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MSK > Wrist/Hand Common Presentations > Flashcards

Wrist/Hand Common Presentations Flashcards

1
Q

Distal radius fractures:

  1. Colles
  2. Smith
  3. Barton
  4. Buckle
A
  1. Colles - dorsal displacement (outward)
  2. Smith - forward displacement (inward)
  3. Barton - through radius and articular surface into joint
  4. Buckle - compressive fracture at distal radius
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2
Q

Scaphoid fracture most common in what age groups/sex?

A

15-30 males

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3
Q

Because scaphoid fracture is common at waist, what should we be concerned about?

A

increased concern for decrease vascular supply and proximal necrosis

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4
Q

Common MOI for scaphoid fracture:

A

FOOSH in position of radial deviation

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5
Q

Symptomology of scaphoid fracture:

A
  1. Deep, dull radial wrist pain (anatomical snuff box)

2. Pain with gripping/ squeezing

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6
Q

Physical examination of scaphoid fracture:

A
  1. Tenderness anatomical snuff box/ scaphoid
  2. Local swelling/ bruising
  3. Often not visible on x-rays directly following injury
    - Thumb spica splint x 3 weeks with f/u x-rays if clinical suspicion is high
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7
Q

Common MOI for hook of hamate fracture:

A

FOOSH

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8
Q

Consider indicators of injury to what two structures with hook of hamate fracture:

A
  • Ulnar nerve function

- Ulnar artery injury

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9
Q

Goal with a lunate fracture?

A

Early recognition

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10
Q

Clinical presentation of lunate fracture:

A

MOI - FOOSH

Symptoms - pain with palpation, swelling and tenderness

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11
Q

What is Kienbock’s disease?

A
  • Can be progression of lunate frx
  • Osteonecrosis of the lunate
  • Unknown etiology, common Hx trauma
  • Important for screening
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12
Q

Concern for what with Kienbock’s disease?

A

carpal collapse

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13
Q

Management of Kienbock’s disease:

A
  • Sx

- Conservative: immobilization 6-10 weeks f/b progression of ROM/ resistive exercises

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14
Q

Inflammatory arthropathies of the hand/wrist:

A
  1. RA - smaller nodule formations, ulnar drift
  2. Septic Arthritis
  3. Gouty Arthritis (nodule formations)
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15
Q

What is boutonniere deformity?

A

Flexion of the PIPJ, hyperextension of the DIPJ

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16
Q

MOA for boutonniere deformity?

A
  • A rupture of the central band

- Lateral bands slip to the palmar side of the axis of rotation of the PIPJ

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17
Q

What is Swan Neck (finger) deformity?

A

Hyperextension of the PIPJ and flexion of the DIPJ

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18
Q

MOA for Swan Neck (finger) deformity?

A
  • Disruption of the volar plate at the PIPJ

- Lateral bands bowstring dorsally, increasing the moment arm of the intrinsic and causing PIPJ extension

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19
Q

What is mallet deformity?

A

Flexion of the DIPJ: extensor tendon rupture

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20
Q

Symptomatology of osteoarthropathy of CMC joint:

A
  • Pain at base of thumb
  • Hx of prior trauma
  • crepitus
  • Pain ROM at end-range (multi-directional)
  • Pain with resistance
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21
Q

Incidence of osteoarthropathy of CMC joint:
Age -
Sex -

A

Women > Men

Age > 45 years more commonly

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22
Q

Patient hx of arthropathies:

A
  • Typically insidious

- Periods of exacerbation/ remission (inflammatory arthropathies)

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23
Q

Physical examination of arthropathies:

A
  • Deformities (more common inflammatory arthropathies): Also including nodules
  • Tenderness to palpation of joint line
  • Diminished ROM
  • Painful/ weak resistance testing
  • Painful/ weak grip testing
  • Painful/ hypomobile joint mobility testing
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24
Q

Inflammatory management of RA:

A
  • Consider period of remission vs. exacerbation

- Thermal/ cryotherapy

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25
Q

Exercise management of RA:

A
  • Gripping/ resistive exercises

- ROM exercises

26
Q

Joint protection for RA:

A
  • splinting

- activity modification

27
Q

What is dupuytren contracture?

A
  • Nodule formation palmar/ digital fascia
  • Pitting of skin observed
  • Impairs motion
28
Q

Natural course of dupuytren contracture?

A
  1. “Cord” structures cause contractures and impaired motion of tendons
    - MCP & PIP commonly affected
    - Less commonly affected DIP
  2. Thickening/ shortening of fascia
29
Q

Risk factors for dupuytren contracture?

A
  • Caucasian
  • Increasing age
  • Male gender (7-15x > women)
  • Alcoholism
  • DM
  • Smoking
  • Hand trauma/ Sx
30
Q

Which digit most commonly affected by dupuytren contracture?

A

5th (70%)

31
Q

T/F Dupuytren contracture is commonly bilateral.

A

True

32
Q

MOI of wrist/hands sprains:

A

Force to wrist exceeding normal range

33
Q

Consider fracture of what with wrist/hands sprains?

