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Clin Med II - Ortho > Hand and Wrist > Flashcards

Hand and Wrist Flashcards

1
Q

Common Hand d/o

A 
Tendon / ligament problems
Fx
Infections
Arthrist
Nerve entrapment / other
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2
Q

Trigger finger - Patho

A

Swollen flexor tendon catches on A-1 pulley

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3
Q

Trigger finger - exam findings

A

Tenderness / pain over A-1 pulley (base of finger)
Catching of digit with flexion
Dx test unnecessary

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4
Q

Trigger finger - tx

A 
Cortisone injection (approx. 60% cure rate)
Sx release of A-1 pulley (approaches 100% cure)
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5
Q

Trigger finger - in general

A 
All ages (even newborns)
Common in DM
Repetitive motion?
Complaint is finger(s) locking/catching
Ring, long, thumb - most common 
Cause - unknown
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6
Q

DeQuervain’s Tenosynovitis - in general

A

Common adult (usually repetitive) d/o
May be seen post-partum
May be confused with thumb or wrist arthritis

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7
Q

DeQuervain’s Tenosynovitis - Exam findings

A

Complaint is wrist/thumb pain when lifting
Tender over 1st dorsal compartment (dorsal-radial wrist)
Swelling
Positive Finklestien’s test

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8
Q

DeQuervain’s Tenosynovitis - dx testing

A

Unnecessary

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9
Q

DeQuervain’s Tenosynovitis - Patho

A

Inflamed / swollen first dorsal compartment tendons and sheath

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10
Q

DeQuervain’s Tenosynovitis - tx

A 
Thumb spica splint
NSAIDs
Cortisone injections (70%)
Sx for refractory cases (release sheath)
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11
Q

Swan neck deformity - in general

A

Flexed DIP, hyperextended PIP
Loss of terminal extensor tendon
Commonly seen in RA or trauma

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12
Q

Swan neck deformity - tx

A

Recommend referral to hand surgeon
Flexible - splint PIP
Rigid - may need sx

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13
Q

Swan neck deformity - dx tests

A

X-ray

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14
Q

Boutonniere deformity - in general

A

Hyperextended DIP, flexed PIP

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15
Q

Boutonniere deformity - patho

A

Caused by loss of central tendon

Volar sublux of lateral bands

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16
Q

Boutonniere deformity - tx

A

May be closed (splint tx) or open (sx repair)

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17
Q

Tendon laceration - in general

A

Flexor or extensor tendons
Be leery of any cut on the hand
PE is key to dx
Often with nerve / vessel injury

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18
Q

Flexor Tendon laceration

A

Profundus and/or Sublimus tendons - recognize the normal cascade
Zones are important
Requires timely repair (within 3 weeks)
6-8 weeks rehab (hand therapist)

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19
Q

Profundus Tendon test

A

Flexion of the DIP only

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20
Q

Sublimus tendon test

A

Flexion of the PIP and MCP of one finger

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21
Q

Mallet finger - in general

A

Direct blow to extended digit
Present with drooping of DIP joint
May have a displaced fx fragment (take an x-ray)

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22
Q

Mallet finger - tx

A

Most tx with extension splint for 8 weeks

If joint is sublux, tx with ORIF or pinning

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23
Q

Gamekeeper’s thumb - in general

A

Ulnar collateral ligament tear of thumb (skier’s thumb)
Cause is blow to / fall on thumb
Severe MP joint pain & swelling

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24
Q

Gamekeeper’s thumb - exam

A

Laxity with valgus stress

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25
Q

Gamekeeper’s thumb - tx

A

If laxity present - sx

If partial tear (stable) - splint for 6 weeks

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26
Q

Phalanx fx - distal

A

Usually tx non-operatively

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27
Q

Phalanx fx - middle, proximal

A

Often unstable

If displaced, intra-articular or malrotated fx - ORIF vs. pinning

If non-displaced - splint appropriately

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28
Q

“jammed” finger - in general

A

Pt presents with swollen PIP joint after a blow to end of finger
All age groups
Often sports related

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29
Q

“jammed” finger - exam

A

Tender
Swollen
Stiff PIP joint

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30
Q

“jammed” finger - imaging

A

Isolated x-ray of digit
AP
Lat
May see small avulsion fx (volar plate injury)

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31
Q

“jammed” finger - tx

A

Early ROM

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32
Q

PIP fx / sublux

A

Presents similar to “jammed finger”
Lateral x-ray is key to dx
Requires CRIF or ORIF
Must restore joint congruity

