MOPS 3: tendon deformities

where are collateral ligaments located in hand?

MCP PIP

what motion does collateral ligaments gets tightened in?

flexion

why do collateral ligaments become tightened in flexion?

increases tension less prone to side to side movements

what are volar plates?

Ligament covered in articular cartilage on palmar side that restrict hyperextension

if have lunate triquetral injury, what increases stability?

ECU

what activation is not beneficial in lunate triquetral injury?

FCR

what activation is used for conservative management of lunate triquetral injury?

only ECU

what is ligament is involved in a wrist sprain?

scapholunate ligament

what do carpal kinematics depend on?

proprioceptive signals

what is type of treatment for wrist ligament injury?

(EX: passive, active, assisted)

active ROM in safe range

what are some proprioceptive treatments for wrist injuries?

mirror training visual occlusion exercises motor imagery

what is progression of stabilizing to strengthening?

(not going full ranges)

isometrics limited arc full arc

what is the primary source of stability?

ligaments

what is secondary source of ligaments?

muscles

what motions are used for wrist injury in general?

PROM AROM within tolerance

what is the dart thrower motion?

radial extension to ulnar flexion from 45 degrees from sagittal plane

what is importance of dart thrower motion?

train wrist in more functional pattern

what planes is dart thrower motion in?

radial/ulnar flex/extend

what is functionality of dart thrower motion?

hammering, pouring, drinking from glass

what is benefit of dart thrower motion?

carpal row is able to stay more stationary

what does dart throwing motion allow pertaining to grip?

stable platform for power and precision grip

when advance from dart throwing what interventions could you use for patient?

body blade Powerball plyometrics (catching ball on rebounder)

what is composition of splint for DTM?

two orthoses

where does FDS split?

prox phalanx level (campers chiasm)

where does FDS insert?

middle phalanx

what is motion of FDS?

flexes PIP joint

what muscle has 1 muscle belly for each digit?

FDS

In the FDS, what digit may lack a muscle belly?

pinky (5th)

what muslce does the FDP course through?

FDS

where does FDP insert?

distal phalanx

what muscle has muscle bellies for digits 3-5?

FDP

what is motion of FDP?

flex DIP

what lubricates and assists the glide of tendons?

flexor tendon shealths

where are flexor tendons located?

digits 2-4 stop at MC level but has extension to little

digits 2-4 have own digital sheaths

what can provide common route for infection to spread?

flexor tendons sheaths

what does impairment in flexor retinaculum allude to?

carpal tunnel

where does flexor tendon sheath run?

MC heads to insertion of FDP

what does flexor tendon sheath facilitate?

gliding and nutrition to tendon

what is jobs of pulleys?

improves ME prevent bowstrinigng

what are the most critical pulleys?

A2 and A4

what composition of zone 1?

FDP

what composition of zone 2?

where is zone 2 located?

synovial sheath to mid middle phalanx

what is composition of zone 3?

carpal tunnel beginning of sheaths

what muscle is in Zone 1?

FDP

what zone deals with adhesions to DIP flexion?

zone 1

what zone deals with jersey finger?

zone 1

what is the extensor reticulum also called?

dorsal transverse carpal ligament

what is present on dorsal side of retianaculum?

compartments to separate extrinsic extensor tendons

what keeps extrinsic extensor tendons from bowstringing?

extensor retinaculum

what is the 1st compartment of extensor expanasion?

deq

what are the dorsal compartments?

I-VI

what is in the first dorsal compartment?

APL EPB

what is action of EDC?

MP extension

what is state of EDC muscle bellies?

poorly defined

acts as 1 muscle with 4 tendons

what muscles have separate bellies?

EIP EDM

where is juncture tendendum of EDC located?

ring to middle and little finger and invariability to index

digits 2-5

what is function of juncture tendendum?

assist extension of adjacent finger

where are odds located in extensor tendon zones?

joints

where are even located in extensor tendon zones?

bones

what tendon zone is impaired in mallet/swan finger?

zone 2

what tendon zone is impaired in boutonniere?

zone 3

what do the lateral bands act like on the extensor side?

FDS

where are lateral bands located in extensor expansion?

where is terminal slip located in extensor expansion?

where is the central slip located in the extensor expansion?

base of middle phalanx

where does dorsal hood start in extensor expansion?

proximal end of metacarpal

what is main idea for tendon injuries of hand?

dont allow scar tissue to limit future function

what is position of flexor tendon repair?

wrist flexed (neutral to 30 degrees)

MCP flexed (70 degrees)

IPs extended

what is position for extensor tendon repair?

static protocol:

wrist and MCP held in extension

(IPS can be free)

what is worry of flexor tendon injry?

develop IP flexion contracture

how to prevent IP flex contracture in flexor tendon impairment?

block MCP in flexion actively extend IP

what is done if patient is not able to reach full active extension in flexor tendon impairment?

IP extend passively MP blocked further into flexion

why does jersey finger need surgery vs mallet finger which can have a splint?

jersey finger: complete rupture of flexor tendon mallet finger: tendon partially torn

How can extensor hood be beneficial in healing?

partial function because it connects to other parts of tendon

maintain alignment of finger

stabilizer of finger

what is tendon repair motion at 1-4 weeks?

passive in direction of repair

active to limits of splint

what exercises may be done in the direction of repair?

place and hold

when is splint usually discharged?

4-6 weeks

At 4-6 weeks, full ROM is easily available what is there more concern for?

tendon rupture

If tendon rupture may be the case, what may be delayed?

resistive exercise

when is AROM and PROM of digits present?

4-6 weeks

when is blocking ROM present?

4-6 weeks

what can be a barrier to ROM?

edema

when is strengthening/resistive exercises usually initiated?

6-8 weeks

what are common complications of extensor tendon repair?

extensor lag adhesions rupture

what are common complications of flexor tendon repair?

PIP flexor contracture adhesions rupture

what locations is most common to have adhesions on? flexor/extensors

flexor

what are treatment of adhesions?

massage resistance exercise ultrasound

when should extensor lag be monitored?

out of splint

what is essential to function of hand?

pivot of MCP joint

flex/ext fibers tight

what is ulnar collateral ligament also called?

skiers thumb

what happenss in collateral ulnar ligament?

over stretch or rupture to UCL tendon un thumb

what is intervention for collateral ulnar ligament?

protective positioning

what zone is mallet finger in?

zone 1 or 2 extensor tendon injury

what happens in mallet finger?

rupture of terminal slip of EDC tendon

-trauma -degenerative changes

what is intervention of mallet finger?

splinted in hyperextension in 6-8 weeks

can splint on mallet finger be taken off at night?

no, will likely move fingers into flexion versus needed extension

what can mallet finger also include impairment in?

bone fragment

what zone of injury is boutonniere deformity in?

zone 3