoulder impingement has issues with the AHI; between the RC and either the AC , coricoacromial ligament or the coracoid
  41. what type of shoulder impingement is due to underlying instability of the GH joint or scapular dyskinesia?
  42. what type of shoulder impingement is undersurface impingement with posterior pain when the supra and infra get pinched between the humeral head and the posterosuperior glenoid rim in a 90/90 position
  43. the space between the head of the humerus and the acromion?
    acromiohumeral interval (AHI)
  44. activation of what muscles  promotes increase in the size of the AHI
    • supraspinatus
    • subscapularis 
    • infraspinatus 
    • teres minor
  45. protracted sapular resting postion
    "diabolo" effect
    GH instability
    scapular dyskinesia 

    these all have what in common?
    they decrease the AHI or increase the AHI pressure
  46. what is the most innervated tissue in the shoulder?
  47. supraspinatus insertion
    infraspinatus insertion
    subscapularis insertion
    long head of the biceps tendon
    shoulder labrum

    what do these structures all have in common?
    potentially involved in shoulder impingement
  48. how many stages are there to shoulder impingement?
  49. what stage with shoulder impingement do you typically see edema and hemorrhage?
  50. what stage with shoulder impingement do you typically see fibrosis and tendonitis?
  51. what stage with shoulder impingement do you typically see bone spurs, RT tears and biceps ruptures?
  52. what is the most commonly involved tendon with shoulder impingement?
  53. pain at musculotedninous junction of involved muscle-
    painful arc between 80-130 abduction
    issues with scapulohumeral rhythm
    non capsular pattern of limitation
    muscle imbalances that lead to faulty kinematics

    these are s/s of what?
    shoulder impingement
  54. what does the hawkins kennedy test for?
    shoulder impingement with internal rotation
  55. what makes a neer test positive?
    pain with scapular elevation
  56. what has to be addressed with shoulder impingement rehabilitation?
    scapular weakness, lack of mobility, and/or instability of the CT junction/t-spine
  57. what are some good exercises for shoulder impingement rehab?
    • T's
    • Y's
    • swimmers
    • t-band for RC
    • pivot prone
    • rowing
  58. in order for the body to work as a whole you must address
    • closed kinetic chains
    • core stabilization 
    • functional movement patterns
  59. what type of protocol do you use for shoulder impingement rehab?
  60. what are the main goals of phase 1 rehab for shoulder impingement?
    • avoid provocative movements 
    • control inflammation and promote healing
    • maintain integrity and mobility of soft tissues
    • develop support in related regions
  61. what are the main goals for phase 2 of shoulder impingement rehab?
    • HEP
    • improve posture
    • develop balance in length and strength of shoulder girdle muscles 
    • develop co-contraction, stabilization, and endurance of scapular/shoulder muscles 
    • progress shoulder function  and total body patterns including core and lE
  62. what are the main goals for phase 3 of shoulder impingement rehab?
    • increase musclular endurance
    • develop quick motor responses to imposed stresses 
    • develop function
  63. insufficient subacromial joint space causing pain with overhead activites
    stage 2 impingement with nonreversible fibrosis or degenerative spurring
    intact or minor tears of RTC, calcific depistis in RC tendons, symptomatic crepitus
    unsuccessful conservative management for 3-12 months

    these are clinical indicators for what?
    surgical intervention for shoulder impingement
  64. the subacromial decompression surgical technique for shoulder impingement is used when there is?
    osteophyte formation
  65. anterior acromioplasty surgical technique for shoulder impingement is used when?
    they have a hooked acromion
  66. is the a RC repair surgery with and without compression?
  67. T/F: position and duration of immobilization of shoulder and initiation of progression of exercise varies with surgical approach
  68. how is the shoulder usually postioned after surgery?
    adduction and medial rotation with forearm supported in sling with elbow flexed to 90 degrees
  69. do acute RC tears typically occur with the younger or middle aged population?
  70. a pt. presents after a traumatic injury with c/o pain and sudden weakness (passive motion intact, active unable/limited in abduction with weakness in flexion and rotation) 

    what would you suspect?
    acute RC tear
  71. No Hx of trauma, present with vague c/o intermittent shoulder pain that is progressing with s/s of impingement in a 45 y/o male. 

