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OCS > Elbow, Wrist, and Hand > Flashcards

Elbow, Wrist, and Hand Flashcards

(56 cards)

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1
Q

What is a Bennett’s fracture?

A

Fracture of the BASE of the first metacarpal

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2
Q

What is a boxer’s fracture?

A

Fracture of the 5th metacarpal

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3
Q

What to do when unsure if a child has a scaphoid fracture. Why?

A

Immobilize the hand and get a work-up to prove it is not a fracture prior to having them return to normal function.
Higher risk of avascular necrosis in young people/children

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4
Q

CPR for scaphoid fractures (4)

A
  1. Male
  2. Sport activity related
  3. Anatomic snuff box pain on ulnar deviation w/in 72 hours of injury
  4. Scaphoid tubercle tenderness at 2 weeks
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5
Q

Cluster of tests for scaphoid fractures (3)

Sensitivity/specificity if all three are present

A
  1. Snuff box tenderness
  2. Scaphoid tubercle tenderness
  3. Longitudinal compression
    100% Sn and 74% Sp
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6
Q

Dinner fork deformity seen in what fracture(s)?

A

Smith’s and Colles’ fractures

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7
Q

Difference between Colles’ fracture and Smith’s fracture

A

Smith’s: distal radius angles towards volar side

Colles’: angles to dorsal side

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8
Q

Colles’ fractures common in what demographic with what MOI?

A

Very common in elderly following a fall.

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9
Q

What is a nightstick fracture?

A

fracture of midportion of ulna

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10
Q

What is a Monteggia fracture?

A

fracture of the proximal ulnar with dislocation of the RADIAL HEAD from the wrist

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11
Q

What is a Galeazzi fracture?

A

fracture of the distal radius with dislocation of the ULNAR HEAD from the wrist

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12
Q

Most common elbow fracture? MOI?

A

Radial head fracture.

FOOSH - close packed position with longitudinal compression

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13
Q

Mnemonic for elbow ossification sequence in children/adolescents

A 
CRITOE 
Capitulum (6 months - 2 years)
Radius (3 years)
Internal (medial) Epicondyle (5 years)
Trochlea (7-10 years)
Olecranon (6-12 years) 
External (lateral) Epicondyle (10-14 years)
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14
Q

Pt unable to extend elbow after injury. Course of action?

A

Referral for radiographs (50% chance of fracture)

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15
Q

Scapholunate dissociation key clinical findings (2)

A
  1. Positive Watson’s shift test

2. Tenderness to palpation (localized under ECRL)

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16
Q

Sign of scapholunate dissociation on imaging?

A

Notable gap between scaphoid and lunate

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17
Q

What is the TFCC?

A

Triangular Fibrocartilage Complex

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18
Q

MOI for TFCC tear? (2 separate common ways)

A
  1. FOOSH with pronated, hyperextended wrist

2. Distraction injury that pulls ulnar side of wrist

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19
Q

TFCC vascularity

A

Periphery vascular, inner portion avascular (similar to meniscus of the knee)

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20
Q

Endoneurium

A

encompasses the axon or nerve fiber; blood-nerve barrier

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21
Q

Perineurium

A

surrounds each fascicle; bidirectional diffusion barrier controlling flow of substances

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22
Q

Epineurium

A

outermost CT of the nerve; highly vascular and provides no diffusion barrier fxn

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23
Q

Sunderland grade

Study These Flashcards
A

5 level grade of nerve damage

24
Q

Recovery prognosis for damage to the epineurium; Sunderland grade

Study These Flashcards
A

No recovery possible (grade 5)

