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Orthopedics > Forearm > Flashcards

Forearm Flashcards

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1
Q

What type of scaphoid fracture are at risk of malunion/AVN

A

proximal fx

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2
Q

What is a Monteggia fracture?

A

proximal ulna fracture (of anterior angulation) resulting in radial head dislocation (often anterior)

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3
Q

complications of Monteggia fracture

A

radial nerve injury, compartment syndrome

nonunion, decreased ROM, etc

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4
Q

what is Galeazzi fracture?

A

distal 1/3 radial shaft fracture and distal radioulnar joint dislocation

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5
Q

What is the most common distal radius fracture

A

colles fracture

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6
Q

distal radius fracture with dorsal displacement (of distal bone fragment)?

A

colles fracture

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7
Q

distal radius fracture with volar displacement

A

smiths fracture

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8
Q

what part of carpal tunnel may compress on the median nerve

A

transverse carpal ligament

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9
Q

what are the contents of the carpal tunnel?

A

9 tendons - FDS (4), FDP (4), FPL

Median nerve

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10
Q

What is Kienbock’s disease?

A

avascular necrosis of the lunate

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11
Q

What test test for de quervain’s tenosynovitis

A

Finkelstein

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12
Q

pronator teres origin and insertion

A

O: medial epicondyle
I: lateral radius - middle 1/3

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13
Q

pronator teres innervation

A

median nerve

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14
Q

pronator teres action

A

pronate and flex forearm

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15
Q

what nerve is compressed in pronator syndrome

A

median nerve

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16
Q

flexor carpi radialis (FCR) origin and insertion

A

O: medial epicondyle
I: 2nd and 3rd metacarpal

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17
Q

FCR innervation

A

median nerve

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18
Q

FCR action

A

flex wrist

radial deviation

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19
Q

what muscle is the radial artery immediately lateral to?

A

FCR

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20
Q

palmaris longus origin and insertion

A

O: medial epicondyle
I: Flexor retinaculum/palmar aponeurosis

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21
Q

palmaris longus innervation

A

median nerve

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22
Q

palmaris longus action

A

flex wrist

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23
Q

what muscles tendon is commonly used for tendon transfers

A

palmaris longus

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24
Q

FCU origin and insertin

A

O: medial epicondyle and posterior ulna
I: pisiform, hook of hamate, 5th metacarpal

