Exam 1 Review Flashcards by Nina Olvera

A patient comes in complaining they have fallen on an outstretched hand; you see their hand and notice it looks like a “silver fork deformity”; based on this information, what do you think this patient has? How would you treat this patient?

Colles Fx

2. Reduce it then 6 weeks cast: First a LAC then a SAC

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What is the hook of hamate the point of attachment for? And why is this important?

Point of attachment for the hypothenar muscles
when fractured through the base, these muscles alternately stress the fx in different directions, pre-disposing to non-union

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What is the most common way to get a wrist fx?

FOOSH
Fall 
On 
Outstretched 
Hand

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What is a Colles Fx?

When a piece of the distal radius breaks off and goes dorsally

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A 64 year old Grandma Moses presents with pain in her anatomical snuffbox and a swollen wrist. She states she fell on her outstreched hand. Based on this info, what does she have? Where would you suspect this fx to be specifically?

Scaphoid Fx involving the waist (adult)

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Han Solo is a professional baseball player. He recently tripped and fell while holding a baseball in his hand. He is complaining of pain with flexion of his little finger. Based on this, what do you Solo has?

A hook of Hamate fx

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A child comes in with wrist swelling, and pain in their anatomical snuffbox. She fell on her outstretched hand. Based on this, what do you think this child has?

Scaphoid Fx involving the distal pole (child)

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Where does the blood supply to the scaphoid come from?
A. Proximal pole
B. Waist
C. Distal pole

C. Distal Pole

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What is a secondary role of the hook of hamate?

as a trochlea for the flexor tendons of the small finger

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What is mallet finger (simple definition)?

A terminal extensor avulsion

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What does a chronic mallet finger lead to?

Swan neck deformity

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Surface irregularities or chronic inflammation can result in what?

Flexor tendon rupture
Ulnar neuritis
Ulnar artery occlusion in Guyon’s canal

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What is another nickname for mallet finger?

baseball finger

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What is Jersey finger?

terminal flexor avulsion

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What is the standard treatment for a hook of hamate fx?

excision of the hook fragment and smoothing the base to prevent future tendon chafing

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What is Mallet finger? And how will the patient present?

It is a rupture of the intrinsic (EDC) on the dorsum of the base of the distal phalanx.
The patient will be unable to extend their DIP

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Describe some features or characteristics of a metacarpal fx.

Transverse and short oblique fx

Usually stable after closed reduction

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How long do you keep a Mallet finger in a splint?

8 weeks!!!!!! (Made a big deal about this in class!)

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What is the max solar angulation that a Boxer Fx can accept?

40 degrees

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What is a Boxers Fx?

injury to the 5th metacarpal

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What is a “seymour fx”?

a crush injury of the DISTAL phalanx where the nail bed gets smushed down by a crushing object–may develop a hematoma under the nail bed (beware: may present like mallet finger)

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If a patient has a subungual hematoma, should you put them on antibiotics?

Yuuuuuppp!!

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How would someone get a Boxers fx? (What is the mechanism?)

Impaction force exerted through the distal end of the metacarpal in closed fist position
-Fx occurs at the neck of the 5th metacarpal

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Brittany Llama-face has just suffered a crush injury to their distal phalax and developed a sublingual hematoma. She is wondering if her nail is going to come back normal or all fugly. What should you tell her?

Wait 6 months: if it comes back ok–than the nail will be ok.

If it comes back fugly or not at all, then she is out of luck! Fugly nail is there to stay…

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What functional test could you do for someone with a suspected Boxers fx?

percussion

T/F: Middle phalanx fractures take longer to heal because of the cortical bone.

True

What is the difference in treatment for a middle phalanx fx that is oblique and spiral VS. an intraarticular fx?

For an oblique/spiral fx, internal fixation is treatment | For an intraarticular fx, anatomic reduction is treatment

What is a Boutonniere deformity?

a central slip rupture

Fill in the blank in reference to Boutonnieres deformity: PIP: ? (flexed or extended) DIP: ?

PIP: Flexed DIP: Extended

What is the result of a volar plate rupture at the PIP and is often accompanied by triangular ligament rupture?

Swan Neck deformity

During a Swan neck deformity, what is causing the hyperextension at the PIP joint?

The lateral bands drift dorsally and exacerbate the hyperextension at the PIP joint

What central slip tendon is disrupted in Boutonnieres deformity?

Exten. Dig. Comm tendon

Your friend who is a geologist has no idea what a Dupuytren's contracture is, but she has one! How would you explain to her what this is?

- -It is a disorder of the skin and underlying tissue on the PALM of the hand. - -Thick, scarring tissue forms under the skin of the palm and may extend into the fingers, pulling them towards the palm and restricting motion. - -Usually occurs in mid-life and is idiopathic; although it tends to run in families

What muscle and nerve are being tested with Froment's test?

ADDuctor pollicis longus and the ulnar nerve

What are some complications to a trigger finger surgery?

1. infection 2. scar 3. stiffness 4. nerve damage

When is surgery considered in a Duputren's contracture? What type of incision is used? And what other method of treatment besides surgery is approved for this contracture?

- -When the contracture is 30 degrees at the MCP and 10 degrees at the PIP joint - -a Z incision is used - -collagenage is approved

What is the most common cause of trigger finger?

tenosynovitis

After trigger finger surgery, when can daily activities be resumed?

