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Clin Med IV Exam 1 > Hand and Wrist Injuries > Flashcards

Hand and Wrist Injuries Flashcards

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1
Q

What is Boxer’s Fracture ?

A

Fx of the 5th metacarpal neck

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2
Q

MOI Boxer’s Fx

A

Object struct w/ a closed fist

VOLAR angulation up to 40deg

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3
Q

Is rotational deformity acceptable in a boxer fracture?

A

NO; need surgery

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4
Q

What kind of splint/cast do you want to put a pt w/ a boxer fx in?

A

ULNAR GUTTER SPLINT 1st then transition to ULNAR GUTTER CAST (3-4wks)

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5
Q

What is a Bennet Fracture-Dislocation?

A

2 part fracture of BASE OF 1ST METACARPAL d/t force ABDUCTION of 1st metacarpal

intra-articular
thumb fracture

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6
Q

Comminuted intra-articular fx of 1st metacarpal is what?

A

ROLANDO FRACTURE

worst prognosis

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7
Q

What kind of splint/cast do you want to put a pt w/ bennet fx in?

A

THUMB SPICA SPLINT/CAST

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8
Q

Indication to do CRPP (closed reduction percutaneous pinning) fixation ?

A
  • <3mm displacement
  • break of fx <50% of palmar slope of MC
  • when concave dome of MC maintained
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9
Q

What is the most frequently fractured carpal bone?

A

SCAPHOID

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10
Q

What area on the hand can you palpate for tenderness when looking for a scaphoid fracture?

A

Snuff box

over scaphoid tuberosity

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11
Q

What ROM is limited in scaphoid fx?

A

Wrist flexion & extension

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12
Q

What MOI can cause a scaphoid injury?

A

FOOSH

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13
Q

What artery provides blood supply to scaphoid?

A

Dorsal carpal branch of radial artery

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14
Q

Which type of scaphoid fx will take longer to heal?
A. distal third fx
B. middle third fx
C. proximal third fx

A

Distal third fx (6-8wks)
Middle third fx (8-12wk)
Proximal third fx (12-23 wks)***

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15
Q

When would you get an MRI for a hand/wrist injury?

A

Occult fx or if surgery is indicated

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16
Q

How would you tx a non-displaced scaphoid fx?

A

THUMB SPICA SPLINT (6wks) followed by cast until radiographs shows signs of union

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17
Q

How often do you want to do a cast change and why?

A

q10-14 days for 1st 6wks

*want cast to remain firm around wrist

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18
Q

Basal Joint Arthritis presentation

A
  • insidious radial thumb pain that worsens w/ use
  • decrease strength & dexterity
  • increase pain w/ opposition (writing, opening jars, carrying heavy objects)
  • Crepitus
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19
Q

Where in the hand is basal joint arthritis seen?

A

1st carpal metacarpal joint

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20
Q

In what pt population is basal joint arthritis most commonly seen?

A

Post-menopausal women

50-70yo

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21
Q

What kind of test can you do to elicit pain for basal joint arthritis?

A

GRIND TEST of trapeziometacarpal joint

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22
Q

Tx for Basal Joint Arthritis?

A
  • Tylenol
  • NSAID (short term)
  • splinting
  • ice
  • intraarticular cortisone injection (not that great)
  • total joint replacement
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23
Q