25
Sunderland Grade 1 injury; what tissue? recovery prognosis?
Myelin | Full recovery
26
Causes of mononeuropathy(ies)
Traumatic Non-Traumatic Peripheral n. entrapment syndromes Peripheral n. lesion
27
Causes of polyneuropathy
``` Metabolic Nutritional Hereditary Immunologically mediated Infectious dz Neoplastic ```
28
Mononeuropathy deficits
1. Motor - weakness; dependent on motor units involved | 2. Sensory - nerve field distal to injury site
29
Polyneuropathy deficits
1. Bilateral and fairly symmetric 2. Affects large fibers distally first 3. Sensory loss before motor loss
30
Clinical features in peripheral nerve injuries
1. Tremors 2. Tendon hyporeflexia 3. Autonomic dysfunction
31
Difference between skier's and gamekeeper's thumb? What structures?
``` Same thing (synonymous) Structures: ulnar collateral ligaments along the MCP joint. ```
32
CPR for Cervical Myelopathy (5)
1. Gait deviation 2. Positive Hoffmann's sign 3. Positive Babinski 4. Positive reverse/inverted supinator sign 5. >45 y/o
33
Meds assoc. with CTS
Metformin Thyroxine Insulin Suphonylureas
34
Proximal ow carpal with a tendon insertion
Pisiform (flexor carpi ulnaris)(near hook of the hamate)
35
resting pressure in carpal tunnel
2-10 mmHg
36
How to test normal light touch sensation when suspecting CTS. What gauges?
Semmes-Weinstein monofilament testing | 2.83-3.22 for normal light touch (level A research)
37
CPR for CTS
Shaking hands Wrist-ration index greater than .67 Boston Carpal Tunnel Questionnaire Symptom Severity scale (CTQ-SSS) >1.9 (0-13 scale) Reduced median sensory field of digit 1 >45 y/o **>3 of these = acceptable diagnostic accuracy
38
Special tests and diagrams for CTS dx
Phalen's Tinel Carpal compression test Katz hand diagram
39
Research level strength on use of neurodynamic tests for CTS dx
Level D (conflicting) evidence
40
Self-report questionnaires for CTS when CTS dx is confirmed
Boston Carpal Tunnel Questionnaire FS (CTQ-FS) | DASH
41
True or False: Clinicians should use lateral pinch strength as an outcome measure for surgically or nonsurgical managed CTS
False - level A (strong) evidence indicates lateral pinch strength should not be used as an outcome measure
42
True or False: Clinicians should not use grip strength as a short-term measure (<3 months) change in individuals following CTR surgery
True - level B (moderate) evidence confirms this
43
True or False: Grip strength and 3 point or tip pinch may be used for s/s assessment in pts with CTS to compare to normal values
True - supported by level C (weak) evidence
44
What modalities should not be used to treat CTS per the CPG
Thermal US Low-level laser therapy or other types of nonlaser light therapy Iontophoresis
45
True or False: Magnets are recommended for CTS management
False - Per level B (moderate) evidence, magnets should not be used nor recommended for CTS management
46
True or False: clinicians' should not recommend use of neutral-positioned wrist orthosis at night for short-term symptom relief
False - per level B (moderate) evidence, neutral-positioned night splints should be recommended for those pts who wish to avoid surgical interventions
47
True or False: CTS risks increase with higher BMI
True - per level I research from a 7 year long study, having a BMI >30 kg/m2 doubled the risk of CTS development
48
Effects of psychological demand on CTS development per Level I research
High job strain (low decision latitude) and high psychological demand increased likely of CTS compared to those with low demand and high control at work
49
Strongest intrinsic factors for CTS development
Female gender Increasing age BMI Lesser extent: OA, DM, cardio dz, prev. MSK issues, hypothyroidism, FMH of CTS, and others
50
AROM range: forearm supination and pronation
80-90 deg each
51
AROM range: wrist flexion and extension
flexion: 90 extension: 70
52
AROM range: wrist RD and UD
RD: 15-20 UD: 20-30
53
AROM range: PIP flexion and extension
flexion: 100-110 extension: 0
54
AROM range: DIP flexion
flexion: 70-80
55
AROM range: thumb MCP joint flexion and extension
flexion: 50-55 extension: 0
56
AROM range: IP joint flexion and extension
flexion: 80-85 extension: 0

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