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MSK (Clinical Conditions) -MIMI > Hand a wrist > Flashcards

Hand a wrist Flashcards

1
Q

Which is the most common bone to fracture is your hand

A

Scahoid

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2
Q

what percentage of carpal bone fractures does scaphiod fracture make up

A

70-80%

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3
Q

most common mechanism of action for fracture of a scaphoid bone

A

fall on a out streached hand

hyperextension and impact of the scaphoid against the rim of the radius

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4
Q

patients with scaphoid fracture complain on

A

pain in the anatomical stuffbox
pain worsten by moving wrist
swelling around the radial and posterior aspects of the wrsit

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5
Q

fractures in the scaphoid occur in what region of scaphoid

A

waist of the scahoid (70-80%)

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6
Q

if fractures of the scaphoid do not occur at the waist where will they occur

A

occur in the proximal pole (20%)

or the distal pole (10%) AKA scaphoid tubercle

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7
Q

a fracture taken immediately after a injury is likely to show how on a x ray

A

may not reveal fracture

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8
Q

why is late diagnosis of carpal bone fracture common

A

cant see the fracture on a x-ray until 10-14 days after

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9
Q

why are carpal bone fractures more commonly seen on a x ray 10-14 days after

A

fracture line may become more visible after some bone reasorption

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10
Q

if still not sure of a scaphoid fracture after 10-14 days x ray what other imaging techniques can you use?

A

CT or MRI

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11
Q

Descrivbe the blood supple to the proximal pole of the scaphoid

A

retrograde

tenuous (weak)

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12
Q

fractures through the waist of the scaphoid can cause

A

avascular necrosis

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13
Q

displacements fractures through the wasit of the scaphoid have high risk of

A

non-union
malunion
avasualr necrosis
late complications of carpal instability and secondary oestoarthritis

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14
Q

colles’ fracture

A

an extra articular fracture of the distal radial metaphysis, with dorsal angulation and impaction

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15
Q

what kind of fracture do you also see in 50% of colles fractures

A

ulnar styloid fracture

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16
Q

colles’ fractures are commonly seen in

A

people with osteoporosis (reduced bone density)
post- menopausal women
high impact trauma

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17
Q

mechanism of injury for colle’s fracture

A

fall onto a outstretched hand with a pronated forearm and wrist in dorsiflexion

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18
Q

how patients present with colles’ fracture

A

painful
deformed
swollen wrist

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19
Q

x ray of colles’ fracture

A

dorsal angulation and impaction are usually visible on plain x-ray

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20
Q

how to treat colles’s fractrure

A

reduction and immobilisation in a cast

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21
Q

complications of colles’ fracture healing

A 
malunion
median nerve paldy and post traumatic carpal tunnel syndrome
secondary osteoarthitis (more common with intra-articular fractures)
tear of the extensor pollicis longus tendon (through attrition of the tendon over a shape fragment of bone
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22
Q

Smiths fracture

A

fracture of the distal radius with palmar angulation of the distal fracture fragment

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23
Q

smiths fractures can be though as the oppostie to

A

colles’ fracture

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24
Q

mechanism of injury for smith fracture

A

fall onto a flexed wrist or a direct ow to the back of the wrist

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25
Q

malunion of a smith fracture results in

A

garden spade deformity

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26
Q

garden spade deformity of the malunion of a smiths fracture can cause what complications think about the nerves in the wrist

A

narrows and distorts the carpal tunnel and can result in carpal tunnel syndrome

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27
Q

What joints in the hand can get arthritis

A

metacarpophalangeal joints

interphalangeal joints

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28
Q

Osteoarthsis LOSS

A

L- LOSS OF JOINT SPACE
O-OSTEOPHYTES
S-SUBCHONDRAL CYTES
S-SUBCHONDRAL SCLEROSIS

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29
Q

Rhumatoid arthritis

A

L – LOSS OF JOINT SPACE
E- EROSION
S- SOFT TISSUE SWELLING
S-SOFT BONE (OSTEOPENIA)

