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Flashcards in Hand (RITA) Deck (37):
1

What is the MOI for skiers thumb/gamekeepers thumb?

forced or repetitive radial deviation of dumb

2

What are complications associated with thumb MCP joint injuries?

chronic laxity leading to DJD
decreased pinch and grip strength
pain

3

What clinical finding is found with thumb MCP joint injuries when ulnar stress is applied to joint?

INSTABILITY
15* valgus deformity compared to uninvolved side

4

What are treatments for thumb MCP joint injuries?

splint
cast
surgical repair of ligament

5

What do you need to rule out for thumb MCP joint injuries?

avulsion fx of MC bone - check X-rays before stress testing

6

What are indications for surgical repair of MCP joint injuries?

complete UCL rupture
UCL injury with fx that is rotated, displaced, or interarticular
Stener lesion

7

What is stener lesion?

aponeurosis of adductor pollicis becomes interposed bw ruptured UCL of thumb and its site of insertion at base of prox phalanx

8

What is the outcome of stener lesion?

UCL cannot heel spontaneously because the ligament looses contact with its insertion site

9

What is primary surgical intervention for MCP joint injuries prior to 6 weeks post injury?

direct reinsertion of ligament onto bone

10

For chronic instability or delayed repair, what is surgical intervention of MCP joint injuries?

tendon transfers or MCP joint fusion

11

With UCL tear, what is prognosis 3 weeks after surgery?

96% full fxn

12

If repair of UCL tear occurs > 6 weeks after injury what is prognosis?

poor

13

The carpal tunnel is formed by?

carpal bones and 9 flexor tendons
covered by carpal ligament

14

CTS is usually related to what conformation of the tunnel?

volumetric increases of contents of tunnel OR decreases of tunnel dimensions

15

What are common causes of CTS?

structural/traumatic changes
underlying systemic/physiological disorders
repeated microtrauma due to repetitive use
pressures within tunnel with positions

16

What is the pressure in the carpal tunnel with neutral wrist?

20 mmhg

17

What is the pressure in the carpal tunnel with 20* flex at wrist?

35 mmhg

18

What is the pressure in the carpal tunnel with 44* flex at wrist?

45 mmhg

19

What is the pressure in the carpal tunnel with 20* ext at wrist?

30 mmhg

20

What is male:female ratio of CTS incidence?

1:3

21

What are risk factors for CTS?

repetitive use
force
posture/unaccustomed work activities
vibration/temperature
personal risk factors

22

What is double crush syndrome?

peripheral nere phenomenon associated with two neurological involvements

23

What is the most common double crush syndrome pathology combo?

CTS/TOS/Cubital tunnel syndrome
clinical evidence in 64%

24

What is the incidence of CTS + TOS?

30%

25

What is the incidence of CTS + cervical radiculopathy?

18%

26

How is double crush syndrome diagnosed?

electrophysiology
pahlens test
tinel test
semmes weinstein

27

What are indications for surgical treatment of CTS?

> 6 month duration of symptoms
not responding to conservative treatment
severe symptoms interfere with sleep and fan
clinical/electrophysio evidence of median nerve dysfxn

28

To treat CTS, the _____ ligament may be released.

transverse retinacular ligament
(arthroscopic or open)

29

A complication of CTS surgery is decreased grip/pinch strength an dexterity for up to ____ months.

25

30

CTS surgery complications include:

decreased wrist/grip/pinch strength
stiffness
nerve adherence
hypersensitivity
pillar pain

31

What is pillar pain?

pain on either side of the incision

32

What factors interfere with surgical treatment success of CTS?

> 65yo
severe pre-op symptoms
poor ncv results
hemodialysis
ETOH abuse/smoking
heavy labor
poor mental health

33

What is DeQuervain's tenosynovitis?

inflammation of tendon sheath of APL and EPB due to excessive friction bw two tendons

34

What factors are associated with DeQuervain's tenosynovitis

DM
hypothyroidism
pregnancy
RA
Gender

35

What are some differential Dxs for DeQuervain's tenosynovitis?

thumb CMC arthritis
scaphoid fx
entrapment of superficial branch of radial n
radiocarpal dysfxn

36

What are symptoms/clinical findings of DeQuervain's tenosynovitis?

decreased strength
pain/swelling/heat at thumb base
℅ pain with resisted MCP thumb extension

37

What sign might be positive with DeQuervain's tenosynovitis?

Finkelstein