    what would you suspect was wrong?
    chronic RC tear
  72. type of repair
    size of tear
    tissue quality
    location of tear
    surgical approach
    onset of tissue failure
    patient variables
    rehab situation
    MD's philosophical approach 

    the all have what in common?
    factors affecting rehab after RC repair
  73. what is the first goal after RC repair?
    maintain the integrity of the repair
  74. what are the 2nd and 3rd goals after RC repair?
    re-establish FROM and dynamic humeral head control
  75. how long is phase 1 of RTC tears?
    `approx 6 weeks
  76. what is the main thing you dont want to do during phase 1 for the first 4 weeks at least of RTC tears?
  77. what is the most flexion PROM for phase 1 of RTC tears?
    140 degrees
  78. what is the most ER PROM for phase 1 RTC tears>
    40 degrees
  79. what is the most abduction PROM for phase 1 RTC tears?
    60-80 degrees
  80. before a pt. can progress to phase 2 of RTC tears they must have achieved what?
    • pain free PROM
    • 140 degrees flex
    • 40 degrees ER
    • 60-80 degrees abduction
  81. during phase 2 of RTC tears when can they progress to AROM?
    after full AAROM is achieved
  82. how long is phase 2 of RTC tears?
    weeks 6-12
  83. how long is phase 3 of RTC tears?
    months 4-6
  84. when can you start doing joint mobs with RTC tears?
    phase 3 with MD approval
  85. when would you being closed kinetic chain exercises with RTC tears?
    phase 3
  86. what are the static stabilizers of the shoulder?
    • glenoid concavity and version
    • labral height
    • glenohumeral ligaments
  87. what are the dynamic stabilizers of the shoulder
    • scapulothoracic musculature
    • rotator cuff
    • proprioceptive and neuromuscular control
  88. what is a failure of compensatory mechanisms regardless of the underlying structure leading to the_____________.
  89. what does AMBRI stand for?
    • A: atraumatic
    • M: multidirectional
    • B: bilateral
    • R: rehabilitation
    • I: inferior capsular shift
  90. what does TUBS stand for?
    • T: traumatic 
    • U: unilateral
    • B: bankart 
    • S: lesions
  91. what does SLAP stand for?
    • S: superior
    • L: labrum
    • A: anterior 
    • P: to posterior
  92. what are  bankart lesions?
    injury to the anterior inferior labrum from anterior dislocation; atraumatic
  93. EMG evidence has shown that pt.'s with MDI have?
    • abnormal patterns of muscle activity
    • increased hand position errors with proprioceptive testing
    • abnormal dnamic humeral head centering
  94. Which is more common, anterior shoulder dislocation or posterior?
  95. what is the combined force that causes the humerus to dislocate posteriorly?
    flexion, abduction, and medial rotation; fall on out stretched arm
  96. what is the combine force that causes the humerus to dislocate anteriorly?
    extension, laterally rotated, abducted 
  97. what lesion is a avulsion of capsule and glenoid labrum off the anterior rim of glenoid due to traumatic anterior dislocation?
    bankart lesion
  98. what is the lesion that is a  compression or impaction fx of postero-lateral aspect of humeral head as result of anterior shoulder instability?
    hill-sachs lesion
  99. during the max protection phase after anterior dislocation how long is the shoulder immobilized in a sling?
    6 weeks
  100. What do you want to avoid during the max protection phase after anterior dislocation of the GH?
    avoid the humeral head from moving into the direction of injury
  101. What is indicated during the max protection phase after anterior dislocation of the GH?
    • managment of pain and swelling
    • grade II jt. mobs
    • AAROM
    • submax isometrics in sling 
    • strengthening/ROM of elbow and wrist
  102. When is an anterior dislocation of the GH said to be in the moderate protection phase?
    6 weeks
  103. what do you begin working on during the moderate protection phase after anterior GH dislocation?
    • increase shoulder mobility
    • increase stability and strength of RTC and scapular muscles
  104. What 3 things must an GH anterior dislocation pt. meet before progressing to the min. protection phase?
    • full, pain-free ROM
    • no palpable tenderness
    • continued progression of shoulder strength 
  105. what are the functions of the GH labrum?
    • increase surface area 
    • promotes stability
    • prevents surface distraction by maintaining negative pressure 
  106.  The protocol for posterior dislocation of the GH is the same for anterior dislocation except for one thing. What is that one thing?
    avoid flexion with adduction and medial rotation 
  107. What is "frozen shoulder" lay term for?
    adhesive capsulitis 
  108. Post-op management for anterior/posterior GH dislocation depends mostly on what?
    technique and MD protocol
