Hand and Wrist Flashcards
(95 cards)
1
Q
Common Hand d/o
A
Tendon / ligament problems Fx Infections Arthrist Nerve entrapment / other
2
Q
Trigger finger - Patho
A
Swollen flexor tendon catches on A-1 pulley
3
Q
Trigger finger - exam findings
A
Tenderness / pain over A-1 pulley (base of finger)
Catching of digit with flexion
Dx test unnecessary
4
Q
Trigger finger - tx
A
Cortisone injection (approx. 60% cure rate) Sx release of A-1 pulley (approaches 100% cure)
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
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
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
8
Q
DeQuervain’s Tenosynovitis - dx testing
A
Unnecessary
9
Q
DeQuervain’s Tenosynovitis - Patho
A
Inflamed / swollen first dorsal compartment tendons and sheath
10
Q
DeQuervain’s Tenosynovitis - tx
A
Thumb spica splint NSAIDs Cortisone injections (70%) Sx for refractory cases (release sheath)
11
Q
Swan neck deformity - in general
A
Flexed DIP, hyperextended PIP
Loss of terminal extensor tendon
Commonly seen in RA or trauma
12
Q
Swan neck deformity - tx
A
Recommend referral to hand surgeon
Flexible - splint PIP
Rigid - may need sx
13
Q
Swan neck deformity - dx tests
A
X-ray
14
Q
Boutonniere deformity - in general
A
Hyperextended DIP, flexed PIP
15
Q
Boutonniere deformity - patho
A
Caused by loss of central tendon
Volar sublux of lateral bands
16
Q
Boutonniere deformity - tx
A
May be closed (splint tx) or open (sx repair)
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
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)
19
Q
Profundus Tendon test
A
Flexion of the DIP only
20
Q
Sublimus tendon test
A
Flexion of the PIP and MCP of one finger
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)
22
Q
Mallet finger - tx
A
Most tx with extension splint for 8 weeks
If joint is sublux, tx with ORIF or pinning
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
24
Q
Gamekeeper’s thumb - exam
A
Laxity with valgus stress
25
Gamekeeper's thumb - tx
If laxity present - sx
If partial tear (stable) - splint for 6 weeks
26
Phalanx fx - distal
Usually tx non-operatively
27
Phalanx fx - middle, proximal
Often unstable
If displaced, intra-articular or malrotated fx - ORIF vs. pinning
If non-displaced - splint appropriately
28
"jammed" finger - in general
Pt presents with swollen PIP joint after a blow to end of finger
All age groups
Often sports related
29
"jammed" finger - exam
Tender
Swollen
Stiff PIP joint
30
"jammed" finger - imaging
Isolated x-ray of digit
AP
Lat
May see small avulsion fx (volar plate injury)
31
"jammed" finger - tx
Early ROM
32
PIP fx / sublux
Presents similar to "jammed finger"
Lateral x-ray is key to dx
Requires CRIF or ORIF
Must restore joint congruity
33
Metacarpal / boxer's fx
```
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
```
34
Metacarpal shaft fx
Tx with splint if non-displaced or minimally displaced
Requires ORIF if significantly displaced or malrotated
35
Bennett's fx
Intra-articulat fx at base of thumb metacarpal
Unstable injury (CMC joint sublux)
Requires ORIF or pinning
36
Distal radius fx - in general
Commonly referred to as Colle's fx
Most common adult upper extremity fx
Usual cause is fall on an outstretched wrist (FOOSH)
37
Distal radius fx - tx
Depends on degree of displacement, age and activity level of pt
38
Colles' fx - exam
Clinical deformity
| Tender over distal radius
39
Colles' fx - x-ray features
Dorsal tilt
Radial inclination
Radial length
Intra-articular vs. extra-articular
40
Smith's fx - in general
"reverse" Colles' fx
| Caused by fall on flexed wrist
41
Smith's fx - characteristic
Volar (palmer) tilit or distal fragment
42
Smith's fx - tx
Usually requires CRIF or pinning
43
Scaphoid fx - in general
Most common fx of carpus
Younger population
Fall on outstretched wrist
44
Scaphoid fx - exam
Snuff box tenderness
45
Scaphoid fx - imaging
X-rays - "scaphoid" view
Initial is often negative
Non-union common
46
Scaphoid fx - tx
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
Scapholunate dissociation
```
Scpholunate ligament tear
Present with swollen / tender wrist
4-5mm widening at S-L interval
Terry Thomas sign
Requires sx repair
```
48
Hand infections - Causes
```
"Fight bite"
Animal bites
Puncture wounds / deep space infections
Flexor tendon sheath infections
Felon / paronychia
Herpetic whitlow
```
49
Human bites - in general
Following an altercation (fight bite)
Usually present 48-72h after
Joint sepsis or abscess
Mixed flora, usually staph aureus or Eikenella
50
Human bites - imaging
x-ray for fx
51
Human bites - tx
