Term
| • Volkman’s Ischemic Contracture |
|
Definition
o Increased pressure within the compartment of forearm
o Caused by direct trauma, tight cast, swelling
o Decreased capillary refill, possible development of contracture, may have nerve entrapment
o Tx: take off cast or fasciotomy (within 6 hours muscle death occurs)
o BEST EXAM FINDINGS:
Hot, overly painful, increased girth |
|
|
Term
|
Definition
o Caused by hyperflexion of distal phalanx with extensor tendon under tension; may have avulsion or base of distal phalanx or ruptured tendon just proximal to insertion (DIP drops volarly cause no longer has an extensor attachment)
o Tx: splinting to neutral or slight hyperextension for 6-8 weeks with no flexion of DIP joint; if flexion occurs, 6 weeks starts again; maintain ROM at other joints; when healed, AROM but no attempts to passively flex finger for 4 weeks; Blocking exercises to encourage flexor digitorum profundus to pull through; stabilize PIP when performing exercise
o BEST EXAM FINDINGS:
No active extension of DIP
Full passive extension of DIP |
|
|
Term
| • Heberdens and Bouchard’s Nodes |
|
Definition
Herbeden
- dorsal surface of DIP with OA
Bouchard’s
- dorsal surface of PIP with OA |
|
|
Term
|
Definition
o Flexion of MCP and DIP and Extension of PIP
o Caused by intrinsic muscle contracture or tear of volar plate; common with RA |
|
|
Term
|
Definition
o Extension of MCP and DIP and Flexion of PIP
o Caused by a tear or rupture or central tendon slip of extensor hood; common with RA
o Rupture central slip extensor force to dip PIP joint buckles into flexion through hood two central bands on top and exaggerate position
o Tx: splinting PIP in full extension for 6 weeks; exercises following healing – active assisted PIP extension and maximal active forced flexion of DIP while PIP is held at 0 degrees two stretch lateral bands and oblique retinacular l to physiologic length continue splinting for 2-4 weeks when not exercising |
|
|
Term
|
Definition
lubrication inflammation of tendon (tendonitis) inflammation of sheath (tenosynovitis)
o Causes sticking of tendon with flexion; typically 3rd or 4th finger; women more than men; mid age, RA
o May be seen in athletes after holding a racquet, golf club, or bat with resulting inflammation
o Pain and tenderness from volar MCP to PIP with intermittent triggering or snapping of the finger; digit often locks in flexion when pt arises from sleep and requires passive assist to fully extend the finger
o Tx: taping or splinting finger in extension at night; NSAIDs, active IP flexion and tendon gliding exercises on an hourly basis; US, soft tissue mobilization, ice; may need surgical release
o BEST EXAM FINDINGS:
Digit won’t extend actively or passively (depending upon extent) |
|
|
Term
|
Definition
o Fx/dislocation injury @ the 1st CMC joint
o Caused by axial force applied to partially flexed thumb; dislocation of metacarpal base while leaving piece behind with trapezium
o BEST EXAM FINDINGS:
radiograph
o Rx:
1) address hypomobility and muscle tightness/weakness after immob
2) If have capsule laxity after the fracture, strengthen surrounding muscle |
|
|
Term
|
Definition
o Caused by falling on open hand; wrist extended with wrist radially deviated
o Complications: AVN, non-union, DJD (no muscle attachments, covered with articular cartilage, blood supply from distal pole); pseudoarthrosis and non-union after 6 months if no medical attention
o BEST EXAM FINDINGS:
PFT in anatomical snuff box
PFC – minimal swelling
AROM – painful with wrist extension and radial deviation (same way injured)
(healing right on T2 MRI, after dark line on T1 and T2, with fluid on T2 in pseudorthrosis)
o Rx
Med: immob for <6 weeks, circular disc of bone stimulator placement, 3 mos healing
PT: treat impairments found after immob; cast, splint 2-4 weeks after cast, only off for exercises, passive ROM to wrist and thumb with putty squeezes |
|
|
Term
| • Dupuytren’s Contracture |
|
Definition
o Contracture of palmar aponeurosis with insidious onset with fibroblast proliferation producing change from noncontractile to contractile tissue; small node in palm of hand is initial symptom; further contraction of palmar fascia leads to flexion contracture of the fingers, especially ring and little fingers; contracture of MCP and PIP
o More common with combo of alcoholism, liver disorders, DM, epilepsy; may appear as a late sequela to shoulder-hand syndrome after MI; Men after age of 30 and women after 45