1 week

What is a felon?

pus in the pulp of the finger

What is a common way someone can get septic flexor tenosynovitis?

Cat bites

After trigger finger surgery, when can athletic activities be resumed?

3-4 weeks

Regina walks in with the pulp of his finger swollen. You begin to drain it but it is clear--what do you suspect this is?

Herpetic Witlow

What are the two ways to treat a trigger finger?

1. Injection of steroid AROUND the tendon | 2. Surgery (only done if the injection does not work)

How would you distinguish between a Herpetic Witlow and a felon?

Herpetic Witlow: clear fluid in the pulp of the finger | Felon: PUS in the pulp of the finger

T/F: Trigger finger can occur in any finger.

True

What is going on with a patient who has septic tenosynovitis?

- fusiform swelling of the digit - the hand or the digit is held in a semi-rigid position - any movement of the finger is painful - tenderness tends to be the greatest over the proximal portion of the tendon sheath*

What is another name for Froment's sign?

Key pinch test

What causes trigger finger?

trigger finger is caused by a thickening on the tendon catching as it runs in and out of the sheath

What test is the "OK" sign testing for?

Median nerve

Which finger joint dislocation is most common?

PIP is most common

How do you treat a finger joint dislocation?

Reduce after x-ray | splint then buddy tape

What test is the opposite of the "OK" sign?

Froment's sign; testing for Ulnar nerve

What mechanism is behind most finger joint dislocations?

hyperextension stress

How do DIP dislocations typically occur?

often by open injury

Where do the MCP dislocations usually occur?

The index or small finger

T/F: the PIP dorsal dislocations are RARE and involve the volar plate.

FALSE: dorsal dislocations are COMMON and usually involve the volar plate

Which PIP dislocations are RARE?

Volar and rotary; Rotary is the rarest!

Which finger dislocation usually needs an open reduction? and why?

MCP dislocation | Often irreducible closed secondary to interposed volar plate

Which finger dislocation is often open injury and easy to reduce and often stable post reduction?

DIP dislocation

If a patient has dislocated finger, what determines their stability?

stability is dependent on collateral ligament injury

If a patient was experiencing Ulnar nerve compression, how would they present?

pain and paraesthesia of the ulnar 1.5 fingers

What is the cubital tunnel?

The cubital tunnel is a space of the dorsal medial elbow which allows passage of the ulnar nerve around the elbow. --It is bordered medially by the medial epicondyle of the humerus, laterally by the olecranon process of the ulna

What causes Radial Tunnel Syndrome?

It is caused by increased pressure on the radial nerve as it travels from the upper arm (the brachial plexus) to the hand and wrist

What do "jamming" dislocations cause?

Swan Neck deformity

T/F: MCP joint dislocations are usually irreducible.

True

If there is a fracture of the base of the first metacarpal--what is this caused and how does this usually happen?

1. Bennet's Fx | 2. Caused by a punch or falling on an ABducted thumb

What is the treatment for a Bennet's fx?

immobilization and rehab

What causes a scathe-lunate dissociation?

Tear of the scapho-lunate ligament that causes rotary subluxation

An archaic carpenter who only uses an old fashioned hammer and nail presents with pain in his wrist. Based on this info, what does this dude have?

Intersection syndrome

What is a rupture of the central slip with a subluxed lateral band (in the hand(?

Boutonnieres deformity

Tony the Tiger got his finger caught in his jersey; to top everything off, he also hit that same finger on the tip--what would be a common injury with these events?

Mallet finger/Baseball finger

Biceps rupture occurs secondary to what?

biceps tendonitis

T/F: Biceps ruptures usually heal on their own

True

Central stenosis of the spinal canal

neurogenic claudication

How do you diagnose neurogenic claudication?

MRI/CT

What is the treatment for neurogenic claudication?

1. Rest 2. Exersize 3. NSAIDS 4. lumbar epidural

In a nutshell, what is frozen shoulder?

significant ROM decrease in the glenohumoral joint

What are some common causes of frozen shoulder?

1. Rotator cuff tendonitis 2. Acute subacromial bursitis o Fractures of humeral head and neck o Paralytic stroke

What disorder may accompany frozen shoulder?

reflex sympathetic dysrophe

T/F: Pain in the thoracic spine is ok.

F: Any pain in the thoracic spine is BAD; refer to specialist.

Regina Llama-Face presents with thoracic back pain with circumferential radiating pain to their thorax. She states it gets worse when she coughs or sneezes. Based on this info, what do you think she has?

HNP

What test do you NOT perform with patients suffering from cervical myelopathy?

Spurlings maneuver

What is DISH?

diffuse idiopathic skeletal hyperosteosis: a rheumatic disease characterized by a significant association with metabolic alterations with as an impaired lipid profile.

What clinical signs do you see in DISH?

a hardening of tendons and ligaments that commonly affects the spine

What is cheiroarthropathy?

Diabetic hand syndrome: a disorder in which the skin on the hands becomes waxy and thickened; eventually finger movement is limited

Which type of Diabetics have a higher chance of getting osteoporosis?

Type I diabetics

Which type of Diabetics have a higher chance of getting osteoarthritis?

Type II diabetics (likely due to obesity)

T or F: People who have had diabetes for a long time have a higher chance of getting Dupuytren contracture.

True

Exam 1 Review Flashcards

(88 cards)