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Medicine II: Orthopedics > Hand & Wrist > Flashcards

Hand & Wrist Flashcards

1
Q

Carpal tunnel syndrome presentation

A

Compression of the median nerve at the wrist. It is the most common peripheral nerve entrapment.

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2
Q

Diagnosing Carpal tunnel syndrome

A

Tinels, Phalens, Reverse Phalens, +/- thenar wasting and electrodiagnositic studies

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3
Q

Tx of Carpal tunnel syndrome

A

Activity modification, splints, NSAIDS, B12, cortisone injections.

Surgical: open vs endoscopic carpal tunnel release (open- cut the extensor retinaculum.

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4
Q

Risk Factors for Carpal Tunnel Syndrom

A

Pregnant, DM, hypothyoid, RA, repetitive use

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5
Q

DeQuervain tendonitis

A

Inflammation of the 1st dorsal compartment. Abductor Policis Longus and Extensor Policis Brevis.

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6
Q

Cause of DeQuervains tendonitis

A

from repetitive use, insidious onset

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7
Q

Presentation of DeQuervains tendonitis

A

Pain with thumb extension, abduction or flexion, thumb with ulnar deviation.

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8
Q

Diagnosis of DeQuervains tendonitis

A

Redness, swelling, crepitus, RSN injections

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9
Q

Tx of DeQuervains tendonitis

A

Non-surgical: Ice, thumb sicca splint, rest, injection

Surgical: surgical release of 1st dorsal compartment

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10
Q

Finkelstein test

A

Fist and go down

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11
Q

Trigger finger presentation

A

irritated tendon- swelling, can form nodule causing finger to catch or lock in flexion or extension.

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12
Q

Cause of Trigger Finger

A

Excessive Use

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13
Q

Tx of Trigger finger

A

Non-surgical: Resting, splinting, NSAIDS, injections;

Surgical: Release of Pulley (A1 pulley most common site)

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14
Q

Ganglion cyst presentation

A

Most common soft tissue tumors of the hand (benign). Cysts are filled with mucin.

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15
Q

Cause of ganglion cysts

A

obscure

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16
Q

Tx of Ganglion cyst

A

Reassurance, Aspiration (high recurrence, not recommended for volvar), surgical excision

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17
Q

Locations of Ganglion Cysts

A

Dorsal (most common)- from SLJ, volvar, radial, retinacular (flexor tendon), mucous cysts (DIPJ)

Occult Ganglion- not visible- SLJ, usually more symptomatic.

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18
Q

Gamekeeper’s thumb labs/tests

A

Get an X-ray, may see Steners Lesion.

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19
Q

Infectious flexor tenosynovitis presentation

A

Infection of flexor tendon sheath usually from a puncture. Usually caused by S. aureus.

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20
Q

Infectious flexor tenosynovitis labs/tests

A

Kanavel Signs

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21
Q

Tx of Infectious flexor tenosynovitis

A

Requires I&D

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22
Q

Kanavel signs

A

4 signs of flexor tenosynovitis:

  1. tenderness along the whole tendon sheath (late sign).
  2. finger held in flexion.
  3. fusiform swelling (sausage digit).
  4. pain with passive extension (earliest finding).
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23
Q

Smith Fractures

A

Fracture of the distal radius from a PALMAR flexion injury. (Inward).

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24
Q

Colles Fracture

A

Fracture of the distal radius with DORSAL displacement from a FOOSH.

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25
Q

Boxers Fracture

A

Fracture of the 5th MC neck as a result of axial load, usually from punching wall, head or mouth. Check for lacerations/cuts on hand for a foreign object (may require removal and I&D)

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26
Q

Risk factors for osteomyelitis

A

Infection of bone by bacteria or fungus, resulting in bony changes and destruction. Develops by spread of infection from contiguous structures or hematogenous spread.

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27
Q

Etiologies for osteomyelitis

A

Most common cause is S. Aureus

28
Q

Clinical presentation of osteomyelitis

A

Pain at site, warmth, swelling, erythema

29
Q

Appropriate diagnostic studies for osteomyelitis

A

Radiographs early in course are normal, later will show bone demineralization, periosteal elevation, late lytic lesions.

Bone biopsy confirms diagnosis/ S. aureus is most common. Blood cultures can help too. Necessary for abx guidance.

30
Q

Treatment for osteomyelitis

A

Abx

31
Q

Finger Infections:

A

Felon, paranychia, flexor tenosynovitis and herpetic whitlow

32
Q

Paranychia

A

infection of the paronchial fold of the nail. Can be bacterial (Staph, MRSA) or fungal (C. albicans)

33
Q

Cause of Paranychia

A

Bacterial- puncture, nail biting, hang nail, or artificial nails

Fungal- constantly wet hands, dishwashers, bartenders

34
Q

Symptoms of Paranychia

A

Bacterial- pain, tenderness, swelling, abscess (pus), warmth

Fungal- swelling, erythema, deformed nail

35
Q

Treatment of Paranychia

A

Bacterial- Bactrim, clindamycin, Keflex, soaks, I&D

Fungal- keep dry, oral or topical antifungals (-azoles)

36
Q

Dupuyten contracture

A

Disease of palmar fascia due to palmar fibromatosis causing nodule, cords in fingers and can lead to contractures.