  109. how long is the freezing time frame with adhesive capsulitis?
    2-9 months 
  110. how long is the frozen time frame with adhesive capsulitis?
    4-12 months 
  111. how long is the thawing time frame with adhesive capsulitis?
    5-26 months 
  112. controlling pain and inflammation, and stimulating pain free motion and decrease muscle guarding is indicated during what phase of frozen shoulder?
  113. distention hydroplasty and mobilization is indicated during what phase of frozen shoulder? 
  114. normalizing motion, scapular movments and stabilization, jt. mobs, and strengthening are indicated during what phase of frozen shoulder?
  115. How are acromioclavicular (AC) sprains/dislocations graded and how many grades are there?
    according to injury; 3
  116. what grade would you give an AC ligament that has partial tearing, jt. tenderness without instability and min loss of function?
    1st degree
  117. what grade would a complete rupture of AC ligaments and partial tear of coracoacromial ligaments with moderate pain and decreased abd/add and there is a palpable gap between acromion and clavicle?
    2nd degree
  118. what would you grade a dislocation between acromion and clavicle; AC and coracoclavicular ligaments torn; distal clavicle displaced superiorly; marked pain; severe limitations in ROM
    3rd degree 
  119. With a grade 1 AC sprain, what do you want to focus on and when can a pt. typically return to work/activity?
    focus on symptom relief; 2 weeks 
  120. with a grade 2 AC sprain, typically how long is a pt. in a sling?
    3-6 weeks 
  121. what is indicated tx with a grade 2 AC sprain?
    pain relief and submax isometrics of shoulder girdle muscles 
  122. what do you want to avoid with grade 2 AC sprains?
    downward displacement of scapula and humeral distraction 
  123. With a clavicular fx, what should you avoid until after 4-6 weeks?
    active shoulder flexion > 40-50 degrees 
  124. what are the four areas in which proximal humeral fx's are classified?
    • humeral head
    • lesser tuberosity 
    • greater tuberosity 
    • humeral shaft 
  125. T/F: a pt. with a proximal humeral fx can have radial nerve issues
  126. you receive a POC for a TSA pt. and it says they are are in the max protection phase. What would focus your treatment on?
    • maintain mobility of adjacent joints; elbow, hand wrist
    • regain shoulder mobility; PROM/AAROM
    • minimize muscle atrophy; gentle muscle setting
    • scapular stabilization
  127. You have a TSA pt. in the moderate protection phase. What do you focus your treatment on?
    • Active control of shoulder while increasing shoulder mobility
    • re-establish mobility and control of shoulder motions
    • improve strength, endurance & stability of shoulder girdle 
  128. What is the earliest a TSA pt. can progress to the min. protection what and what criteria must they meet?
    • 6 weeks
    • pain free AROM thru functional ranges
    • >3/5 strength 
  129. What will you focus your treatment on for a pt. in the min. protection phase of TSA?
    improve mobility, strength, stability and endurance 
  130. what diagnosis is multi-factoral and can involve several different structures and dysfunctions or combinations therof related to the peripheral nerves?
    thoracic outlet syndrome
  131. what are the special considerations for TSA?
    • rotator cuff integrity
    • posture concerns
    • immobilization and post op positioning
  132. what are the 2 categories of TOS and what are the 2 subcategories of those?
    • vascular: arterial & venous
    • Neurogenic: true (obj. findings) disputed (clinical findings) 
  133. EAST/Roos, Cyriax Release, and palpation of the plexus are ___________ tests for _____.
    provocative; TOS 
  134. You are reading a initial eval for your pt. who has c/o numbness and pain that comes and goes in the RUE. You see the PT screened the cervical spine, upper ribs and T-spine and the shoulder. What was the PT screening for?
    regional interdependence with TOS
  135. What are the ways in which you can develop TOS?
    • compression of nerves through the brachial plexus
    • faulty posture; forward head, thoracic kyphosis
    • neural tissue entrapment
  136. what what joint does the elbow extend and flex?
    humeroulnar and humeroradial 
  137. at what joint does forearm pronation supination happen?
  138. what nerve causes sensory changes in ulnar border of hand?
  139. what nerve causes sensory changes in lateral aspect of forearm to anatomic snuffbox, radial side of dorsum of wrist/hand?
  140. what nerve causes sensory changes in the palmar aspect of digits, dorsal aspect of distal phalanges
  141. medial collateral ligament issue
    ulnohumeral joint dysfunction
    medial tendinosis/epicondylitis
    ulnar nerve irritation or subluxation
    valgus extension 

