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P- 2 - Ortho 2 > 1 - Hand And Wrist (1) > Flashcards

1 - Hand And Wrist (1) Flashcards

(80 cards)

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1
Q

What is location of insertion for flexor digitorum superficialis?

A

Middle phalanx

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2
Q

What are the muscles in the compartment affected by DeQuervian Tenosynovitis?

A

Abductor Pollicis Longus and Extensor Pollicis Brevis

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3
Q

Name the muscles of the 1st tendon compartment of the wrist:

A

Abductor pollicis longus

Extensor pillicis brevis

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4
Q

Name the muscles of the 2nd tendon compartment of the wrist:

A

Extensor carpi radialis longus and brevis

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5
Q

Name the muscles of the 3rd tendon compartment of the wrist:

A

Extensor pollicis longus

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6
Q

Name the muscles of the fourth tendon compartment of the wrist:

A

Extensor digitorum

Extensor indicis

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7
Q

Name muscles of the fifth tendon compartment of the wrist:

A

Extensor digiti minimi

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8
Q

Name the muscles of the sixth tendon compartment of the wrist:

A

Extensor carpi ulnaris

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9
Q

Which tendon compartments extend the wrist?

A

Two and six

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10
Q

Which tendon compartment extends all four fingers?

A

Four

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11
Q

What are juncturae tendinum?

A

Tendon interconnections

Can complicate locating a specific injury

Kinda like collateral circulation

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12
Q

For the proximal, middle, and distal phalanx, where are the growth plates?

A

On the proximal end

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13
Q

For the metacarpals, which end is the growth plate on?

A

Distal end

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14
Q

Lunate fx’s commonly produce what type of fx?

A

Die punch

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15
Q

Hamate fx’s are commonly associated with which sport?

A

Tennis (FOOSH)

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16
Q

Triquetrum fx’s commonly produce what type of fx?

A

Avulsion

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17
Q

Ganglion cysts commonly emerge as a result of a tear in the:

A

Scapholunate ligament

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18
Q

What is Kienbock disease?

A

Idiopathic necrosis of the lunate

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19
Q

How will Kienbock disease appear on radiograph?

A

Sclerotic lunate (more radiopaque than the other carpals)

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20
Q

What are the three areas that must be palpated as part of a wrist exam for suspected scaphoid fx?

A
  1. Snuffbox with wrist in ulnar deviation
  2. Dorsoradiocarpal joint at scapholunate interval
  3. Scaphoid tubercle
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21
Q

DDx radial-sided wrist pain (list five):

A
  1. Thumb base (carpometacarpal joint 1) OA
  2. Scaphoid fx
  3. de Quervain tenosynovitis
  4. Intersection syndrome
  5. Scapholunate ligament insufficiency
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22
Q

DDx ulnar-sided wrist pain (list six):

A
  1. TFCC injury
  2. DRUJ instability
  3. Ulnar impaction syndrome
  4. Kienbock disease
  5. Ulnar neuropathy at Guyon canal
  6. ECU tendon subluxation
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23
Q

TFCC stands for:

A

Triangular fibrocartilage complex

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24
Q

DRUJ stands for:

