ch19: wrist and hand

Question 1

carpal bones

Answer 1

Pisiform
Triquetrum
Lunate
Scaphoid
Trapezium
Trapazoid
Capitate
Hhamate

please tell little Suzy tuck to come home

Question 2

types of grips

Answer 2

• power grip (baseball bat)
• precision grip (baseball)
• fencing grip (fencing, thumb same side as finger)

Question 3

Finkelstein test

Answer 3

• fist with thumb inside
• pt ulnar deviates
  +ve= pain over abd pollicis longus and extensor pollicis brevis
  = quervain tenosynovitis,

Question 4

anatomical snuff box

Answer 4

• ext pollicis longus
• ext pollicis brevis
• abd pollicis longus

Question 5

phalens

Answer 5

• reverse prayer position for 1min
  *careful not to shrug sh
  +ve= numbness tingling
  = compression of median nerve/carpal tunnel syndrome

Question 6

wrist flex/median nerve compression

Answer 6

pt forearm resting on table
- in supination and wrsit flexion
- AT applies compression to median nerve where it passes in the carpal tunnel
+ve= recreate symptoms in 30s = median nerve neuropathy

Question 7

pinch grip test

Answer 7

entrapment of the ant interosseous nerve
- pinch tip of index w/ thumb
- normal = tip to tip
+ve = pulp to pulp

Question 8

scaphoid compression

Answer 8

• used to rule in/out scaphoid fx
• holding the thumb, a longitudinal force is applied, compressing the metacarpal bone into the scaphoid
  +ve = pain

Question 9

watson test

Answer 9

scapholunate instability
- forarm slight pronated
- pressure applied to the scaphoid with the yhumb on the volar side.
- opposing hand grasp metacarpals and moves pt wrist from ulnar deviation and slight extension to radial deviation and slight extension
+ve = clunk and pain

Question 10

gamekeepers thumb

Answer 10

• ulnar collateral lig sprain of the first MC jnt

Question 11

triangular fibrocartilage complex tear
structures

Answer 11

TFCC
5 structures?
1- articular disk, (elongated triangular structure is resting btw the ulnar/radius and lunate and triquetrym
2- deep and superficial layers of the subcruentum lig
3- two disk-carpal lig

Question 12

jersey finger

Answer 12

force extension of finger
- rupture of flexor digitorum profundis tendon from attachment on the distal phalanx
- ring finger more common: assumes posisiotn of slight extension relative to the other fingers

• fingers presents in full extension while other have slight flex (10deg)

Question 13

mallet finger

Answer 13

baseball finger
- objects hit distal finger while ext m is taught
- forceful flexion (catching a ball)
- avulsion of the lateral bands of the extensor
- finger presents stuck in dip felxion

Question 14

boutonniere deformity

Answer 14

• blunt trauma to the dorsal aspect of the PIP
• or, rapid, forceful flexion of ht ejnt vs resistance
• central slip of extensor tendon wrips at middle phalanx
• deformity can dev over 2-3 wks
• hyperextension at MP jnt and fledion at PIP, hyper ext at DIP

Question 15

pseudo-boutonnière deformity

Answer 15

injury to volar plate that lead to flexor deformity of the PIP jnt that ressembles boutonniere deformity
- but: central slip of the extensor tendon is not involved

Question 16

trigger finger

Answer 16

snapping flexor tendons
- peopoe w/ multiple serve trauma to palmar aspect of the hand or indv who perform repeated mvt and clenching of the fingers
- most common in middle or ring finger
- thickenening of tendon sheat
- finger becomes locked in flexion

Question 17

de Quervain tenosynovitis

Answer 17

• friction among the tendons, stenosing sheath and bony process
  pain reproduced:
• abd the thumb vs resistance
• finklestein

Question 18

intersection syndrome

Answer 18

tendinitis or friction tendinitis in the 1st and second dorsal compartments
- oversuse radial extensors by excessive curling
-s/s
- tenderness on the dorsum of the forearm
- crepitation or squeaking is noted w/ passive or active motion
- swelling along affected tendons