    these are possible causes for what?
    medial elbow pain
  142. olecranon tip fx
    posterior impingment (throwers)
    trochlear chondromalacia

    these are possible causes for what?
    posteromedial elbow pain 
  143. radiocapitellar jt.dysfunction
    ulnohumeral jt. dysfunction
    radial head injury
    radial nerve/radial tunnel
    lateral instability
    lateral epicondalgia 

    these are possible causes for what?
    lateral elbow pain
  144. biceps tendonitis/rupture
    capsular strain
    arthritc changes
    dislocation of the elbow
    pronator syndrome
    median nerve

    these are possible causes of what?
    anterior elbow pain 
  145. what is the most common work-related injury of the elbow?
    lateral tendinosis 
  146. they found sufficient evidence to support that _______________________ have strong association with lateral epicondalgia
    repetitive, forceful movements and posture 
  147. what are the indicators for poor prognosis with lateral epicondalgia?
    • forceful, repetitive movements
    • awkward postures
    • unskilled or untrained workers 
  148. what is lateral epicondalgia most commonly referred to as?
    tennis elbow 
  149. When is where is pain most felt with lateral epicondalgia?
    wrist extensor tendons along lateral epicondyle with gripping activities 
  150. T/F: lateral epicondalgia is an overuse syndrome. 
  151. what is indicated during the protection phase of lateral epicondalgia?
    • control pain, edema and spasm
    • maintain soft tissue and joint mobility
    • maintain integrity of UE function
    • posture and proximal stability 
  152. what is indicated during the controlled motion/return to function phase of lateral epoconalgia?
    • gradually increase flexibility of muscle and create mobile scar
    • strengthen muscle and improve muscular endurance
    • progress to functional training and conditioning
  153. with laterl epicondalgia you want to focus on __________ phase exercises to gradually increase ___________ to more stress
    eccentric; resistance 
  154. what is commonly referred to as "golfers elbow"
    medial epicondalgia 
  155. what is the overuse condition affecting orgin of pronator teres, FCR, flexor digitorum and FCU
    medial epicondalgia 
  156. what is the acute MOI for MCL sprain?
    valgus force or FOOSH 
  157. what is the chronic MOI for MCL sprain?
    throwers, repetitive valgus 
  158. with MCL reconstruction when could you expect to have the brace unlocked, resume light activity and resume full activity?
    • 6 weeks
    • 3 months 
    • 1 year 
  159. with medial valgus stress overload when can strengthening and stretching of the shoulder begin?
    3 weeks 
  160. what do you need to be especially mindful of with fractures near the forearm?
    compartment syndrome 
  161. what are the three compartments of the forearm??
    • dorasl
    • volar (palmar)
    • mobile wad
  162. what is defined as critical increase in pressure within an enclosed myofascial space that decreases tissue oxygenation and can cause permanent muscular or nerve damage?
    volkmann's ischemia 
  163. what are the 4 conditions associated with volkmanns?
    • fractures/dislocations
    • casting 
    • arterial injury
    • snakebite
  164. what is the hallmark of volkmanns?
    pain out of proportion to the injury
  165. Volkmanns treatment indicates avoidance of what?
  166. there are 2 types of supracondylar fractures. what are they?
    • type 1: fall on extended, outstretched arm; most common
    • type 2: direct trauma to posterior aspect of elbow 
  167. how long is a closed reduction distal humerus fx immobilized?
    4-6 weeks 
  168. why is the arm immobilized in a flexed position with distal humerus fx?
    to allow the triceps to help maintain fx in stable position 
  169. Do you want to focus on the contralateral limb during distal humerus fx? why?
    yes; central neurilaztion 
  170. what are some complications with distal humerus fx?
    • nonunion
    • malunion
    • joint contracture
    • volkmanns ischemic contracture 
  171. what are intercondylar "T" and "Y" fx?
    fractures occuring between the condyles of the humerus.
  172. what are the 4 types of T & Y fx?
    • type 1: nondisplaced; immobilized 3 weeks
    • type 2: displaced fx w/o rotation of fragments
    • type 3: displaced fx w/ rotational deformity-ORIF
    • type 4: severely comminuted fx with sinificant separation btw condyles; ORIF or "bag of bones technique" 
  173. what is the bag of bones technique?
    compression hoping that gravity pulls it all together and it heels- no forces thru the elbow early on
  174. radial head fractures typically result from?