o Similar to bishops or benediction but no sensory or motor loss
o BEST EXAM FINDINGS:
- try to take them out of position
o Rx
- conservative treatment prior to surgery with US and soft tissue to loosen
- after surgery isometric contraction, tendon glides, splinting, passive ROM of all joints, Scar mob |
|
|
Term
|
Definition
o Displaced fracture of distal third of radial shaft and dislocation of distal radial ulnar joint
o BEST EXAM FINDINGS:
Radiograph |
|
|
Term
|
Definition
o Fx of proximal half of ulna with anterior angulation and anterior dislocation of proximal radioulnar joint from hyperextension and pronation
o BEST EXAM FINDINGS:
radiograph |
|
|
Term
| • Street Fighter’s Fracture/boxers (all mets) |
|
Definition
o Traumatic Fracture of 5th metacarpal from punching; often with dislocation
o BEST EXAM FINDINGS:
radiograph |
|
|
Term
|
Definition
o MCP hyperextension with PIP and dip flexion
o Loss of intrinsic (ulnar n) and over activity of extensors at proximal phalanyx
o BEST EXAM FINDINGS:
Mmt intrinsic |
|
|
Term
|
Definition
| o thumb flexed at MCP and hyperextended at IP |
|
|
Term
|
Definition
o fracture of distal radius; Classic deformity-dinner fork, dorsal angulation of distal fragment
o MOI=FOOSH; Most common in elderly woman secondary to osteoporosis; CRPS often after
o Common co-morbidities of ucl sprain and avulsion of ulnar styloid, EPL rupture, CTS
o BEST EXAM FINDINGS:
radiograph
o Rx
With external fixator: ROM to maintain above and below, strength above and below, wound care, out of fixator range of motion and strengthening |
|
|
Term
|
Definition
o reverse colles, from fall on flexed wrist with distal radius fracture and anterior angulation
o BEST EXAM FINDINGS:
radiograph
o Rx
With external fixator: ROM to maintain above and below, strength above and below, wound care, out of fixator range of motion and strengthening |
|
|
Term
| • DeQuervian’s Tenovaginitis |
|
Definition
o Involved EPB and APL (1st tunnel); thickening of the synovial lining (may also have inflammation and swelling of synovial lining)
o Pain is felt over distal radial aspect of radius, may radiate into thumb or up forearm; onset is insidious; pain with use of thumb such as wringing or grasping activities
o Differential Diagnosis: osteoarthrosis of trapezium-1st metacarpal joint; here, you will have joint plays that are restricted and painful and the following will be negative:
Pain on resisted thumb extension and abduction
Finkelstein’s
o Caused by: tightness of fascial sheath, weakness, bad mechanics, hypo or hypermobility in CMC or MCP joint, typing or wide gripping activities
o Tx: anti-inflammatory meds, brace, strengthen, pt education, stretch muscles and capsule, TFM with tendons taught
o BEST EXAM FINDINGS:
MSTT
PFC
MLT
Special Test: Finkelstein’s (active thumb flexion, active finger flexion, passive ulnar deviation)
PFT last option but not best 4 |
|
|
Term
|
Definition
o Tightness of intrinsic (lumbricals)
o MCP extension with passive PIP flexion
o If able unable to flex pip flex MCP
o If able to flex PIP:
Tight intrinsic
o If unable to flex:
Hypomobile joint capsule
Hypermobile joint capsule
Adhesion
Tight extrinsics
Effusion/edema
Bone spur |
|
|
Term
|
Definition
o Caused by FOOSH
o Can’t push up off chair, possible numbness/tingling if effects median nerve; any wrist extension will hurt; wrist extension with bony block endfeel
o Hypermobility of its articulations with capitate, scaphoid, triquetrum (can become hypomobile if left for a long time)
o BEST EXAM FINDINGS:
Accessory mobility, radiograph, prom |
|
|
Term
|
Definition
o Osteochondrosis of lunate; decreased blood supply/avn; repetitive motions like a jackhammer
o BEST EXAM FINDINGS:
Imaging!! (will be sore with palpation for tenderness) |
|
|
Term
| • Carpal Tunnel Syndrome (median nerve injury) |
|
Definition
o Common in older women; keyboard operators, hairdressers, dental hygienists
o Caused by: trauma, ergonomics, displaced lunate, retinaculum tightness, edema, effusion, tight wrist flexors, pronator teres syndrome (mimics it), C5-T1 nerve roots (mimics it)
o Insidious onset unless resulting from fracture, dislocation, swelling of the wrist
o Pt may c/o waking up at night because of the pain; increase in symptoms during static positioning
o Differential Diagnosis:
C6 or C7 nerve root involvement; If nerve root involvement, the pt is rarely awakened at night due to parasthesia and use of the hand does not bring on symptoms