A

Carpal fracture

34
Q

Symptomology of wrist/hands sprains:

A
  • Local pain that resides & returns
  • Swelling
  • ecchymosis (bruising)
  • tenderness
  • pain with movements that place tensile load (stretch) on sprained structure
35
Q

Gamekeeper’s thumb -

A

Sprain of 1st MCP - ulnar collateral lig sprain

36
Q

MOI of Gamekeeper’s thumb:

A
  • Valgus moment to 1st MCP

- skiing injury

37
Q

Physical examination of Gamekeeper’s thumb:

A

Local tenderness/ swelling

+Ulnar collateral ligament test

38
Q

T/F Healing of TFCC lesion more likely if more superficial.

A

True, better vascular supply

39
Q

Common MOI of TFCC lesion:

A
  • FOOSH

- Repetitive pronation/ supination with loading

40
Q

Physical Examination of TFCC lesion:

A
  • Medial wrist pain (with opening door)
  • Clicking/ popping with wrist motions
  • Tenderness in area of TFCC
  • Swelling with more acute trauma
  • A/PROM painful/ limited ulnar deviation (also supination with ulnar deviation position to start)
  • Pain/ tenderness with mobility testing of radiocarpal joint with ulnar deviation bias
41
Q

What is intercarpal instability?

A
  • Disruption/damage of interosseous &/or mid-carpal ligaments
  • Independent movement of carpals
42
Q

What is dissociative intercarpal instability?

A

Involves carpals of the same row

43
Q

What is Dorsal Intercalated Segment Instability (DISI)?

A
  • Scapholunate dissociation
  • Dorsal tilt of lunate
  • Lunate remains connected to triquetrium, but not scaphoid
  • Lunate no longer follows scaphoid into flexion
44
Q

What is Volar Intercalated Segment Instability (VISI)?

A
  • Lunotriquetrum dissociation
  • Volar tilt of distal lunate
  • Lunate remains connected to scaphoid, but not triquetrium
45
Q

Physical examination of Dorsal Intercalated Segment Instability (DISI):

A
  • FOOSH extension/ ulnar deviation
  • Pain/ weakness with Grasping
  • Tenderness over scaphoid/ lunate
  • Laxity with joint mobility testing
46
Q

T/F Volar Intercalated Segment Instability (VISI) presents very similarly to DISI.

A

True

47
Q

Where does tendinopathy of extensors of wrist and fingers occur?

A
  • Intersection Syndrome (ECRL & ECRB where crossing deep to APL & EPB)
  • Tenderness 6-8 cm proximal to Lister’s tubercle
48
Q

Patient interview of tendinopathies:

A
  • Typically insidious onset

- Microtrauma MOI

49
Q

Physical examination of tendinopathies:

A
  • Tender locally
  • Painful with tensile loading (stretching): P/AROM and resistive testing
  • Possibly palpable thickening of tenosynovium
  • Crepitus with tendon moving through tendon sheath
50
Q

What is trigger finger?

A

Enlargement of tendon/ pulley affecting tendon as it pistons through A1 pulley (nodule gets caught in flexion)

51
Q

Trigger finger typically where in hand?

A

MC head

52
Q

What digit most common for trigger finger?

A

3rd

53
Q

Risk factors for trigger finger?

A
  • DM
  • young children
  • menopausal women
  • RA
54
Q

Physical examination of trigger finger:

A
  • C/o Painful snapping at MCP area during flexion/ extension motions of fingers
  • Limited/ painful finger motion
  • Crepitus with motion (palpable vs. auditory)
55
Q

What is De Quervain’s Tenosynovitis (DQT)?

A
  • Disorder involving the tendons of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons
  • Thickening of soft tissue structures surrounding the involved tendons = impaired tendon gliding
56
Q

T/F No active inflammatory process with De Quervain’s Tenosynovitis (DQT).

A

True

57
Q

Prevalence of DQT:

A

Men: 0.5% - 0.7%
Women: 1.3%- 2.1%

58
Q

Associated patient demographics of De Quervain’s Tenosynovitis (DQT):

A
  • Female Gender
  • Work-related injury (texting, typing, tracker ball mouse)
  • Computer users who use a mouse or trackball
  • Text messaging
  • Repetitive fine-motor task (typing)
59
Q

Physical examination of De Quervain’s Tenosynovitis (DQT):

A
  1. Local Tenderness
  2. Painful ROM that places tensile load (stretch) on APL & EPB (AROM - abduction/extension worse – not so bad PROM)
    • Finkelstein’s Test
  4. Painful resistance testing APL & EPB
60
Q

What is a ganglia?

A
  • Thin-Walled cyst over joint capsule/ tendon sheath
  • Filled with mucoid hyaluronic acid (spontaneous)
  • Possible compression on ulnar/ median nerves
61
Q

Symptoms of ganglia:

A
  • May or may not be painful

- Ache with flexion/ extension of joint

MSK (18 decks)

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