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distal radioulnar joint is a
uniaxial pivot type
radoiocarpal joint is a
biaxial ellipsoid (pivot)
the TFCC functions to
reinforce ulnar wrist - binds ulna + radius together
cushions wrist -radius bares 60-80 of load
CMC (fingers 2-5) joint is a
plane joint
name of the carpal bones proximal to distal
scaphoid, lunate, triquetrum, pisiform
trapezium, trapezoid, capitate, hamate
CMC joint thumb is
saddle joint
MP joints 1-5 are
condyloid joints
PIP and DIP are
uniaxial hinge joint
A1 versus A3 (pulley system)
trigger finger relief = A1
surgery in flexor can sacrifice = 3
A2 + A4 can cause
flexor loss
arches of hand
longitudinal arch - long ways/vertical through center of palm
proximal transverse arch - proximal to hand across thumb horizontally
distal transverse arch - distal (metacarpal arch) horizontally across MP
zone I and II are bad because
they create too much scar tissue
kienbocks disease MOI
trauma, repetitive stress, or short ulna
kienbocks disease s/s
stage 1: aching/stiffness, pain with motion, and mild swelling
stage 2: more severe symptoms including swelling and pain with motion
stage 3: decrease ROM, painful radial instability
stage 4: constant pain, chronic swelling, decrease ROM, decrease grip strength
stage 3 and beyond of kienbocks disease is
not salvageable
management of kienbocks disease
stage 1: immobilize
stage 2 and 3a: revascularization procedures
stage 3b: fusion of carpals or proximal row carpectomy
stage 4: proximal row carpeectomy or wrist fusion
PT management of kienbocks disease
pain control, maintain ROM, progressive ROM and strengthening
TFCC dysfunction MOI
trauma, overuse and chronic fraying, associated with DRUJ instability
TFCC dysfunction s/s
reduced grip, tenderness with palpation between FCU tendon and ulna styloid process, pain with axial loading
skierâs thumb MOI
repeated twisting and hyperabduction injury
skierâs thumb s/s
unstable pinch and grasp
positive valgus stress test
carpal instability MOI
trauma/fracture, RA
carpal instability s/s
wrist pain, stiffness - tenderness over lunate and scaphoid, clicking + snapping, decreased grip strength
dorsal intercalated segmental instability
scaphoid + lunate - lunate stays extended migrates dorsal and wedges between hamate and capitate
volar intercalated segmental
lunate stuck in flexed position
acute carpal instability
closed or open reduction
ligament repair
immobilizations
progressive ROM and strengthening
chronic carpal instability
athrodesis, arthroplasty
ganglion cyst MOI
young adults, trauma and defects occurring with capsular structures
ganglion cyst s/s
painless lump typically on dorsum of wrist
management of ganglion cyst
aspiration but more common to reoccurrence
duputyrenâs contracture MOI
genetic, men > women, 50-70 yrs old, metabolic changes
duputryenâs contracture s/s
nodular thickening in the palm
PIP and MCP flexed (often bilaterally)
duputryenâs contracture management
cannot stop progression of disorder, BUT
stretching, friction massage, tendon glides, and modalities
trigger finger MOI
uncertain - can be associated with RA, DM, and gout
trigger finger s/s
discomfort at base of digit
locking of finger/thumb
worse in morning
osteoarthritis most common in
CMC
RA s/s
joint pain, stiffness, swelling
ulnar drift
nodules at MCP and PIP joints
complex regional pain syndrome s/s
loss of hair on hand
brittle fingernails + shiny skin
increase/decrease sweating of palm
temperature difference between hands
deQuervains disease MOi
unusual or unaccustomed use of hand
deQuervains disease s/s
pain, swelling at radial wrist
palpable thickening of tendon sheath
+finkelsteinâs test
mallet finger s/s
distal phalanx rests in a flexed position
swan neck deformity MOI
tearing to volar plate
contracture of intrinsic muscles
RA, ehlerâs danlos syndrome
swan neck deformity s/s
flexion of MCP + DIP joints
hyperextension of PIP joints
boutonniere deformity s/s
extension of MCP + DIP, flexion of PIP
flexor digitorum superficialis lesion s/s
inability to actively flex at PIP joints when adjacent fingers are held in extension
flexor digitorum profundus lesion s/s
inability to actively flex at DIP joint when PIP joint is in extension
flexor pollicis longus lesion s/s
inability to actively flex at IP joint when MCP joint is in extension
A2 and A4 injury to flexors s/s
bowstringing of flexor tendons and reduced motion
extensor tendon versus flexor tendon rehab
extensor less rigorous and intense than flexor rehab (extensors immobilize for month then PT straight forward, flexors mobilize immediately and PT is complicated)
extensor tendon lesion s/s
loss of hyperextension at MCP joint
extensor lag of finger
relative weakness and pain in one finger when compared to another
CTS MOi
anatomical/pathological
diseases and predisposing factors
chronic physical stress
individual and environmental factors
sleep postures
CTS s/s
worse at night
burning, tingling, needles and pins
numbness in median nerve sensory distribution (1-3)
hand weakness and incoordination
+tinelâs sign + phalenâs
hand elevation test + compression over carpal tunnel
CTS prediction rule
shaking hands for symptom relief
wrist-ratio index greater than 0.67
symptom severity scale greater than 1.9
reduced median sensory field of digit 11
age greater than 45 yrs
ulnar tunnel syndrome s/s
direct pressure over guyot canal
sensation loss little finger and half of ring finger
decreased strength for thumb add/finger abd + add/finger of little finger
drop wrist deformity s/s
paralysis of wrist and finger extensors
forearm pronation
drop wrist deformity MOI
trauma of shoulder, elbow, humerus fractures
compression
hand myelopathy s/s
inability to extend + adduct the ring and little finger
exaggerated triceps reflex
+pathological reflexes
colles fracture s/s
silver fork deformity
pain with wrist/hand movements
local tenderness
smith fracture s/s
local tenderness + pain with wrist/hand mvts
radial styloid fracture s/s
local tenderness + pain with wrist/hand mvts
scaphoid fracture s/s
pain with wrist extension
weak and painful grip
pain with compression through 1st MC
tenderness anatomical snuffbox
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