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25
FCU innervation
ulnar nerve
26
FCU action
flex wrist, ulnar deviation
27
what is the most powerful wrist flexor
FCU
28
FCU may compress which nerve?
ulnar
29
FDS origin and insertion
O: 2 heads - humeroulnar and radial heads 1. medial epicondyle and proximal ulna 2. anteroproximal radius I: Middle phalanges of digits (not thumb)
30
FDS innervation
median
31
FDS action
flex PIPJ (and flex digit and wrist)
32
FDP origin and insertion
O: anterior ulna and interosseous membrane I: distal phalanx (IF, +/- MF, RF, SF)
33
FDP innervation
IF, +/- MF -- median nerve/anterior interosseous nerve +/- MF, RF, SF -- ulnar nerve
34
FDP action
flex DIPJ (also flex digit and wrist)
35
what is jersey finger
avulsion of FDP from its distal insertion on the distal phalanx
36
FPL origin and insertion
O: anterior radius and proximal ulna I: distal phalanx of thumb
37
FPL innervation
median n/AIN
38
FPL action
flex thumb
39
what does the AIN innervate
all three deep flexors (along with median nerve)
40
how do you test AIN function?
make okay sign
41
what muscules are most susceptible to Volkmann's contracture
FDP and FPL
42
origin and insertion of pronator quadratus
O: medial distal ulna I: anterior distal radius
43
pronator quadratus innervation
median nerve/AIN
44
pronator quadratus action
pronate forearm
45
primary pronator?
pronator quadratus
46
anconeus origin and insertion
O: posterior lateral epicondyle I: posterior proximal ulna
47
anconeus innervation
radial nerve
48
anconeus action
forearm extension
49
extensor digitorum/extensor digitorum communis origin and insertion
O: later epicondyle I: MCP - sagital band, P2 central slip, P3 terminal slip (digits 2-5)
50
extensor digitorum/extensor digitorum communis innervation
radial/PIN
51
extensor digitorum/extensor digitorum communis action
extend digits
52
boutonniere is caused by tendon avulsion of what muscle and where?
extensor digitorum/extensor digitorum communis at P2
53
mallet finger is caused by tendons avulsion of what muscle and where
extensor digitorum/extensor digitorum communis at P3
54
extensor digiti minimi (EDM) origin and insertion
O: lateral epicondyle I: MCP - sagital band, P2 central slip, P3 terminal slip of digit 5 (small finger)
55
extensor digiti minimi (EDM) innervation
radial/PIN
56
extensor digiti minimi (EDM) action
little finger extension
57
extensor carpi ulnaris origin and insertion
O: lateral epicondyle I: base of 5th MC
58
extensor carpi ulnaris innervation
radial/PIN
59
extensor carpi ulnaris action
hand extension and adduction
60
which muscle can cause painful snapping over the ulna
extensor carpi ulnaris
61
name the superficial extensors
aconeus extensor digitorum communis extensor carpis ulnaris extensor digiti minimi
62
brachioradialis muscle origin and insertion
O: lateral condyle I: lateral distal radius
63
brachioradialis innervation
radial
64
brachioradialis action
flex forearm
65
what muscle is a deforming force in radius fractures
brachioradialis
66
extensor carpi radialis longus action
wrist extension
67
extensor carpi radialis longus origin and insertion
O: lateral condyle I: base of 2nd MC
68
extensor carpi radialis longus innervation
radial nerve
69
extensor carpi radialis brevis origin and insertion
O: lateral epicondyle I: base of 3rd MC
70
extensor carpi radialis brevis innervation
radial nerve/PIN
71
extensor carpi radialis brevis action
wrist extension
72
what muscle tendon degenerates in tennis elbow?
extensor carpi radialis brevis
73
supinator origin and insertion
O: posterior medial ulna I: proximal lateral radius
74
supinator innervation
radial/PIN
75
supinator action
forearm supination
76
abductor pollicis longus origin and insertion
O: posterior radius/ulna I: base of 1st metacarpal
77
abductor pollicis longus innervation
radial/PIN
78
abductor pollicis longus action
abduct and extend thumb (CMCJ)
79
what tendon is affected in de Quervain's disease
abductor pollicis longus
80
extensor pollicis brevis origin and insertion
O: posterior radius I: base of thumb proximal phalanx
81
extensor pollicis brevis innervation
radial/PIN
82
extensor pollicis brevis action
extend thumb (MCPJ)
83
extensor pollicis longus origin and insertion
O: posterior ulna I: base of thumb distal phalanx
84
extensor pollicis longus innervation
radial/PIN
85
extensor pollicis longus action
extend thumb (IPJ)
86
which tendon will turn 45 degrees as Lister's tubercle
extensor pollicis longus
87
what muscles comprise superficial extensors
anconeus extensor carpi ulnaris extensor digiti minimi extensor digitorum communis
88
extensor indices proprius origin and insertion
O: posterior ulna I: MCP - sagital band, P2 - central slip, P3 - terminal slip
89
extensor indices proprius innervation
radial/PIN
90
extensor indices proprius action
extend index finger
91
What nerve provides sensory to the volar wrist capsule
AIN
92
What nerve provides sensory function to the posterior forearm?
radial nerve via the posterior cutaneous nerve of forearm
93
what does the PIN provide sensory function to?
dorsal wrist capsule
94
what nerve provides sensory function to the radial forearm?
musculocutaneous nerve (C5-C7) via lateral cutaneous nerve of forearm
95
what nerve provides sensory function to medial forearm?
medial cutaneous nerve of forearm (C8-T1)
96
What another name for ulnar tunnel
Guyon's canal
97
What supplies the scaphoid? %?
Palmar scaphoid branch (from superficial palmar branch - which anastomoses with superficial palmar arch from radial artery) -- supplies 25% of distal scaphoid Dorsal scaphoid branch (from radial artery)-- supples 75% of proximal scaphoid
98
signs of triangular fibrocartilage complex tear?