Thoracis Outlet Syndrome: parasthesia may involve the entire hand or pt isn’t sure which fingers are affected; OR, may just be ulnar border b/c of involvement of the lower cord
o Objective tests may reveal thenar weakness, sensory deficit, positive Tinel’s, modified Phalen’s and reverse Phalen’s, ULTT
o Tx: NSAIDs, treat the cause, modify activities (grip, ergonomics, etc), nerve glides, splint
o BEST EXAM FINDINGS:
Paresthesia in median nerve distribution
Muscle weakness/motor changes in median nerve
C/o night pain (pain is irritation, tingling is regeneration with tinels) |
|
|
Term
|
Definition
o UCL sprain to first MCP joint; can range from a slight tear to an avulsion and dislocation of the MCP joint (avulse portion of proximal phalanx base)
o Amount of instability is determined by weakness of pinch, swelling over joint, tenderness of joint that is aggravated with passive motion
o Tx: Grade III, surgical repair; Grade II: protected ROM (avoid hyperabduction) and strengthening, with emphasis on stability rather than mobility; splint with thumb spica to allow for healing; pain free thumb MCP flexion and extension and gradually add pain free rotation and opposition; Grip and pinch strengthening at 4-6 weeks; address function
o Radiology needed to r/o fracture
o BEST EXAM FINDINGS:
Radiograph |
|
|
Term
|
Definition
o UCL sprain to first MCP joint; can range from a slight tear to an avulsion and dislocation of the MCP joint (avulse portion of proximal phalanx base)
o Amount of instability is determined by weakness of pinch, swelling over joint, tenderness of joint that is aggravated with passive motion
o Tx: Grade III, surgical repair; Grade II: protected ROM (avoid hyperabduction) and strengthening, with emphasis on stability rather than mobility; splint with thumb spica to allow for healing; pain free thumb MCP flexion and extension and gradually add pain free rotation and opposition; Grip and pinch strengthening at 4-6 weeks; address function
o Radiology needed to r/o fracture
o BEST EXAM FINDINGS:
Radiograph |
|
|
Term
|
Definition
| o Fracture to ulna secondary to blunt trauma |
|
|
Term
| • Osteoarthritis of the first CMC |
|
Definition
o Usually females, involves trapeziometacarpal joint, palmar or ulnar joint
o Initially show pain, then subluxation, then add deformity, marked weakness, dropping objects, localized tenderness
o RX: cortisone, arthroplasty, TFM, joint compression, splint, mobs
o Best exam: PFT, grind test |
|
|
Term
|
Definition
| o Stiffness and capsular restriction; usually secondary to edema, usually from vasodilators like histamine floating and increasing vascular permeability that increase fibrin deposition |
|
|
Term
|
Definition
o History of trauma; diagnosis should be made through exclusion
o Most common ligament is lunate-capitate & and radiocarpal; ulnar collateral ligament often sprained with Colles’ fracture
o MOI: striking ground with a club, FOOSH
o Pain is felt with use of the wrist or by having pt lean forward and transmit body weight though arm, forearm, extended wrist and hand
o Tx: edema control, pain control, maintaining/increasing ROM, strengthening, joint mobs if needed; may need to splint or tape, restrict activities that are bothersome
o BEST EXAM FINDINGS:
Laxity with joint mobs (stress test), pFT and PFC |
|
|
Term
|
Definition
o Best exam findings: MSTT into extension and RD, MLT into flexion and UD, PFC and PFT
o RX
Price initially, tape, splint, anti-inlamm; TFM over sheath in subacute!
Progress range of motion and strengthening |
|
|
Term
|
Definition
o Best exam findings: MSTT into extension and RD, MLT into flexion and UD, PFC and PFT
o RX
Price initially, tape, splint, anti-inlamm; TFM over sheath in subacute!
Progress range of motion and strengthening |
|
|
Term
|
Definition
o Best exam findings: MSTT into extension, MLT into flexion, PFC and PFT
o RX
Price initially, tape, splint, anti-inlamm; TFM over sheath in subacute!
Progress range of motion and strengthening |
|
|
Term
|
Definition
o Best exam findings: MSTT into flexion and rd, MLT into extension and UD, PFC and PFT
o RX
Price initially, tape, splint, anti-inlamm; TFM over sheath in subacute! |
|
|
Term
|
Definition
o Best exam findings: MSTT into extension, MLT into flexion, PFC and PFT (listers)
o RX
Price initially, tape, splint, anti-inlamm; TFM over sheath in subacute!
Progress range of motion and strengthening |
|
|