```
I&D or arthrotomy
Deep cultures
Pack open
Heal by secondary intention
Cephalexion or augmentin for 7-10d
```
52
Animal bites - in general
Most are pets
Often provoked
Multiple bite or punctures common
Consider rabies prophylaxis
53
Animal bites - organisms
Alpha strep
| Pasturella multicoda
54
Animal bites - tx
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
Deep space infection
```
Uncommon - 2% of hand infections
Penetrating trauma or puncture
Thenar / mid-space infections
MRI can be helpful
Sx drainage
Abx required
```
56
Flexor Tenosynovitis - in general
Flexor tendon sheath infection
10% of all hand infections
Usual cause is penetrating trauma
Flexor tendon sheath is perfect environment for infection
57
Flexor Tenosynovitis - usual organism
Staph
| Strep
58
Flexor Tenosynovitis - Kanaval's signs
Semi-flexed posture of digit
Fusiform swelling
Tenderness, erythma along tendon
Severe pain with passive motion (extension)
59
Flexor Tenosynovitis - tx
Urgent sx drainage
Irrigation cathereter flush for 24h
IV abx for least 24h, then oral for 7-10d
60
Felon - in general
Deep pulp infection
| 10-15% of hand infections
61
Felon - hx
Hx of puncture wound
62
Felon - organism
Usually staph aureus
63
Felon - dx
Intense pain
Redness at pulp
X-ray to r/o fb or osteo
64
Felon - tx
Surgical drainage
Cx's
Abx
Daily soaks and dressing changes
65
Paronychia - in general
infection of soft tissue around nail
Usually trauma induced (manicure, hangnail)
66
Paronychia - organisms
Acute - staph
Chronic paaronychia - candida albicans
67
Paronychia - dx
Marked tenderness at later nailfold
Erythema
Fluctuance
Pus
68
Paronychia - tx
Early - nail trimming, soaks, abx
Late - partial nail removal, drain abscess
69
Herpatic whitlow - in genreal
Viral with incubation of 2-14d
Occupational / medical exposure
Extremely painful / sensitive - usually at fingertip
70
Herpatic whitlow - dx
Painful / clear vesicales at fingertip
Sensitivitiy / burning may preclude vesicles
Viral cultures
Consider bacterial cultures
71
Herpatic whitlow - tx
Sx / debridment is contraindicated
Self-limiting
Consider anti-virals
Recurrence is common
72
OA - in general
```
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
Conservative management of OA
Rest / splinting
NSAIDS, ASA, Tylenol
Intra-articular cortisone injections
Glucosamine, chondroitin sulfate
74
Sx Management of OA - thumb CMC joint
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
Wrist arthritis
```
Relatively uncommon
M>>F
>60yo
SLAC pattern
Responds well to wrist supports & cortisone injections
```
76
Nerve compression - Median N. concerns
CTS
Pronator syndrome
Anterior interossesous syndrome
77
Nerve compression - ulnar N. concerns
Guyon's canal
| Cubital tunnel
78
Nerve compression - radial N. Concerns
Posterior interosseous N. compression
| Radial tunnel
79
CTS - in general
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
CTS - Patho
Mild to moderate compression gives no lasting injury
Longstanding and severe pressure contributes to axonal injury
Loss of motor function usually irreversible
81
CTS - presenting complaints
```
"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
CTS - eval
Inspection - thenar atrophy
Sensability - loss of 2 point discrimination
Provocative testing - positive Tinel's, Phalen's compression test
83
CTS - dx testing
```
Electrodx studies (gold standard)
EMG / NCS
```
84
CTS - tx
Conservative - splints, NSAIDs, therapy, exercises
Steroid injections
Sx release - open or endoscopic
85
Ganglion cysts - in general
```
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
Ganglion cysts - tx
Observe if painless of does not "bother pt"
Aspiration - 50/50 cure
Sx excision - 10% recurrence
87
Dupuytren's contracture - in general
Hereditary d/o (northern European families)
M>F
>40yo
Not a tendon problem
88
Dupuytren's contracture - patho
Thickening of palmer fascia
89
Dupuytren's contracture - presentation
Starts with a painless nodule
Contracture / cord is a late problem
90
Dupuytren's contracture - tx
Educate pt
Observe nodules
Sx excise cords - >30°
Inject collagenase - Xiaflex
91
Xiaflex injection - in general
Palpable cord
Ideal candidate - isolated MP joint contracture
92
Xiaflex injection - limitations
Only one joint per cord at a time
Reimbursement / cost
93
Dupuytren's diathesis
```
Severe cases
Severe digital contractures - multiple digits including thumb
Knuckle pads
Plantar fibromatosis (Lederhosen's dz)
Peyronie's dz (penile contracture)
```
94
Lederhosesn's dz
Plantar fibromatosis
95
Peyronie's dz
penil contracture