Boutonniere Deformity

A

Flexion of PIP joint
Hyperextension DIP joint

*Manifestation of RA in hands

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24
Q

Swan Neck Deformity

A

Hyperextension PIP joint

Flexion DIP joint

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25
Causes of swan neck deformity
Trauma RA Scleroderma Psoriatic arthritis
26
What test can you do to dx Carpal tunnel syndrome?
Tinnel test | Phalen test
27
What nerve is being compressed in carpal tunnel syndrome?
MEDIAN NERVE
28
What is compressing the median n in carpal tunnel syndrome?
Transverse carpal ligament | d/t decrease canal size or increase vol of soft tissue structures in canal
29
What can you do to tx carpal tunnel syndrome?
- Wrist splint - PT - Ergonomics - Steroid injection - Surgery
30
Positive Finkelstein test is diagnostic for what?
deQuervain's Tenosynovitis | stenosing tenosynovitis of 1st dorsal compartment of wrist
31
Si/Sx deQuervain's Tenosynovitis
pain, swelling, point tenderness along dorsal radial aspect of wrist
32
Tx of deQuervain's Tenosynovitis
- rest/activity modification - thumb spica cast/splint immobolization - NSAIDs - PT - steroid injection - surgical decompression of 1st dorsal compartment
33
``` When would you NOT use a thumb spica cast/splint? A. Bennet fracture B. Scaphoid fx C. deQuervain's Tenosynovitis D. Boxer fx E. Gamekeeper's thumb ```
D. boxer fx (fx of 5th MC neck)
34
What is being injured in Gamekeeper's thumb?
Ulnar collateral ligament of thumb at MCP joint causes decrease thumb grip
35
What imaging do you need for gamekeeper's thumb?
Stress view and MRI | Plain films might not show deviation
36
Tx Gamekeeper's thumb?
Partial tear: -thumb spica cast/splint 4-6wks Complete tear: - open repair of avulsed ligament - necessary stener lesion
37
Kanavel cardinal signs are for what? and what are they?
HAND INFECTIONS 1. Tenderness along flexor tendon 2. edema 3. Pain w/ passive extension**** 4. flexed resting posture
38
What can cause a hand infection?
Cat bite human bite puncture wound (IV drug use)
39
Common bacteria hand infection
Staph* Strep Pasteurella (cat bite) Oral anaerobes
40
Why would get an x-ray for a hand infection?
Looking for FOREIGN BODIES & OSTEOMYELITIS
41
TX hand infection?
``` Cephalexin (Keflex) Clindamycin Cefazolin Unasyn Vancomycin ``` Surgical wash out
42
Tx for finger dislocation?
- Volar alumafoam splint - buddy tape - tylenol, nsaid, ice - follow up w/ hand surgeon
43
Presentation of mallet finger?
Inability to extend DIP joint | slight flexion at rest "mallet"
44
MOI of mallet finger?
extended DIP undergoes sudden FLEXION | extended finger struct at tip by an object
45
What splint do you put a mallet finger in?
STAX SPLINT 6-8wks in slight hyperextension (10deg) MUST NOT REMOVE FOR 6-8WKS
46
Presentation of jersey finger?
Inability to FLEX finger at DIP joint | slight extension at joint
47
What tendon is being injured in a jersey finger?
Flexor Digitorum Profundus (FDP) tendon (from insertion at base of distal phalanx
48
MOI jersey finger
Sudden HYPEREXTENSION of actively flexed finger (grabbing opponent's jersey during rugby) Ring finger is commonly involved
49
What imaging would you get for jersey finger?
MRI--shows disruption of FDP at volar base of distal phalanx +/- avulsion fx X-ray often normal
50
Presentation of trigger finger
- difficult to straighten or bend affected finger - finger transiently gets "locked" in flexed position & then w/ painful snapping sensation goes into extension - pt has to MANUALLY extend their finger
51
MOI of trigger finger
- stenosing flexor tensoynovitis - d/t repetitive microinjury from frequent flexion-extension movement of fingers --> result in thickening of flexor tendon sheath & tendon
52
In what pt population may you see a trigger finger?
Women 50-60yo Diabetic Rheumatoid arthritis
53
Tx of trigger finger
NSAID Splinting Glucocorticoid injection Surgery--release A1 pulley
54
Pt presents w/ the inability to grip everyday objects. The pt noticed this after falling from skiing. X-ray doesn't show any abnormalities. What additional view may you get to help you with your diagnosis?
Stress view --> for gamekeeper's (skier) thumb | MRI for surgical planning
