Hand and Wrist

Question 1

Special Tests: Dequervain’s Tenosynovitis

Answer 1

Finkelstein’s Test

Question 2

Special Tests: Osteoarthritis

Answer 2

CMC Grind Test

Question 3

Special Tests: Carpal Tunnel (4)

Answer 3

1. Phalen’s: at lest 60 seconds
2. Tinel’s
3. Hand Elevation: above head for at least 2 min
4. Durkan’s: carpal tunnel compression for 30 seconds

Question 4

Special Tests: Durkan’s Test

Answer 4

Carpal Tunnel: Compression of carpal tunnel for 30 sec.

Question 5

Special Tests: Scaphoid lunate instability

Answer 5

Watson Test: passive movement from extension and ulnar deviation to flexion and radial deviation + Volar force to scaphoid

Question 6

Special Tests: Watson test

Answer 6

Scaphoid Lunate Instability: passive movement from extension and ulnar deviation to flexion and radial deviation + Volar force to scaphoid

Question 7

Special Tests: Lunate triquetrum instability

Answer 7

1. Reagan’s Test (Shuck Test): Stabilize triquetrum in one hand, move lunate anterior/posterior w/o other hand
2. Kleinman Shear Test: Similar to above using only thumbs

Question 8

Special Tests: Reagan’s Test

Answer 8

Lunate Triquetrum Instability: Stabilize triquetrum in one hand, move lunate anterior/posterior w/o other hand

Question 9

Wrist meniscus

Answer 9

TFCC: Triangular fibrocartilage complex

Question 10

Function of TFCC

Answer 10

Primary stabilizer of distal radioulnar joint

Contributes to ulnocarpal stability

Question 11

Carpal bones (8)

Question 12

Ischemic necrosis of flexor muscles of the forearm

Answer 12

Volkmann’s Contracture

• Brachial artery injury
• Compartment syndrome
• Improper tourniquet

Question 13

Volkman’s contracture

Answer 13

Ischemic necrosis of flexor muscles of the forearm

Question 14

Contraction of palmer fascia due to fibrosis

Answer 14

Dupuytren’s Contracture

• Genetic predisposition
• Men > 40
• DM
• ETOH
• Epilepsy

Question 15

Injection treatment for dupytren contracture

Answer 15

Clostridium histolyticum

Question 16

Rheumatoid Arthritis: Common deformities

Answer 16

• Ulnar deviation of finger: ECU weakness → Radial wrist deviation → flex/ext mismatch due to increased torque of ulnar finger flexors → ulnar deviation
• Boutonniere deformity: Hyperextension of MCP + Flexion of PIP
  
  • Weakness/rupture of extensor hood → subluxaation of extensor tendons past PIP
• Swan neck deformity: Flexion of MCP + Hyperextention of PIP + Flexion of DIP
  
  • Contracture of deep flexor muscles/intrinsic of hand
• Pseudobenediction Sign: Extensor tendon rupture → inability to extend 4th and 5th digits
• Floating Ulnar Head: Elevation of ulnar head at dorsum of wrist
  
  • Distal radioulnar instability due to synovial proliferation

Question 17

First sign of effusion of radiocarpal joint

Answer 17

Loss of full wrist flexion

Question 19

1st Dorsal wrist compartment

Answer 19

1. EPB
2. APL

Question 20

2nd wrist compartment

Answer 20

1. ECRB
2. ECRL

Question 21

3rd dorsal wrist compartment

Answer 21

1. EPL

Question 22

4th Dorsal Wrist Compartment

Answer 22

1. EDC
2. EIP

Question 23

5th Dorsal wrist compartment

Answer 23

EDM

Question 24

6th Dorsal wrist compartment

Answer 24

ECU

Question 25

Pathology or 1st dorsal wrist compartment

Answer 25

**Dequervain's Tenosynovitis** * Inflammation/irritation of EPB and APL * (+) Finkelstien's Test

Question 26

Compartments of intersection syndrome

Answer 26

1st + 2nd ![]()

Question 27

**Intersection Syndrome:** Cause

Answer 27

Repetitive wrist flexion/extension activities

Question 28

* Swelling and tenderness at intersection of 1st and 2nd dorsal compartments * Pain w/ resisted wrist extension * Pain/crepitus

Answer 28

Intersection syndrome

Question 29

Most common site of hand OA

Answer 29

1st CMC joint

Question 30

Bouchard's nodes

Answer 30

PIP

Question 31

Heberden's nodes

Answer 31

DIP

Question 32

Osteonecrosis/AVN of the lunate

Answer 32

Kienbock's disease

Question 33

Kienbock's disease

Answer 33

Osteonecrosis/AVN of lunate

Question 34

* Pain over ulnar side of wrist on palpation * Swelling over dorsal aspect of wrist * Decreased grip strength * Negative ulnar variance

Answer 34

Kienbock's Disease

Question 35

**Scaphoid Fracture:** mechanism

Answer 35

Fall on dorsiflexed wrist

Question 36

Borders of anatomic snuffbox

Answer 36

Radial: EPB, APL Ulnar: EPL Base: Scaphoid bone

Question 37

Avulsion to flexor digit rum profundus Sudden extension on DIP when flexed

Answer 37

Jersey Finger

Question 38

* Sudden extension on DIP when flexed * Pt unable to actively flex DIP

Answer 38

Jersey Finger

Question 39

Avulsino of extensor tendon to DIP

Answer 39

Mallet finger

Question 40

* Avulsion of extensor tendon to DIP * DIP is flexed at rest * Pt unable to actively extend

Answer 40

Mallet finger

Question 41

Gamekeeper's thumb/skier's thumb

Answer 41

UCL injury to thumb: Valgus stress

Question 42

* Tenderness over ulnar side of MCP joint * Increased laxity and pain w/ valgus stress * Valgus stress to thumb

Answer 42

UCL injury

Question 43

Stener lesion

Answer 43

aponeurosis of adductor pollicis muscle lies between MCP and distal end of UCL Prevents spontaneous healing

Question 44

Prevents spontaneous healing of UCL injury

Answer 44

Stener lesions

Question 45

Aponeurosis of adductor pollicis muscle lies between MCP and distal end of UCL, preventing spontaneous healing of UCL injury

Answer 45

Stener lesion

Question 46

**Carpal Tunnel:** Risk factors

Answer 46

* CHF/ESRD * Thyroid disorder * Pregnancy

Question 47

* Pain on ulnar side of wrist, dorsal aspect, just distal to ulnar styloid * Pain + Clicking/catching w/ wrist movement * Decreased grip strength * Pain w/ axial loading of carpal bones w/ wrist in ulnar deviation * Pain w/ resisted radial wrist deviation

Answer 47

TFCC injury

Question 48

Risk factor for TFCC injury

Answer 48

Postivie ulnar variance