Hand & Wrist MSK Problems Flashcards Preview

Clin Med IV - Ortho > Hand & Wrist MSK Problems > Flashcards

Flashcards in Hand & Wrist MSK Problems Deck (86):
1

Name the carpal bones

Some lovers try positions that they can't handle

Scaphoid, lunate, triquetrum, pisiform
Trapezium, trapezoid, capitate, hamate

2

______ make up 25% of all metacarpal fractures

5th metacarpal fracture

3

Boxer's fracture

5th metacarpal fracture

4

Common mechanism of injury for Boxer's fracture

Punching object

5

Volar angulation of _____ is acceptable in Boxer's fracture but _____ is not acceptable

up to 40 degrees
Rotational deformity

6

When is surgery indicated for Boxer's fracture?

Volar angulation >45 deg.

7

Position of UE in thumb spica cast

Wrist at 25 deg extension

8

Indications for thumb spica cast

- Scaphoid fx
- Bennett's fracture dislocation
- Extra-articular fx of 1st metacarpal
- UCL injury
- Post-reduction of thumb dislocation

9

Bennett fracture-dislocation

Intra-articular 2-part fracture of base of 1st metacarpal

10

Mechanism of injury of Bennett fracture-dislocation

Forced abduction of 1st metacarpal

11

Most frequent thumb fx

Bennett fracture-dislocation

12

Rolando fracture

Comminuted fracture of 1st metacarpal base

13

Indications for CRPP fixation of Bennett fracture-dislocation

- <3mm displacement
- Beak of fragment <50% palmar slope of metacarpal
- Concave dome of metacarpal maintained

14

When is ORIF w/ AO cortical screw indicated in Bennett fracture-dislocation

When CRPP is not possible

15

Most frequently fractured carpal bone

Scaphoid (waist > proximal 3rd > distal 3rd)

Distal 3rd most common in kids

16

Mechanism of injury of scaphoid fracture

FOOSH

17

Clinical presentation of scaphoid fracture

- FOOSH w/ tenderness in anatomical snuff box
- Limited wrist flexion/extension
- Pain on radial side of wrist w/ radial and ulnar deviation

18

80% of blood supply to scaphoid is from _______

Retrograde blood flow from radial artery

19

How does the time to union differ depending on the location of a scaphoid fracture?

Distal 3rd = 6-8 wks
Middle 3rd = 8-12 wks
Proximal 3rd = 12-23 wks

20

Risk of AV necrosis is highest for ______ scaphoid fractures

Proximal

21

Tx non-displaced scaphoid fx

- Thumb spica cast for 6 wks followed by short cast until signs of union seen
- Cast change q10-14 days for first 6 wks to adjust for atrophy

22

Tx displaced scaphoid fx

ORIF followed by thumb spica cast for 6-8 wks

23

Basal joint arthritis

Arthritis of 1st CMC joint

24

Epidemiology of basal joint arthritis

Postmenopausal white women

25

Clinical presentation of basal joint arthritis

- Insidious radial thumb pain, worse w/ use
- Decreased ADLs, strength, dexterity
- Pain w/ opposition (writing, opening jars)
- Dorsoradial prominence of thumb metacarpal base

26

Conservative tx for basal joint arthritis

- Tylenol +/- NSAIDs
- Splinting
- Ice
- Cortisone injection

27

Definitive tx for basal joint arthritis

Total joint replacement → Excise distal half of trapezium, replace space with reconstructed flexor carpi radialis tendon or allograft via "anchovy technique"

28

Boutonniere deformity

Flexion of PIP w/ hyperextension of DIP

29

What condition is Boutonniere deformity commonly associated with?

Rheumatoid arthritis

30

Tx Boutonniere deformity

- Splinting
- Surgery → must try at least 3 months splinting first

31

Swan neck deformity

Hyperextension of PIP joint & compensatory flexion of DIP joint

32

50% of swan neck deformity cases are associated with _____

Rheumatoid arthritis

33

Tx swan neck deformities

- Silver ring splints
- Joint fusion
- Joint arthroplasty

34

Carpal tunnel syndrome

Median n. compressed d/t decreased space under transverse carpal ligament

35

What special tests suggest carpal tunnel syndrome

+Tinel's sign
+Phalen's sign

36

Tx carpal tunnel syndrome

- Wrist splint (esp. at night)
- PT
- Steroid injections
- Surgery

37

Epidemiology of deQuervain's tenosynovitis

Women of childbearing age (esp. during pregnancy)

38

Special tests for deQuervain's tenosynovitis

+Finkelstein test

39

Definitive tx for deQuervain's tenosynovitis

Surgical decompression of 1st dorsal compartment

40

Gamekeeper's thumb

Injury to UCL of thumb at MCP joint

41

Imaging for Gamekeeper's thumb

- Stress views on X-ray
- MRI if surgery planned

42

Tx gamekeeper's thumb

- Partial tear → thumb spica cast/splint immobilization for 4-6 wks
- Full tear → surgery followed w/ cast for 3-6 wks and OT

43

Kanavel's 4 cardinal signs of infectious flexor tenosynovitis

- Tenderness along flexor tendon
- Edema
- Pain with passive extension*
- Flexed resting posture

44

Common causes of hand infections

- Cat bite
- Human bite
- Puncture wounds (IVDA)

45

Usual bacteria involved in hand infections

- Staph
- Strep
- Pasteurella
- Oral anaerobes

46

Tx hand infection

- Targeted IV abx
- Pain management
- Surgical washout

47

What is important in treating finger dislocation?