55
Pt presents w/ 4th DIP joint in slight extension. Pt cannot actively flex the finger. Pt noticed this after playing rugby and grabbing the opponent's shirt. What injury may this be?
Jersey Finger--avulsion injury of flexor digitorum profundus tendon
56
45yo pt w/ a hx of heroin use presents w/ erythematous and swollen hand. Hand is slightly flexed and passive extension elicits pain. Based on the dx, what tx would you use? A. I & D B. Cephalexin C. Metronidazole D. NSAIDs
B. Cephalexin for the hand infection! Also surgical wash out Caused by: cat bite, human bite, puncture wound
57
55yo postmenopausal female presents w/ her 4th finger in a flexed position. She reports that she has manually extend her finger and when she does, it is VERY painful. What mechanism is causing this injury?
Stenosing flexor tenosynovitis --> thickening of flexor tendon sheath; repetitive microinjury from frequent flexion-extension Trigger Finger
58
Presentation of Duputren's Contacture?
- thickening or nodules in palm - painless initially - can progress to be painful w/ inflammation - usually ulnar side of both palms - 4th and 5th fingers affected earliest - loss of full extension of hand & fingers
59
MOI of duputren's contracture
Benign slowly progressive fibrosis of palmar fascia commonly male >50yo White northern european
60
Tx of Duputren's contractures?
- cortisone injection into sheath - surgery w/ open fasciotomy - collagenase injection - ppx external beam radiation therapy
61
T/F Mucous cyst seen in all ages
False! Seen in pt 50-70yo Ganglion cyst is seen in all ages
62
Presentation of ganglion cyst
- swelling +/- joint pain - cyst smooth, firm, rounded & rubbery (usu dorsal wrist) - sometimes tender
63
Tx ganglion cyst
-splinting -needle aspiration (apple jelly appearance) -surgical removal for recurrent cysts (40% recurrence rate)
64
Mucous cyst presentation
- visible swelling dorsal side of finger (DIP joint) - translucent nodule - groove in fingernail*
65
Tx mucous cyst
- intralesional corticosteroid injections | - surgical excision
66
HSV-1 + Painful fingertip = ?
Herpetic whitlow
67
Herpetic whitlow presentation
Painful, edematous fingertip w/ vesicular lesions | Most common digit: thumb, index finger
68
Dx herpetic whitlow
Clinical Tzank smear Viral cx Serum antibody titers
69
Tx Herpetic Whitlow
- Self-limited (approx 3wks) - Sx relief - Acyclovir - Famciclovir - Valacyclovir
70
Felon presentation
- throbbing pain - tension - edema - erythema
71
MOI of felon
- infection of fingertip pulp - thumb and index finger common affected - can lead to ischemic necrosis & osteomyelitis
72
Dx felon
Clinical | Culture any fluid (staph, MRSA, eikennel corrodens, GI pathogens)
73
Tx Felon
I&D Abx directed at staph & MRSA (cephalexin, doxycycline, dicloaxacillin, clinda, nafcillin, bactrim)
74
What would you NOT want to inject in a fingertip/nail injury?
No ring block | No epi
75
How would you tx a subungal hematoma of of the nailbed?
Trephination --> drill hole
76
Stellate laceration to nail. How would you repair?
- put any free tissue back into place - suture nail bed - small absorbable sutures - suture nail plate back - trephination
77
Early presentation of compartment syndrome
Pain out of proportion to injury | Parethesia (pin and needle sensation
78
Late presentation of compartment syndrome
``` Pain Pallor Parethesia Paralysis Pulselessness --> LAST ```
79
What pt population may you see compartment syndrome in?
- Athletes - young men - following trauma - pt w/ casted extremity - pt w/ fx of radius & ulnar
80
TX for compartment syndrome?
Fasciotomy (relieve pressure in compartment) Will need to return to OR for closure at later date
81
How often can you give an intra-articular corticosteroid injection to a single joint within a year?
3 injections per joint in 12month period
82
Adverse reactions to intra-articular corticosteroid injection
- Blanching of skin - localize fat atrophy - injection - transient rise in blood glucose
83
Non traumatic cases that can cause compartment syndrome
- Animal venom - Injection recreational drug - Prolong compression - Thrombosis vascular dz

Clin Med IV Exam 1 (9 decks)

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