  175. what is the carrying angle of men
    10 degrees 
  176. what is the carrying angle of women?
    13 degrees 
  177. a radial head fracture can lead to increased valgus deformity called?
    gunstock deformity
  178. what are the 4 classifications for radial head fractures?
    • type 1: nondisplaced; immobil. 5-7 days up to 4 weeks
    • type 2: marginal fx w/ displacement; ORIF or excise radial head
    • type 3: comminuted fx of entire radial head; fx area excised
    • type 4: any radial head fx w/ dislocation 
  179. how do olecranon fx typically occur?
    fall on the point of the elbow or forceful contraction of triceps 
  180. how is nondisplaced olecranon fx treated?
    immobilzation 6-8 weeks 
  181. how is a displaced olecranon fx treated?
  182. what is the most common complication of olecranon fx?
    decreased elbow extension 
  183. how is an olecranon fx immobilized?
  184. a _____ degree flexion contracture is common with olecranon fx/
  185. what does the median nerve innervate in the forearm and where does it pass thru?
    flexors and hand intrinsics on thenar side; carpal tunnel at wrist 
  186. what does the ulnar nerve innervate in the forearm?
    hand intrinics especailly on hypothenar side 
  187. what does the radial nerve innervate on the forearm?
    elbow, forearm, and extrinisic finger extensors 
  188. What are the 4 neurogenic hand pathologies?
    • CTS
    • cubital tunnel syndrome
    • radial tunnel syndrome
    • PIN syndrome 
  189. what is sensory loss and motor weakness that occurs when the median nerve is compromised in the carpal tunnel?
    carpal tunnel syndrome 
  190. what is CTS secondary to?
    postural dysfunction
  191. what types of exercise can you do in the max protection phase after CTS surgery?
    • tendon and nerve glides
    • Active wrist extension, passive flexion
    • active pronate/supinate/deviate 
    • shoulder and elbow
    • postural 
  192. when does the mod/min phase of rehab after CTS surgery begin?
    10th-14th day 
  193. when do you being strengthening after CTS surgery?
    4 weeks
  194. what is described as inflammation of the abductor pollicis longus and extensor pollicis brevis occuring from continued repetive use in ulnar deviation postion?
    De Quervain's Tenosynovitis 
  195. what is an example of a traumatic TFCC injury?
    loaded wrist in pronation;bad hand stand 
  196. what is a degenerative injury to the TFCC typically from?
    ulnar impaction 
  197. A complex ligament wrist sprain of the wrist can be treated in what two ways?
    • rigid cast immobilization for 6-12 weeks 
    • ORIF immobilized for 2 months then cast for 4 weeks 
  198. with a complex sprain to the wrist, after the cast/spint is removed what types of exercise would you begin and when would you progress it?
    • AROM in pain-free ranges
    • resistance can be added once AROM is increased and pain is decreased 
  199. what is a colle's fracture?
    distal radius 
  200. what is the most common MOI for colle's fx?
  201. what does rehab begin for a colles fx pt?
    immeditely after immobilization 
  202. with a colle's fx when can you add resistance?
    after bone union; typically 5-8 weeks 
  203. what is known as a reversed colles fracture?
    smiths fx
  204. T/F:  ulnar fractures typically don't happen alone, instead they are typically found with distal radial fx's. 
  205. what accounts for 60% of all carpal fx and what is the typical MOI?
    scaphoid; foosh 
  206. how long does it typically take for a scaphoid fx to show on xray and how many views does it usally take for 1 to have a positive?
    2 weeks; 6 shots 
  207. ______________  or ______________ are contraindicated after immobilization of scaphoid until bone union is confirmed. 
    passive stretching, mobilizations 
  208. what is an acute sprain of ulnar collateral ligament of the thumb?
    skiers thumb 
  209. what is the MOI for skiers thumb?
    sudden valgus stress and hyperextension 
  210. where would you palpate for a scaphoid fx?
    anatomic snuffbox
  211. a fx of the 2nd, 3rd, 4th, or 5th metacarpal neck is called what?
    boxers (fighter) fracture
  212. what is a bennetts fx?
    subluxation of 1st proximal metacarpal 
  213. what does dupuytrens contractures typically affect?
    palmar fasica of hands and feet 
  214. what tendon is injured with a mallet finger?
    extensor tendon at the DIP joint
  215. what tendon is injured with a boutonniere defromity?
    central extensor tendon at the PIP joint
  216. what are some common deformities you might see in the hands of RA patients?
    • ulnar drift of MCP's, radial deviated wrist
    • bouchards nodes