37
Q

Risk factors for Dupuyten contracture

A

FHx, M>F, EtOH, Seizure meds, DM, European/Scandinavian, repetitive microtrauma

38
Q

Symptoms of Dupuyten contracture

A

Can’t lay flat on table (table top test), +/- pain

39
Q

Types of Dupuyten contractures

A

Ledderhose- plantar side of foot
Garrods pads- knuckle pads on fingers
Peyronies disease- fibromas of penis can cause curvature

40
Q

Treatment for Dupuyten contracture

A

open excision of ds., needle aponeurotomy, xiaflex injections (collagenase clostridium histolyticum- enzyme that dismantles collagen)

41
Q

Felon

A

infection in the tip of the finger (pulp) can form abscess. It is extremely painful and red

42
Q

Cause of Felon

A

Usually from a finger puncture; S. Aureus

43
Q

Caveat of Felon

A

can spread to bone resulting in osteomyelitis and ito flexor sheath

44
Q

Treatment of Felon

A

I&D

45
Q

Gatekeepers Thumb

A

hyperextension to MPJ with radial deviation, tearing of the UCL with or with out bone fragment.

46
Q

Patient Presentation with Gatekeepers Thumb

A

Pain, swelling, eccyhmosis and weakness with pinch and rotation.

47
Q

Physical Exam and Treatment for Gatekeepers Thumb

A

Stress thumb at MPJ level into medial deviation. If enpoint present, can treat with sicca thumb cast. If no endpoint it present, treat with surgery.

48
Q

Steners Lesion

A

If bone involved, may see it on X-ray. Bone/tendon is displaced from phalynx. End of UCL is flipped over the adductor aponeurosis and cannot reattach with out surgery.

49
Q

Special Tests for Gatekeepers Thumb

A

Stress test for UCL of the thumb

50
Q

Patient Presentation with a Boxers Fracture

A

Pain, swelling and tender to palpation

51
Q

Treatment for a Boxers Fracture

A

Short arm ulnar gutter cast in most cases. If flexes >40 degrees consider reduction. Usually results in loss of normal cascade of MC with fist, not a functional problem.

52
Q

Treatment of a Collies Fracture

A

Non-displaced: sugartong splint/cast (X-ray weekly for 3 wks to make sure it does not displace);
Displaced- ORIF.

53
Q

ORIF

A

Open Reduction Internal Fixation

54
Q

Treatment of a Smiths Fracture

A

Non-displaced: sugartong splint/cast (X-ray weekly for 3 wks to make sure it does not displace);
Displaced- ORIF.

55
Q

Animal Bites with the highest risk of infection:

A

The most common animal bite’s occur from dogs and cats, the risk of infection is much higher from a cat bite compared w/ a dog bite.

56
Q

Causative organisms for Rabies in Animal Bites:

A

The most common causative organism for infection is Pasteurella multocida (gram negative rod), esp in cat bites. Staph aureus, alpha-hemolytic streptococci, Bacteroides and Fusobacterium can occur from dog bites.

57
Q

Human Bites vs Animal Bites

A

Human bite wounds contain greater concentrations of bacteria compared to animal bites.

58
Q

Causative organisms for infection in Human Bites

A

S. aureus and alpha-hemolytic streptococci are MC causative organisms but Eikenella corrodens is also a/w human bite wounds.

59
Q

Rabies Prophylaxis

A

Wound cleansing markedly reduces the likelihood of rabies. You should receive a tetanus shot if you have not been immunized in ten years. Should also get a rabies shot!

60
Q

Mechanism of Injury for a Scaphoid Fracture

A

FOOSH, minimal swelling most feel it is sprained leading to a delay in diagnosis

61
Q

Symptoms of a Scaphoid Fracture

A

Tender to palpation in snuff box.

62
Q

Treatment of a Scaphoid Fracture

A

Must treat as if a fracture even with negative findings due to possible decreased blodd supply leading to avascular necrosis. If non-displaced can treat in a thumb spica (6-12 weeks).

For more proximal fracture of displaced- ORIF

63
Q

Imaging for a Scaphoid Fracture

A

X- ray in 1st 3 weeks can be negative. May get CT to confirm Diagnosis.

64
Q

Tendon Function

A

Full ROM of each tendon against resistance and compare with other side. Pain along course of tendon during resistance testing suggests a partial laceration even if strength appears adequate.

Flexor digitorum profundus: flexing DIP agaisnt resistance while MCP and PIP are held in extension

Flexor digitorum superficialis: flexing PIP joint against resistance while other fingers held in extension

65
Q

Testing Median Nerve

A

Actively flex distal phalanx of thumb against resistance
* Opposition by touching tip of thumb to tip of little finger, oppose resistance

Thumb abduction by placing hand palm up and raising thumb to perpendicular while palpating belly of abductor pollicis muscle to ensure it is contrasting

66
Q

Testing Radial Nerve

A

Extend fingers and wrist, With thumb in hitchhiking position, test resistance to further extension

67
Q

Testing Ulnar Nerve

A

Actively spread fingers apart against resistance and then push them together against resistence.

Hypothenar muscles: extend fingers and move little finger away from others

Thumb adduction: thumb tightly against side of index finger, put paper b/t thumb and index finger and pull away

Medicine II: Orthopedics (9 decks)

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