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Musculoskeletal > Elbow, Hand and Wrist I-IV > Flashcards

Elbow, Hand and Wrist I-IV Flashcards

(49 cards)

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1
Q

Proximal Carpal Row

A

Scaphoid, lunate, triquetrum, pisiform

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2
Q

Distal Carpal Row

A

Trapezium, trapezoid, capitate, hamate

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3
Q

Carpal Motion in Flexion

A

Scaphoid flexes further, rest of proximal row remains straight

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4
Q

Radial Deviation

A

Scaphoid moves more vertically on lateral x-ray (flexes out more)
Pulls lunate with causing flexion also
Proximal row flexes

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5
Q

Ulnar Deviation

A

scaphoid has less than 45 degree angulation
pulls lunate into extension
Trequitrum drops under hamate (extends)
Entire proximal row extends

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6
Q

DISI

A

Disruption of sorsal portion of the scapho-lunate interosseous ligament and radioschophocapitiate ligament
Pathologic gapping between scaphoid and lunate
Lunate twisted dorsally
Test integrity placing thumb over scaphoid tubercle and index finger on dorsum of hand
Scaphoid will move vertically and be felt by index finger

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7
Q

VISI

A

disruption of dorsal portion of the luno-triquetral interosseous ligament
longitudinal metacarpal arch, pull of interosseous, tendon insertions proximally

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8
Q

Phalanges

A

Pull of lumbrical and interosseous muscles provide a deforming force on fractures of the proximal phalanx

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9
Q

Thumb Metacarpal

A

Carpal fracture due to tendons

Avulsion caused by APL

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10
Q

Extrinsics

A

MP joint extension

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11
Q

Intrinsics

A

Flex MP joints

Extend IP joints

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12
Q

Swan Neck Deformity

A

PIP joint hyperextension
DIP joint flexion
Dorsal subluxation of lateral bands

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13
Q

Rheumatoid Arthritis

A

PIP synovitis with dorsal displacement of lateral bands

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14
Q

Mallet Injury

A

Proximal retraction of lateral bands due to loss of distal anchor (terminal tendon)
Extensory band shifts proximally (increasing resting tone of extensors) and over time wears out restraining the ligaments
Causing swan neck to develop, ligaments can wear out restraining ligaments, swan neck develops

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15
Q

Bouonierre Deformity

A

PIP flexion
DIP Hyperextension
Injury to central slip with volar subluxation of lateral bands
Tender to palpation over the middle phalanx-presume boutinierre splint in extension
With rhematoid arthritis PIP joint synovitis with central slip rupture or volar subluxation

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16
Q

Boutonierre Trauma

A

Axial load injury

Triangular ligament tear or central slip extensor tear

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17
Q

Cubital Tunnel Syndrome

A

Tinels sign, elbow hyperflexion test (hyperflex elbow 1 minute, look for tingling, 1st dorsal interosseous and FCU weakness when severe
Nerve conduction velocity NCV and EMG usually negative except when advanced stage

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18
Q

Capal Tunnel Syndrome

A

Thumb/middle finger paresthesias
Symptoms worse at night
Drop things/hand clumsiness
Paresthesias while driving

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19
Q

Carpal Tunnel Exam

A 
Tinels
Pgalens
Carpal tunnel compression test
APB strength
NCV/EMG usually positive
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20
Q

Carpal Tunnel Etiology

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A 
Metabolic diabetes
Hypothyroidism
Pregnancy
Idiopathic/multifactorial
Occupational
Flexor tenosynovitis
21
Q

Carpal Tunnel Findings

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A

Weakness of abductor pollicis brevis

22
Q

Carpal Tunnel Treatment

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A 
Cock up splint
Activity modification/ergonomics
NSAID
Injection
Surgical release of TCL
23
Q

Flexor Tenosynovitis

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A

Highly repetivie finger motions
Prolonged gripping
Thyroid disorders
Diabetes

24
Q

Trigger Fingers

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A

Flexor tendon swells and is too big to get under pulley band
Flexor pulley system
Tucking fingers in tight when flexing
Patient unable to extend affected finger

25
Trigger Finger History
Diabetes, hyper extension strain, contusion, overuse of digit
26
Treatment
NSAID, injection, release of A-1 pulley
27
De Quervain's Disease
1st dorsal compartment DC1 tenosynovitis/impingement | Caused by trauma, overuse, retinacular ganglion cystm radial styloid spur
28
De Quervain's Pt. History
``` 2 hands lifting with forearms in neutral rotation New mother Trauma to radia lwrist Ulnar deviation strain Tingling/burning dorsal thumb and index ```
29
De Quervain's Disease PE
Finkelstein's maneuver Pain with resisted APL, EPB Palpatory tenderness over DC1
30
De Quervain's Treatment
Long opponenes (forearm based thumb spica) splint NSAD Injection Release of DC
31
Thumb CMC Joint Pathology
Pain at base of thumb and thenar palm Worse with pinching Synovitis, laxity of anterior oblique ligament, women >>men, degenerative disease
32
Thumb CMC Joint Pathology History
Pain with pinching/holding | Manipulates small parts all day
33
Thumb CMC Clinical Findings
``` Palpatory joint tenderness Grind test Distraction-torque test Laxity of CMC joint Radiographs (static stress more common in nondominant hand) ```
34
Thumb CMC treatment
``` Modify activity Short opponens splin NSAD Injection Surgery (reconstruct ligament, excise trapezium) ```
35
Tests for Radial, MEdian and Ulnar Nerves
1. Make OK sign (median nerve) | 2. Cross fingers (radial (extends fingers), ulnar (cross them))
36
Dupuytren's Disease
Overuse of wrist and hand muscles Progressive fibro-proliferative disease leads to characteristic cord and nodule formation in palm and fingers Collagen deposition thickens the cords which contracts the tissue tightly, pulling fingers into flexion
37
Ulnar Claw Hand
Clawing of ulnar digits (4-5) Ulnar nerve impingement in cubital tunnel Pt. presents with clawing (hyperextension of MP joints 4/5, flexing of IP joints)
38
Ulnar Claw Treatment
``` Modify activity Avoid elbow flexion beyond 30 degrees Night splint NSAID Surgery ```
39
Mallet Finger
Finger droops at the tip due to injury to terminal extensor mechanism
40
Mallet Finger History
Inability to extend DIP joint, sports related injury, minor trauma
41
Mallet Finger PE
Tenderness at site of injury Passive extension intact Hyperextension may present in PIP joint (compensatory swan neck deformity)
42
Mallet Finger treatment
Splint DIP in slight hyperextension Only DIP joint, leave PIP free Surgery
43
Origin of wrist extensors
From lateral epicondyle of humerus and all innervated by radial nerve
44
Long finger flexors origin
medial epicondyle and innervated by median and ulnar nerves
45
Intrinsic ligaments
Connect bone-bone
46
Extrinsic ligaments
Thickening in capsules of wrist
47
Hook of hamate
Found 1 cm distal and 1 cm radial from the pisiform | Should feel like a pea if you roll finger over that area
48
Interosseous muscles
Primary flexors of MP joint
49
Lumbricals
Help take tension off flexor tendons | Easier to extend the fingers

Musculoskeletal (7 decks)

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