ulnar wrist pain Pain worse with ulnar deviation +Fovea sign - tenderness in the soft spot between the ulnar styloid and flexor carpi ulnaris tendon, between the volar surface of the ulnar head and the pisiform
99
How can TFCC tear occur
class 1 - traumatic (associated with ulnar styloid fx) Class 2 - degenerative
100
how is TFCC tear treated
typically conservatively with NSAIDs and immobilization In severe cases - repair/debride tear (traumatic) or ulnar shortening procedure
101
what is de quervain's tenosynovitis
inflammation of the first dorsal compartment - APL/EPB associated with tendon abnormality. Often occurs in middle aged women
102
treatment of de quervain's tenosynovitis
1. Splint and NSAIDs 2. Corticosteroid injection into sheath 3. Surgical release
103
most common area for ganglion cyst to occur
dorsal wrist - SL joint
104
Sites where median nerve compression can occur causing pronator syndrome
1. Ligament of Struthers 2. Pronator teres 3. Bicipital aponeurosis 4. FDS aponeurosis/arch
105
What is pronator syndrome
proximal median nerve compression
106
What is AIN syndrome
Rare nerve compression same sites as pronator syndrome (ligament of struthers, pronator teres, FDS aponeurosis/arm, bicipital aponeurosis) motor symptoms only
107
Symptoms/PE of AIN syndrome
Hx: weakness, +/- pain PE: weak thumb (FPL) and index finger pinch (FDP)
108
Symptoms/PE of pronator syndrome
Hx: numbness, tingling, +/- weakness PE: decrease palm sensation, + pronator or FDS sign
109
What is carpal tunnel associated with?
metabolic diseases - thyroid disease, diabetes, pregnancy
110
Hx and PE for carpal tunnel
numbness, +/- pain PE: +/- thenar atrophy, + Tinel/Phalen/Durkin's
111
Treatment for pronator/AIN syndrome
1. Activity mod/rest 2. NSAIDs, splinting 3. Surgical decompression of all proximal sites
112
Treatment for carpal tunnel syndrome
1. Activity modification 2. NSAIDs, night splints 3. Corticosteroid injections 4. Surgical decompression
113
what is PIN syndrome and where can it occur?
Compression in radial tunnel 1. fibrous bands 2. leash of henry - aka recurrent radial artery 3. extensor carpi radialis brevis 4. Arcade of Frohse (proximal supinator edge) 5 Distal edge of supinator
114
Hx/PE for PIN syndrome
Hx: hand/wrist weakness, +/- elbow pain PE : weak thumb/ finger extension; tenderness to palpation at radial tunnel
115
Workup for PIN syndrome?
XR: look for radiocapitellar abnormality MR: evaluate for masses EMG/NCS: confirms diagnosis and localizes lesions
116
treatment for PIN syndrome?
1. activity mod 2. NSAIDs/splints 3. complete surgical decompression
117
How does radial tunnel syndrome differ from PIN syndrome?
Pain only, no weakness
118
How does AIN syndrome differ from pronator syndrome?
motor symptoms only (+/- pain)
119
What areas can cause radial tunnel syndrome
same as PIN syndrome: 1. fibrous bands 2. leash of henry - aka recurrent radial artery 3. extensor carpi radialis brevis 4. Arcade of Frohse (proximal supinator edge) 5 Distal edge of supinator
120
Work up for radial tunnel syndrome?
XR: evaluate RC joint MRI: evaluate for masses EMG/NCS: no useful
121
treatment for radial tunnel syndrome
1. activity mod 2. NSAIDs/splints 3. complete surgical decompression
122
What is Wartenberg's syndrome?
Compression of superficial radial nerve at the wrist between ECRB and BR tendons sensory symptoms only
123
Hx/PE for Wartenberg's syndrome
Hx: pain and paresthesias of the dorsoradial hand without motor symptoms PE: decreases sensation at IF and thumb, +Tinel's sign with pronation
124
workup for Wartenbergs syndrome
XR and MRI not helpful EMG/NCS maybe helpful
125
treatment for Wartenbergs syndrome
1. activity mod 2. NSAIDs/splints 3. complete surgical decompression
126
what is ulnar tunnel syndrome
Compression of the ulnar nerve at the ulnar tunnel (Guyon's canal) located at the wrist
127
etiology of ulnar tunnel syndrome
1. ganglion (MC) 2. hamate malunion 3. thrombotic artery 4. muscle
128
Hx/PE of ulnar tunnel syndrome
Hx: Numbness, weakness in hand PE: paresthesias and weakness of small finger and ring finger, +Tinel sign over Guyon's canal
129
Treatment of ulnar tunnel syndrome
1. activity mod 2. NSAIDs/splints 3. surgical decompression or address underyling cause (e.g. ganglion excision)
130
work up for ulnar tunnel syndrome
``` XR: look for fracture (hook of hamate) CT: for fx or malunion) MR: useful for masses US: evaluate for thrombosis EMG: confirms diagnosis ```
131
What is the name for instability within a carpal row (two types)
Carpal instability, dissociative (CID)
132
What are the two types of carpal instability dissociative
1. Dorsal intercalated segment instability (DISI) | 2. Volar intercalated segment instability (VISI)
133
etiology of dorsal intercalated segment instabiilty
- due to scapholunate ligament disruption or scaphoid fx/nonunion - deformity: scaphoid flexes, lunate extends - may lead to Scaphotrapeziotrapezoidal (STT) arthritis or scapholunate advanced collapse (SLAC)
134
What is etiology of volar intercalated segment instability?
- due to lunotriquetral ligament disruption (also requires dorsal radiocarpal ligament injury)
135
Hx for carpal instability dissociative?
Trauma, pain, +/- popping
136
PE findings for carpal instability dissociative?
+/- decreased ROM | +/- snuffbox or SL/LT interval tenderness, + Watson test (DISI) or Regan test (VISI)
137
Evaluation for carpal instability dissociative?
XR - wrist and clenched fist views | MRA - can confirm ligament injury
138
What would you see on XR in a DISI
SL gap > 3 mm SL angle >70 degrees "ring sign"
139
what would you see on XR in VISI
disrupted carpal arches
140
Treatment for CID
Acute/early - Fx: ORIF of scaphoid - Ligament: SL or LT ligament repair or reconstruction with pin fixation - Capsulodesis Chronic/Late - Limited fusion

Orthopedics (6 decks)

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