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30
Q

Rheumatoid arthritis has what kind of distribution

A

symmetrical polyarthritis

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31
Q

how patients resent with Rheumatoid arthritis

A

pain and swelling of the PIPs and MCPJ of the fingers
redness overlying the joint
stiffness - worse in moring or after perdios of inactivity
carpal tunnel syndrome (compression of the median nerve in the carpal tunnel, in this case due to synovial swelling)
fatigue and flu like symptoms (due to the systemic nature of rheumatoid disease

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32
Q

adanced rheumatoid arthitisi will present

A

nodules in the fingers and elbow

advanced deformities

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33
Q

two most common defomaties seen with patients with advanced rheumatoid arthritis

A

swan neck deformity

boutonniere deformity

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34
Q

what is a swan neck deformity

A

Poximal interphlangeal joint is hyperextend

Metacarpal phalangeal joint and distal interphlangeal joint is flexed

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35
Q

why is the PIP hyperextensted

A

there is a imbalance between the muscles froces acting on the PIPJ (extension>flexion))

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36
Q

Describe Boutonniere deformity

A

the metacarpophalangeal joint and distal interphalangeal joiny are hyperextended
Proximcal interphalngeal joint is flexed

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37
Q

why do you see this shape in boutonniere deformity

A

immflamtion in the PIP leads to lengthening or ruture of the central slip of extensor digitorum at its inserion into the base of the middle phalanx on the dorsal surface of the finger. the lateral bands slip down the sides of the finger so that they are on the palmar surface and instead od acting as extensors act as flexors. as well as hyperextendinf the Distal interphalangeal joint

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38
Q

Psoriatic arthropathy apprence

A

skin condition causes red,flaky patches of skin covered with silvery scales

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39
Q

typical locations of psoriatic arthopathy

A

elbows,knees,scalp and lower back

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40
Q

psoriatic arthopathy can lead to

A

arthritis

41
Q

which joints are most effected by psoriatic arthritis

A

DIPJ

42
Q

Joint in hand most commonly effected by osteoarthitis is

A

1st carpometacarpal joint (between the trapezium and the first metacarpal)

43
Q

osteoarthisis of the 1st CMC joint complaints

A

pain at the base of their thumb
pain is exacerbated by movement and relieved by rest
stiffness following periods od rest (in the mornings)
swelling aroun the base of the thumb

44
Q

later stages of 1st CMC joint oestoarthitisis you will see

A

frist metacarpal subluxes in an ulnar direction, resulting in loss of normal contour and squaring of the hand

45
Q

heberden’s nodes are a classic sign of

A

osteoarthitis and effect the Distal interphalangeal joint

46
Q

herberden’s nodes begin with either two mechanism

A

chronic swelling of the affected joints or

sudden onset of pain,swelling and loss of manual dexterity

47
Q

heberden’s nodes typicall start with swelling containing what

A

gelatinous hyaluronic acid

48
Q

where about do heberden’s nodes appear on DIP joint

A

dorsolateral aspect

49
Q

whats a bouchards node’s

A

same as a herberden’s but occurs in PIPJs

50
Q

carpal tunnel syndrome compression of what nerve

A

MEDIAN NERVE

51
Q

Wrist factors for carpal tunnel

A

obesity, repetitive wrist work, pregnancy, rheumatoid arthritis and hypothrodism

52
Q

what nerve compression may result in

A

ischaemia, focal demyelination, decrease in axonal calibre and eventually axonal loss

53
Q

patients complaients with carpal tunnel syndrome

A

paraesthesia in the dsitrutio of the median nerve (thumb, index finger, middle finger, radial half of ring finger)
worse at night went the wrist drifts into flexon during sleep, narrowing the carpal tunnel further

54
Q

with carpal tunnel syndrome the sensation to the palm is spaed, why

A

palmar cutaneous branch of the median nerve branches proximal to the carpal tunnel and passes superficial to it into the palm (so is not compressed)