Question 19

dupuytren contracture

Answer 19

dev of nodules in the palmar aponeurosis. limit finger ext and eventually cause flexion deformity
s/s
- fixed flexion deformity
- frequent ring or little finger
- finger cannot be extended

Question 20

Ganglion cyst

Answer 20

• benign tumor masses typically on dorsal aspect of the wrist
• associate with tissue sheath degeneration
• freely mobile and palpable
• spontaneous
• surgery the only permanent solution

Question 21

subungal hematomas

Answer 21

• blood forming under fingernail

Question 22

paronychia

Answer 22

• infection along the nail fold
• nail fold become red, swollen and painful
• can produce purulent drainage
• spak in warm water or refer to physician if does not resolve

Question 23

anterior interosseous nerve syndrome
signs
slow and acute

Answer 23

acute = suddenly lose use of flexor pollicis longus and index finger profundus tendons

slow: gradual weakening of these muscles

Question 24

median nerve entrapment

Answer 24

• ant interosseous syndrome
• carpal tunnel

Question 25

ulnar nerve entrapment

Answer 25

- ulnar tunnel syndrome - cyclist palsy - bowlers thumb

Question 26

radial nerve entrapment

Answer 26

- distal post interosseous nerve syndrome - superficial radial nerve entrapment

Question 27

carpal tunnel

Answer 27

s/s - pain at night - releived by shaking hand - NTB - pinch/grip strength limited -

Question 28

ulnar tunnel syndrom

Answer 28

entraped in tunnel of guyon - s/s - motor sensory - NTB; little finger - cant grasp paper btw thumb and index finger - tapping close to the pisiform = tingle in little finger -

Question 29

cyclist palsy

Answer 29

ulnar nerve entrapment - leaning on hand bars for extended period of time - swelling in hypothenar - disapear rapidly after completion of the ride

Question 30

bowlers thumb

Answer 30

- compression of the ulnar digital sensory nerveon the medial aspect of the thumb in the web space while gripping the ball s/s - NTB on medial thumb - swelling or thickening over medial plamar aspect -

Question 31

distal post interosseous nerve syndrome

Answer 31

- compression occurs as it passes dorsally over the distal radius and enters wrist capsule - gymnast at risk bc repetitive forceful wrist ext

Question 32

superficial radial nerve entrapment

Answer 32

- compress as it pierces the deep fascia to became subcutaneous btw the tnedons of the ext carpi rad longus and brachioradialis - worst with repeated pronation and supination - gloves too tight - tight wrist bands s/s - burning pain - sensory changes - night pain over dorsoradial aspect of the wrist, hand, thumb, index finger

Question 33

colles fx

Answer 33

occurs within 1.5 in of the wrist jnt - result in a diner fork deformity - distal segment displaces in a dorsal and radial direction

Question 34

smith fx

Answer 34

reverse colles - distal segment moves palmar

Question 35

Monteggia fx

Answer 35

fx of prox third of the ulna accompanied by a dislocation of the radial head

Question 36

galeazzi fx

Answer 36

distal radioulnar dislocation is secondary to the marked shortening of the radius caused by the severe ulnar displacement and dorsal angulation of the distal radial fragment

Question 37

gymnast wrist

Answer 37

stress fx to distal radial epiphyseal plate - caused by compression - excessive wrist loading -s/s - pain over dorsum of the wrist - inc with max ext - diffuse tenderness

Question 38

kienbock disease

Answer 38

avascular necrosis of the lunate - vascular pathway disrupted - repetitive trauma - unrecognized lunate fx -

Question 39

rolando fx

Answer 39

fx of base of the first metacarpal involving comminuted fx

Question 40

bennet fx

Answer 40

unique fx at the base of the first metacarpal involving a simple intra-articular fx - usually associated with dislocation

Question 41

boxers fx

Answer 41

unique fx involving the neck of the 4th or 5th metacapal