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33
Q

Metacarpal / boxer’s fx

A 
Usually caused by a direct blow
Present with local pain / swelling
Check carefully for rotational deformity (requires ORIF)
"Knuckle" often depressed
Most tx non-operatively
Can accept 45° of angulation
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34
Q

Metacarpal shaft fx

A

Tx with splint if non-displaced or minimally displaced

Requires ORIF if significantly displaced or malrotated

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35
Q

Bennett’s fx

A

Intra-articulat fx at base of thumb metacarpal
Unstable injury (CMC joint sublux)
Requires ORIF or pinning

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36
Q

Distal radius fx - in general

A

Commonly referred to as Colle’s fx
Most common adult upper extremity fx
Usual cause is fall on an outstretched wrist (FOOSH)

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37
Q

Distal radius fx - tx

A

Depends on degree of displacement, age and activity level of pt

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38
Q

Colles’ fx - exam

A

Clinical deformity

Tender over distal radius

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39
Q

Colles’ fx - x-ray features

A

Dorsal tilt
Radial inclination
Radial length
Intra-articular vs. extra-articular

40
Q

Smith’s fx - in general

A

“reverse” Colles’ fx

Caused by fall on flexed wrist

41
Q

Smith’s fx - characteristic

A

Volar (palmer) tilit or distal fragment

42
Q

Smith’s fx - tx

A

Usually requires CRIF or pinning

43
Q

Scaphoid fx - in general

A

Most common fx of carpus
Younger population
Fall on outstretched wrist

44
Q

Scaphoid fx - exam

A

Snuff box tenderness

45
Q

Scaphoid fx - imaging

A

X-rays - “scaphoid” view
Initial is often negative
Non-union common

46
Q

Scaphoid fx - tx

A

Thumb spica splint if clinical suspicion for fx
Non-displaced fx require 8-12 week in thumb spica cast
Displaced fx’s require ORIF

47
Q

Scapholunate dissociation

A 
Scpholunate ligament tear
Present with swollen / tender wrist
4-5mm widening at S-L interval
Terry Thomas sign
Requires sx repair
48
Q

Hand infections - Causes

A 
"Fight bite"
Animal bites
Puncture wounds / deep space infections
Flexor tendon sheath infections
Felon / paronychia
Herpetic whitlow
49
Q

Human bites - in general

A

Following an altercation (fight bite)
Usually present 48-72h after
Joint sepsis or abscess
Mixed flora, usually staph aureus or Eikenella

50
Q

Human bites - imaging

A

x-ray for fx

51
Q

Human bites - tx

A 
I&D or arthrotomy
Deep cultures
Pack open
Heal by secondary intention
Cephalexion or augmentin for 7-10d
52
Q

Animal bites - in general

A

Most are pets
Often provoked
Multiple bite or punctures common
Consider rabies prophylaxis

53
Q

Animal bites - organisms

A

Alpha strep

Pasturella multicoda

54
Q

Animal bites - tx

A

Superficial - away from tendons and/or joints, then 7-10d augmentin
Deep - ie joint or tendon sheath - urgent sx drainage, oral abx
DO NOT CLOSE PUNCTURE WOUNDS

55
Q

Deep space infection

A 
Uncommon - 2% of hand infections
Penetrating trauma or puncture
Thenar / mid-space infections
MRI can be helpful
Sx drainage
Abx required
56
Q

Flexor Tenosynovitis - in general

A

Flexor tendon sheath infection
10% of all hand infections
Usual cause is penetrating trauma
Flexor tendon sheath is perfect environment for infection

57
Q

Flexor Tenosynovitis - usual organism

A

Staph

Strep

58
Q

Flexor Tenosynovitis - Kanaval’s signs

A

Semi-flexed posture of digit
Fusiform swelling
Tenderness, erythma along tendon
Severe pain with passive motion (extension)

59
Q

Flexor Tenosynovitis - tx

A

Urgent sx drainage
Irrigation cathereter flush for 24h
IV abx for least 24h, then oral for 7-10d

60
Q

Felon - in general

A

Deep pulp infection

10-15% of hand infections

61
Q

Felon - hx

A

Hx of puncture wound

62
Q

Felon - organism

A

Usually staph aureus

63
Q

Felon - dx

A

Intense pain
Redness at pulp
X-ray to r/o fb or osteo

64
Q

Felon - tx

A

Surgical drainage
Cx’s
Abx
Daily soaks and dressing changes

65
Q

Paronychia - in general

A

infection of soft tissue around nail

Usually trauma induced (manicure, hangnail)

