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Foundations III-Musculoskeletal/Rheum > Forearm/Wrist > Flashcards

Forearm/Wrist Flashcards

(56 cards)

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1
Q

What are the different types of adult forearm fractures?

A

UNSTABLE:

  • Both bone forearm fracture
  • Galiazzi fracture
  • Monteggia fracture

STABLE
Nightstick fracture

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2
Q

What is a both bone fx?

A

Radial shaft fracture

Ulnar shaft fracture

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3
Q

What is a glaiazzi fx?

A

Mid to distal radial shaft

Assoc. carpoulnar dislocation

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4
Q

What is a monteggia fx?

A

Mid to proximal ulnar shaft

Assocradial head dislocation

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5
Q

What is a nightstick fracture?

A

Mid to distal ulnar shaft fracture

stable fx

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6
Q

What are some common distal radial fxs in adults?

A

Colle’s (MC)

Smith’s

Barton

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7
Q

What is a Colle’s fracture?

A

MC

Distal radius fracture fragment is tilted dorsally

+/- involvement of articular surface of radius

+/- ulnar styloid fracture

MOA: FOOSH

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8
Q

What is a smith’s fx?

A

Distal radius fracture fragment is tilted ventrally

MOA: wrist down when pt falls

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9
Q

What is a barton fx?

A

Intra-articular fracture associated with dislocation of the carpus

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10
Q

What x-ray view should you use to dx a colle’s or smiths fx?

A

lateral view

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11
Q

What are colle’s fractures reduced?

A

by closed manipulation

wrist first dorsiflexed, traction initiated as distal and volar thumb pressure applied over distal fragment

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12
Q

What is a radial torus “buckle” fx? Who is it MCly seen in?

A

Distal metaphysis

Buckling of cortex due to compression failure

MC in children <10

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13
Q

What is a greenstick fracture?

A

Complete fx of the tension side of the cortex with buckling of the compression side

On x-ray complete disruption on one side with buckle on opposite side

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14
Q

Tx of radial torus “buckle” fracture?

A

Immobilization x 4-6 weeks (cast or brace)

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15
Q

What is the MCly scaphoid fx?

A

Scaphoid Fractures

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16
Q

MOA of scaphoid fx?

A

FOOSH

Limited blood supply leads to high incidence of nonunion and osteonecrosis

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17
Q

Who usually gets scaphoid fx from FOOSH? What about radial fx?

A

kids/younger pts

older pts

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18
Q

Clinical findings of scaphoid fx?

A

Snuffbox pain / TTP

ROM limitations

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19
Q

Management of scaphoid fractures?

A

Long-arm thumb spica cast x 6-12
weeks

If clinical exam is indicative of fracture but x-rays are negative, cast and repeat x-rays in 10-14 days**

If follow up x-rays still negative but clinical concern persists order MRI

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20
Q

What are some complications of scaphoid fxs?

A

Avascular necrosis or failure to union

tx: internal fixation
or bone graph with anastomosis

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21
Q

Describe fractures of the metacarpals and phalanges

A

Displaced transverse and oblique fractures tend to angulate

Spiral fractures tend to rotate

Displaced*, spiral, comminuted and intra-articular fractures should be referred to specialist for further evaluation

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22
Q

What is the MC fx of the hand?

A

boxer’s fracture

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23
Q

Describe a boxer’s fracture

Study These Flashcards
A

Distal metaphysis of

5th metacarpal
Results from closed fist striking an object

24
Q

Management of a boxer’s fracture?

Study These Flashcards
A

Ulnar gutter splint <15 degrees (transverse, oblique, base & head)

Surgconsult:

  • Intra-articular
  • > 15 degrees -angulation
  • Comminuted
  • Spiral
25
What is DeQuervain’s tenosynovitis?
Inflammation of the sheath that surrounds the abductor pollicus longus and extensor pollicus brevis tendons Tendon sheath thickens and constricts the tendons
26
Presentation of DeQuervain’s tenosynovitis?
Pain + tenderness in the first dorsal extensor compartment (anatomic snuffbox) aggravated by attempts to move thumb or make a fist +/-Swelling Crepitation as patient flexes and extends thumb may be noted
27
What test can be used to eval for DeQuervain’s tenosynovitis?
Finklestein Test: Pain with passive stretching of the tendons - Direct the patient to place the thumb in their palm. - Have them cover the thumb with the fingers of the same hand, forming a fist. - Gently deviate the wrist towards the ulna. This stretches the inflamed tendons over the radial styloid, reproducing the patient's pain.
28
Tx of DeQuervain’s tenosynovitis?
NSAIDs Thumb spica splint Avoid offending activity Steroid injection
29
What is an ulnar collateral ligament sprain?
"Gamekeeper’s thumb” or “Skier’s thumb” UCL injury at 1st MCP joint Acute or chronic valgus stress
30
How can you dif. DeQuervain’s tenosynovitis v. scaphoid fx?
hx of traumatic fall with scaphoid fx
31
eval for ulnar collateral ligament sprain?
Pain and swelling localized to ulnar aspect of thumb Assess for stability by stressing the UCL - pain only: mild sprain - pain + laxity: mod sprain - pain +sig laxity: complete tear
32
Tx of ulnar collateral ligament sprain?
Brace: mild to moderate sprain Surg consult: complete tear or avulsion fracture involving >25% of the articular surface
33
What is a mallet finger?
MC due to traumatic injury to the tip of a fully extended finger Rupture, avulsion or laceration of extensor tendon at base of distal phalanx
34
Presentation of mallet finger?
Pain and inability to extend at the DIP
35
Tx of mallet finger?
xray CONTINUOUS splinting for 6-8 weeks If extension is lost at any point, healing is disrupted and the clock starts again Surgical pinning if full extension not achieve
36
When should you make a surg consult for mallet finger?
Failure with conservative care Complete tendon laceration Fx involving >30% of the articular surface
37
surg tx of mallet finger?
place pin into bone x 3-4 weeks
38
What is a flexor tendon injury "jersey finger" ?
Spontaneous (RA) or Traumatic (forced extension of actively flexed finger) MC flexor digitorum profundus 4th (ring) finger affected most commonly 75%
39
Presentation of Flexor Tendon Injury “Jersey Finger”?
Pain/swelling at palmar aspect of DIP Proximal fullness if tendon retracted Affected finger more extended at DIP when hand at rest Inability to flex at affected DIP joint
40
During PE of pt with suspected Flexor Tendon Injury “Jersey Finger”, should you try to passively force the finger into extension?
NO order xray to eval for bony avulsion
41
Management of Flexor Tendon Injury “Jersey Finger”?
Early surgical repair in all cases Splint finger in presenting position Hand surgeon referral Best recovery if repaired within 7-10 days of injury
42
Possible complications of flex tendon injury?
Fibrosis and scarring of tendon sheath Assoc. with delayed surg repair
43
What is trigger finger?
Nodular thickening of the flexor tendon MC at the MP joint MC idiopathic (but RA and DM at increase risk)
44
Tx of trigger finger?
Steroid injections x 2 only Surg release if persistent despite injection
45
What is Dupuytren’s Contracture? Who is it usually seen in?
Palmar fibromatosis “Viking disease” Nodular thickening and contraction of palmar fascia Men >50, northern European descent
46
Presentation of Dupuytren’s Contracture?
Minimal discomfort MC ring finger Flexion of finger at MCP then PIP which occurs gradually
47
Tx for Dupuytren’s Contracture?
Xiaflex injection: -Breaks down collagen adhesion - Injected into contracted cord - Manipulation the following day
48
Describe ganglia of the wrist/hands
aka Synovial Cyst, Mucous cyst Cystic swelling overlying a joint or tendon sheath Herniation of synovial tissue from a joint capsule or tendon sheath Generally affect persons 15-40 years of age
49
Where do ganglia of the wrist/hand typically occur?
Common locations: - Dorsum of the wrist - Volar radial aspect of wrist Less common: - Base of finger - DIP joint
50
Tx of ganglia of wrist/hand?
If typical s/s = reassurance acute or severe sxs: =immobilization will relieve symptoms and may cause a decrease in size (not permanent) Needle aspiration Surgical excision NOT biblical method
51
Can you aspirate a mucous cyst?
no, risk of joint infection
52
What are the MC causes of arthritis of the hand?
Osteoarthritis Secondary degenerative joint disease
53
Presentation of osteoarthritis of the hand?
DIP and PIP joints are most often involved Stiffness and loss of motion in the fingers
54
What are bouchard nodes? Herberden nodes?
bony nodules at the PIPs nodules at the DIPs
55
Presentation of subungual hematoma?
Traumatic and painful MOA: hitting thumb with hammer, getting finger caught in door, drop a weight on foot, etc.
56
Management of subungual hematoma
if traumatic: xray Decompression: Microcautery 18 G needle Heated paperclip

Foundations III-Musculoskeletal/Rheum (7 decks)

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