55
Q

long term carpal tunnel can result in thenar muscle atropy why

A

motero branch of the median nerve to the thenar musce exists the median nerve distal to the carpal tunnel

56
Q

which mucles make up thenar

A

flexor pollicis brevis (superficial head)
abductor pollicis brevis
opponens pollicis

57
Q

what motion can the pollicis do in thenar atrophy

A

flex - flexor pollicis longus is innervated by the anterior interosseous branch of the median nerve in the forearm,
deep head of the flexor pollicis bervis is innervated by the ulnar nerve

Adduction - adductor pollicis is supplied by the ulnar nerve

58
Q

what canal does ulnar nerve eater wrist though

A

Guyan’s canal

59
Q

ulnar tunnel syndrome patients report

A

paraethesai in the ring and little finger

progression to weakness of the intrinsic muscles of the hand suppled by the ulnar nerve

60
Q

what muscles in hard are suppled by the ulnar nerve

A

adductor pollicis
palmar and doral interossei
lumbricals (ring to little finger(
deep head of flexor pollicis berves

61
Q

Dupuytren’s contracture

A

loacliased thickening and contracture of the palmar aponeurosis leading to a flexor deformity of the adjacent finger

62
Q

earl on patients with dupuytren’s contracture notice

A

thickening in their palm

63
Q

whats leads to the contracture kater in duputrens contracture

A

myofibroblasts within the nodule contract leading to the formation of tight bands called cords in the palmar fascia
overlying skin tighly adherent to the palmar aponerosis
fingers becomes stuck in a flexed position and cannot be passively strightened

64
Q

Dupuytrens contracture inherentence

A

autosomal dominant 70%

sporadic 30%

65
Q

common age to get dupuytrens contracture

A

40 -60 years old common in males

66
Q

Conditions that increase the risk of developing Dupuytren’s contracture

A

type 1 diabetis
smoking
heart disease
HIV

67
Q

Where is a common location to damage the radial nerve

A

spinal groove of humerus

68
Q

why is the radial nerve likely to be damaged in a shaft fracture

A

closely associated with the bone

69
Q

radial nerve damnage can patients still extend their elbow

A

yes
extension will be normal or midly compromised
the never head to the long and medial heads of the tricepts is given off prior to the radial nerve entering the spinal groove
the nerve supplying to the lateral head of the tricept is given off in the spiral groove, but this is generally proximal to the fracture and is unaffected
anconeus is paralysed but this has only a minor role in elbow extention

70
Q

whyc muscle is paralysed in elbow extenion if radial nerve damage

A

Anconeus

71
Q

radial nerve damage effected wrist how

A

wrsit and fingers flexed (wrsit drop)
paralysis of brachioradialis and all extensors muscles of the wrist and fingers
the wrist and finger are flexed when the forearm is pronated because of unopposed flexor muscles and gravity

72
Q

radial never damage distribution of sensory impairment

A

posterior cutaeous nerve of the arm branch if radial nerve is unaffected
the lower lateral cutaneous nerve of the arm and psoteior cutaeous never of the forearm branch high in the spinal groove and unaffected

Paraesthsia is therefore usually in the distrution of the superficial branch of the radial nerve

73
Q

the median nerve gives off no muscular branches to the muscles of the arm therefore supplies

A

pronator teres, flexor carpi radialis, palmaris longus and flexor digitorum superficialis
(all originate from the medial epicondyle)

74
Q

what kind of injuty could damage the median nerve in arm

A

supracondylar fracture of the humerus

75
Q

median nerve injury above elbow results in loss of what mucles

A

in antrior foearm both pronators are weak and the flexors of the wrsit are paralysed

except flexor carpi ulnaris and the ulnar hald of the flexor digitorum profundus (supplied by ulnar nerve)

76
Q

median nerve injury above elbow resulrs forearm in what direction

A

supinated

due to the unopposed action of supinator and bicep brachii

77
Q

wrist is flexed in median nerve damage due to

A

pull of flexor carpi ulnaris

78
Q

median nerve damage effecting thumb

A

flexon of thumb is weak or absent as flexor pollicis longus is paralysed but the deep head of the flexor pollicul breve may have some residual innervation from the ulnar nerve

