Chapter 15 – The Wrist, Hand, and Fingers Pages

QUIZ Question #1 Which active and passive motions may be limited due to a TFCC injury? Question #2 Describe the SPECIFIC areas of decreased sensation due to Carpal Tunnel Syndrome. Question #3 List three (3) other S &S of CTS.

Wrist Sprains Mechanism of injury for many wrist pathologies may be similar Must rule out all possible injuries Evaluative Findings Table 15-5, page 553

Triangular Fibrocartilage Complex Injury Trauma may result in permanent disability if left untreated Athletes & closed kinetic chain sports Greater risk of TFCC injury Must differentiate from UCL sprain Evaluative Findings Table 15-6, page 554

Carpal Tunnel Syndrome Compression of median nerve as it passes through carpal tunnel (Fig. 15-8, page 528) May occur due to: Repetitive microtrauma Acute trauma Result of progressive degeneration of structures within tunnel May have effect on athletics and ADLs

Carpal Tunnel Syndrome Signs and Symptoms Paresthesia and pain along median nerve distribution Often occurs at night due to impeded venous return Atrophy of thenar muscles Decreased grip strength Achy pain on volar aspect of forearm

Carpal Tunnel Syndrome Evaluative Findings Table 15-7, page 554 Tinel’s Sign Figure 15-25, page 553 Phalen’s Test for Carpal Tunnel Syndrome Box 15-13, page 555

Carpal Tunnel Syndrome CTS closely resembles symptoms of impingement of C7 nerve root and proximal neuropathy of median nerve Conservative Treatment Rest Modification of activities, posture, work stations NSAIDs Splinting

Carpal Tunnel Syndrome Surgical Treatment Relieve compression on median nerve Initial period of NSAIDs and immobilization post- op, followed by AROM and strengthening

Wrist Fractures Colles’ Fracture Fracture of radius approximately 1.5 inches proximal to radiocarpal joint; distal radius displaced dorsally Often used to describe any distal radius fracture Figure 15-26, page 556

Wrist Fractures Smith’s Fracture Also called reverse Colles’ fracture Distal radius fracture that is displaced palmarly Evaluative Findings Table 15-8, page 556