Check NV status before and after reduction

48

After reducing finger dislocation, what should you do?

- Volar Alumafoam splint w/ buddy tape
- Tylenol, NSAIDs, ice
- Follow up w/ hand surgeon

49

Mallet finger

Disruption of extensor mechanism of DIP joint

50

Common mechanism of injury of mallet finger

Sudden flexion of DIP joint while play sports

51

Clinical presentation of mallet finger

Inability to extend DIP joint → slight flexion at rest

52

Tx of Mallet finger

- Stax splint for 8 wks with DIP in slight hyperextension → DO NOT allow DIP to flex at all during this time

53

Jersey finger

Avulsion injury of flexor digitorum profundus tendon from insertion at base of distal phalanx

54

Mechanism of injury of Jersey finger

Sudden hyperextension of flexed finger

55

_______ is most commonly involved Jersey finger

Ring finger - FDP insertion here is anatomically weaker than others

56

Clinical presentation of Jersey finger

- Inability to flex finger at DIP joint → slight extension at rest
- TTP at volar aspect of distal finger

57

Imaging of Jersey finger

- X-ray usually normal (may show bony avulsion if present)
- MRI best

58

Tx Jersey finger

- Partial tear → splint, NSAIDs, PT
- Complete tear → surgery

59

Trigger finger

Stenosing flexor tenosynovitis from repetitive microinjury d/t frequent flexion-extension of fingers

60

Trigger finger has high prevalence in ______ and _____

Diabetics
RA pts

61

Clinical presentation of trigger finger

Difficult to straighten or bend affected finger → transiently locked in flexed position with painful snapping sensation when extended → often have to manually extend finger

62

Tx trigger finger

- Conservative tx → NSAIDs, splinting, steroid injection
- Definitive tx → surgery to release A1 pulley

63

Dupuytren's contracture

Benign, slowly progressive fibrosis of palmar fascia leading to loss of full extension of hand and fingers

64

Epidemiology of Dupuytren's contracture

Northern European male

65

Clinical presentation of Dupuytren's contractures

- Initial complaint of thickening or nodules in palm (painless initially)
- 4th and 5th fingers affected earliest

66

Tx Dupuytren's contractures

- Cortisone injections
- Collagenase injections
- Ppx external beam radiation therapy to slow progression
- Surgery → open fasciotomy

67

Ganglion cyst

- Fluid-filled swelling overlying joint or tendon sheath
- Contains mucinous or gelatinous fluid ("apple jelly")

68

Usual location of ganglion cysts

Dorsal wrist

69

Tx ganglion cyst

- Rest via splinting
- Aspiration with 18G needle and 3cc syringe
- Surgical removal (Note: 40% still recur)

70

Where are mucous cysts usually located on hand?

Dorsal DIP

71

Clinical presentation of mucous cyst in hand

- Swelling of dorsal side of finger
- Groove in fingernail d/t pressure on matrix

72

Tx mucous cyst

- Triamcinolone injection
- Surgical excision

73

Most common cause of herpetic whitlow

HSV-1

74

Clinical presentation of herpetic whitlow

- Painful, edematous fingertip with vesicular lesions
- Most commonly affects thumb & index finger
+/- Prodrome of fever, malaise

75

Diagnostics that can be helpful in diagnosing herpetic whitlow

Mostly clinical dx but can use:
- Tzank smear
- Viral culture
- Serum antibody titers

76

Tx herpetic whitlow

- Self-limited to 3 wks
- Symptomatic relief (e.g. unroof vesicles)
- Acyclovir, famciclovir, valacyclovir

77

Felon

Infection of fingertip pulp

78

Most common pathogens of felon

- Staphylococcus
- MRSA
- Eikenella corrodens in DM pts who bite nails
- GI pathogens

79

Tx felon

- I&D → culture any fluid
- Abx against staph & MRSA (dicloxacillin, cephalexin, Bactrim, clinda, nafcillin, doxy)

80

What's important to know about compartment syndrome?

Surgical emergency!!

81

Common sites of compartment syndrome

Leg and forearm

82

What do casts have to do with compartment syndrome?

Casted extremity within first few days of injury can cause compartment syndrome d/t swelling

83

Clinical presentation of compartment syndrome

Pain out of proportion
Pallor
Paresthesia
Paralysis
Pulselessness

84

Tx compartment syndrome

Fasciotomy → pack with dressing → return to OR for closure at later date

85

Current practice limits intra-articular corticosteroid injections to _________

3 injections/joint in 12 month period

86

Side effects of corticosteroid injections

- Blanching of skin
- Localized fat atrophy
- Infection
- Transient rise in blood glucose