79
Q

median nerve damnage which fingers effected

A

index and middle fingers

80
Q

median nerve damage what happens when they try and make a fist

A

Hand on benediction index and middle finger stay straight

81
Q

Ape hand deformity

A

seen in medial nerve damanage, deformity with the thenar wasting in a high median nerve lesion

82
Q

above elbow median nerve damage loss of sensory to what region

A

palm, and 3 and a half digits

back of hand top of index and middle finger

83
Q

injury to the median nerve at the wrist (low median nerve injury) mechanism of injury

A

compression carpal tunnel

penetrating injury - broken glass

84
Q

what muscles are intact in a lower median nerve injury compared to a higher median nerve injury

A

muscles of common flexor origin at the medial epicondyle
pronator teres, flexor carpi radialis, palmaris longus and flexor digitorium superficialis
and flexor digitorium produndus

85
Q

muscles paralysed in lower median nerve damanage

A

LOAF
L lumbricals to the index and middle fingers
O opponens pollicis
A abductor pollicis brevis
F flexor pollicis brevis (superficial head)

86
Q

what muscles does the ulnar nerve supply in arm

A

THE ULNAR NERVE DOES NOT SUPPLY ANY MUSCLES IN THE ARM

87
Q

the ulnar nerve at the level of the elbow gives off a branch to

A

flexor carpi ulnaris which originates from the common flexor origin on the medial epicondyle and from the ulna

88
Q

where does the ulnar nerve supple in the forearm

A

ulnar half of flexor digitorum prfundus (to the ring and little fingers)
and palmar cutaneous branch and doral cutaneous branch
these functions will be intact in a low ulnar injury at the level of the wrist

89
Q

ulnar nerve supplies what in hand

A

muscles of the hypothenar eminence, adductor pollicis and the deep head of flexor pollicis brevis , interossei the lumbricals to the ring and little finger, palmaris brevis and palmar digital branches to the ulnar 1 and half digits
if nerve damnaged at wrist lose all these fucntions

90
Q

what shape hand can long term dmange to ulnar nerve cause

A

claw hand

fingers hyper extended and MCP and flexed at both the PIP and DIP

91
Q

Why are the MCPJs of the ring and little finger hyperextended and the IPJs flexed

A

3rd and 4rd lumbrical muscles supplied by ulnar nerve and paralysed

92
Q

lumbricals allow what movement

A

flex the digits at the MCPJ and extend the digits at the IPJ via the dorsal extensor expansion

93
Q

ulnar claw MCPJs hyperextended why

A

unopposed extension from the extensor digitorum in the posterior compartmebt of the forearm

94
Q

ulnar calw PIP and DIP flexed why

A

unapposed flexion from the flexor muscles in the anterior compartment of the arm

95
Q

ulnar nerve lesion at wrsit cause loss of sensation

A

palmar aspect of the ulnar 1 and half digits and the dorsum over the distal phalanges only

96
Q

injury to the ulanr nerve at the elbow mechanism of injury

A

medial epicondylar fracture

compression in the cubital tunnel

97
Q

what muscles lost is ulnar nerve drainage at elbow

A

muscles of the hypothenar eminence, adductor pollicis and the deep head of flexor pollicis brevis , interossei the lumbricals to the ring and little finger, palmaris brevis and palmar digital branches to the ulnar 1 and half digits

PLUS

flexor carpi ulnarsi, ulnar half od flexoe digitorum profuncuds (to ring and little finger) and loss of sensation in the dorsal and palmar cutaneous branches

98
Q

is the ulanr claw more or less pronodced in elbow damange

A

less pronocuded but more muscles dmanged

99
Q

Ulnar paradox

A

ulnar claw will be present bu as flexor giditorium profunduc is paralysed there will not be any flexion at the DIPJ of the ring and little finger

MSK (Clinical Conditions) -MIMI (7 decks)

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