A

Distal radioulnar joint

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25
ECU stands for:
Extensor carpi ulnaris
26
What are the components of the TFCC?
1. The articular disc 2. The dorsal and volar radioulnar ligaments 3. The meniscus homologue 4. The extensor carpi ulnaris tendon sheath 5. The ulnocarpal ligaments
27
What tendons border the anatomical snuffbox:
Extensor pollicis brevis Extensor pollicis longus
28
What intersection syndrome?
Pain due to inflammation at the crossing of extensor pollicis longus over extensor carpi radialis longus and brevis Common in weigh lifters, d/t repetitive wrist extension
29
Describe Dupuytren’s Contracture:
Thickened nodule on palmar aponeurosis, proximal to the MCP Grade 1 - nodule Grade 2 - some flexion Grade 3 - full forced flexure
30
Which type of arthritis often presents with ulnar deviation in late-stage dz?
RA
31
Which type of arthritis typically affects the PIPs and DIPs?
OA
32
Thenar atropy is associated with which nerve?
Median
33
Hypothenar atrophy is associated with which nerve?
Ulnar
34
Two point discrimination of __mm is considered normal:
5
35
In a nail injury, damage to the ___ ___ could result in permanent deformity
Germinal matrix
36
What is a transverse physeal injury to the distal phalanx that may displace and require extraction of interposed nail matrix to prevent malunion?
Seymour fracture
37
How are symptomatic subungal hematomas typically treated?
Decompression (punch a small hole in the nail, let the blood drain out) Cautery, 18-gauge, whatever you got
38
If the subungual hematoma is greater than __ %, must remove nail and repair underlying nail matrix lesion:
50
39
When working on the nail, what three things must you consider first:
1. Adequate anesthesia 2. Hemostasis 3. Sterile preparation of the finger
40
What type of sutures are recommended when working in the nailbed?
Absorbable gut suture
41
Wound management post-procedure (nail injuries):
Keep it clean and dry Non-adherent sterile gauze Xeroform dressing Splint finger for protection
42
What’s the MC pathogen in hand infections?
Staphylococcus aureus
43
What is the paronychia?
The soft tissues directly surrounding the fingernail
44
Felon vs herpatic whitlow - how to differentiate?
Small vesicles suggest herpetic whitlow
45
Felons are characterized by:
Severe pain and swelling in the fingerpad The entire pulp is swollen, erythematous, and tender
46
Swelling associated with a felon or paronychia should not extend proximal to the __ __ __:
Distal flexion crease If it does, possibly infection of tendon sheath
47
What surgical procedure is commonly required for a felon?
I and D Either central volar longitudinal or dorsal midaxial
48
After and I and D for felon, do you suture the wound?
NO! Let that sucker drain, that’s why you cut ‘em. Allow the wound to close by secondary intention
49
Untreated felons can lead to:
Osteomyelitis of the distal phalanx
50
Goals of treatment for finger amputations:
Provide a tip with good soft tissue coverage, adequate sensation, and to preserve as much length as is consistent with good function
51
When should replantation be considered?
Thumb: amputated at or proximal to the IP-joint Finger: amputated proximal to the middle of the middle phalanx, or when multiple fingers are amputated
52
How to care for the amputated part?
Wrap in sterile gauze soaked in normal saline Placed in plastic bag Bag goes on ice
53
What important of patient history must be obtained amidst the chaos of an amputation?
Tetanus immunization status
54
Common adverse outcomes of amputations:
``` Painful stump Loss of motion, grip or pinch strength Infection/necrosis Cold sensitivity CRPS ```
55
Flexor digitorum superficialis inserts:
On the middle phalanx
56
Flexor digitorum profundus inserts:
On the distal phalanx
57
What is Jersey Finger? Why is it called that?
Flexor tendon injury or rupture Commonly occurs when a player grabs a jersey during football, rugby, etc
58
The pt cannot flex at the DIP joint - which tendon is ruptured?
Flexor digitorum profundus
59
In an FDP rupture, a radiograph may show:
An avulsed fragment of the distal phalanx
60
Loss of flexion and of grip and pinch strength in the involved and adjacent fingers suggests:
Flexor tendon injury
61
Surgical exploration of flexor tendon injuries should be done how soon after the injury?
As soon as possible, within one week
62
What is a boutonniere deformity?
Extension deformity at the PIP joint and hyperextension deformity at the DIP
63
Boutonniere deformity is caused by a rupture of the:
Central portion of the extensor tendon at its insertion into the middle phalanx
64
In a boutonniere injury, the PIP joint flexes from the unopposed pull of the:
Flexor tendon
65
Tx for boutonniere:
PIP joint splinted in extension for 6 weeks in young people, 3 weeks in older folks DIP is left free
66
Describe de Quervain tenosynovitis
Swelling or stenosis of the sheath that surrounds the Abductor Pollicis Longus (APL) and Extensor Pollicis Brevis (EPB) tendons on the thumb side at the wrist (1st dorsal compartment)
67
De Quervain tenosynovitis is commonly seen in:
The postpartum period (repetitive motion, picking up baby)
68
What is the test used to evaluate for de Quervain tenosynovitis:
Finkelstein (fist the thumb, ulnar deviation, positive pain)
69
Tx for de Quervain tenosynovitis:
2 wks NSAIDS Spica splint If that fails, steroid injection
70
Dupuytren’s disease commonly seen in:
DM Smoking Repetitive trauma (vibration)
71
Which finger is MC to Dupuytren?
4th digit
72
Early stage Dupuytren appearance:
A palmar nodule that may resemble a callus
73
Distal radial fx - articular step-off more than ___mm considered problematic:
2
74
Describe mallet finger:
Caused by rupture or avulsion of the insertion of the extensor tendon at the base of the distal phalanx
75
Name a possible adverse outcome of mallet finger:
Permanent flexion of the DIP joint
76
How long to wear the stack splint for mallet finger?
6 to 8 weeks
77
What is the most useful clinical test to assess carpal tunnel syndrome?
Median nerve compression test
78
What is Phalen Maneuver?
Place the wrists in flexion (pt pushes the dorsal aspects of the hands against each other) x 60 seconds Aching and numbness within the median nerve root distribution is a positive test for carpal tunnel
79
What is Tinel Sign?
Tapping over the median nerve producing tingling, in the digits of the median nerve distribution is positive test for carpal tunnel
80
How do you count cows?
With a cowculator

P- 2 - Ortho 2 (5 decks)

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