66
Q

Paronychia - organisms

A

Acute - staph

Chronic paaronychia - candida albicans

67
Q

Paronychia - dx

A

Marked tenderness at later nailfold
Erythema
Fluctuance
Pus

68
Q

Paronychia - tx

A

Early - nail trimming, soaks, abx

Late - partial nail removal, drain abscess

69
Q

Herpatic whitlow - in genreal

A

Viral with incubation of 2-14d
Occupational / medical exposure
Extremely painful / sensitive - usually at fingertip

70
Q

Herpatic whitlow - dx

A

Painful / clear vesicales at fingertip
Sensitivitiy / burning may preclude vesicles
Viral cultures
Consider bacterial cultures

71
Q

Herpatic whitlow - tx

A

Sx / debridment is contraindicated
Self-limiting
Consider anti-virals
Recurrence is common

72
Q

OA - in general

A 
Most common of al larthritides
Hallmark - DIP (85%)
Herberdens nodes
Mucous custs
Thumb CMC 65%
PIP joint 45% (Brouchard's nodes)
Knees 62%, hips 30% - when hand involved
73
Q

Conservative management of OA

A

Rest / splinting
NSAIDS, ASA, Tylenol
Intra-articular cortisone injections
Glucosamine, chondroitin sulfate

74
Q

Sx Management of OA - thumb CMC joint

A

Fusion of CMC joint in younger / active pts
Limits motion eliminates pain
Allows maintenance of grip and pinch strength
CMC joint tendon interpostition arthroplasty

75
Q

Wrist arthritis

A 
Relatively uncommon
M>>F
>60yo
SLAC pattern
Responds well to wrist supports & cortisone injections
76
Q

Nerve compression - Median N. concerns

A

CTS
Pronator syndrome
Anterior interossesous syndrome

77
Q

Nerve compression - ulnar N. concerns

A

Guyon’s canal

Cubital tunnel

78
Q

Nerve compression - radial N. Concerns

A

Posterior interosseous N. compression

Radial tunnel

79
Q

CTS - in general

A

Dysfunction of median nerve cause by increased pressure within the carpal canal
Related to increased volume with the carpal canal
Inflammation or edema or synovium (cumulative trauma, arthritides)
Altered fluid balance (PG)

80
Q

CTS - Patho

A

Mild to moderate compression gives no lasting injury
Longstanding and severe pressure contributes to axonal injury
Loss of motor function usually irreversible

81
Q

CTS - presenting complaints

A 
"Numbness / tingling" - thumb, index, and middle digits
Pain / aching in hand or forearm
More frequent or severe at night
Weakness or clumsiness of hand
Able to "shake out" s/s
82
Q

CTS - eval

A

Inspection - thenar atrophy
Sensability - loss of 2 point discrimination
Provocative testing - positive Tinel’s, Phalen’s compression test

83
Q

CTS - dx testing

A 
Electrodx studies (gold standard)
EMG / NCS
84
Q

CTS - tx

A

Conservative - splints, NSAIDs, therapy, exercises
Steroid injections
Sx release - open or endoscopic

85
Q

Ganglion cysts - in general

A 
Common d/o of wrist
May be volar or dorsal (most common)
May be painful or cosmetic issue
Unknown cause
May follow simple traumatic injury
A simple cyst, filled with mucin, with stalk arising from wrist capsule
86
Q

Ganglion cysts - tx

A

Observe if painless of does not “bother pt”
Aspiration - 50/50 cure
Sx excision - 10% recurrence

87
Q

Dupuytren’s contracture - in general

A

Hereditary d/o (northern European families)
M>F
>40yo
Not a tendon problem

88
Q

Dupuytren’s contracture - patho

A

Thickening of palmer fascia

89
Q

Dupuytren’s contracture - presentation

A

Starts with a painless nodule

Contracture / cord is a late problem

90
Q

Dupuytren’s contracture - tx

A

Educate pt
Observe nodules
Sx excise cords - >30°
Inject collagenase - Xiaflex

91
Q

Xiaflex injection - in general

A

Palpable cord

Ideal candidate - isolated MP joint contracture

92
Q

Xiaflex injection - limitations

A

Only one joint per cord at a time

Reimbursement / cost

93
Q

Dupuytren’s diathesis

A 
Severe cases
Severe digital contractures - multiple digits including thumb
Knuckle pads
Plantar fibromatosis (Lederhosen's dz)
Peyronie's dz (penile contracture)
94
Q

Lederhosesn’s dz

A

Plantar fibromatosis

95
Q

Peyronie’s dz

A

penil contracture

Clin Med II - Ortho (13 decks)

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