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Clinical Medicine II > Hand + wrist > Flashcards

Hand + wrist Flashcards

(58 cards)

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1
Q

Pain, burning, tingling along median nerve, frequently dropping things
Night pain + numbness
Radiation into forearm, elbow, shoulder, neck and chest
Feels need to “shake” or “rub” hands

A

carpal tunnel syndrome

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2
Q

Entrapment of medial nerve at wrist – MC compression

A

carpal tunnel syndrome

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3
Q

PE:
Thenar atrophy (thumb opposition weakness)
Median nerve compression test
+ Phalen’s test
+ Tinel’s sign
Two point discrimination >5mm
Test:
EMG/NCV
XR

A

carpal tunnel syndrome

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4
Q

How do you treat carpal tunnel syndrome?

A

Splinting
Steroid injection
Ergonomic modifications
Surgery

Pregnancy = resolves after birth + only can use splint

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5
Q

Nodular or cord-like thickening near distal palmar crease
Ring + pinky most commonly involved
Extension limited, flexion normal
May resemble callus
Non tender

A

dupuytren’s contracture

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6
Q

RF for dupuytren’s contracture

A

“Viking” - northern European descent
Genetic
Men >50 years
ETOH, smoking, diabetes, repetitive trauma

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7
Q

thickening/fibrosis of palmar fascia

A

Dupuytren’s contracture

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8
Q

How do you treat dupuytren’s contracture?

A

Splints to slow progression

Can try steroid injection or collagenase

Surgery if severe and interferes w/ function

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9
Q

Pain + swelling over radial styloid w/ movement or making a fist

A

de quervain’s tenosynovitis

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10
Q

Irritation + swelling of tendons on thumb side of wrist (abductor pollicis + extensor pollicis) → inflammation causes constriction → “triggering” or “sticking”

A

de quervain’s tenosynovitis

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11
Q

+ Finkelstein’s test
Tender to palpitation
Crepitation

XR: to rule out bone pathology, calcium deposit in tendon
Draw blood uric acid to rule out gout

A

de quervain’s tenosynovitis

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12
Q

How do you treat de quervain’s tenosynovitis?

A

Immobilize
2 week course of NSAIDS

Injection
Surgery

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13
Q

Dorsal or volar
Painful or painless
Can change in size w/ activity
lump

A

ganglion of wrist

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14
Q

Cystic structure from synovial sheath or joint cavity, one wave valve

A

wrist ganglion

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15
Q

A wrist ganglion does/does not transilluminate

A

does

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16
Q

how do you treat a wrist ganglion?

A

Reassurance
Immobilization
Aspiration (recurrence)
Surgical excision

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17
Q

2 types of arthritis in your hand

A

rheumatoid
osteoarthritis

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18
Q

MCP joints + wrists, ulnar drift of fingers, hyperextension of PIP, flexion of DIP (swan neck deformity)

A

rheumatoid arthritis

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19
Q

DIP + PIP, thumb carpometacarpal

A

osteoarthritis

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20
Q

rheumatoid vs osteoarthritis

A

Rheumatoid = systemic affecting synovial tissue

Osteoarthritis = loss of articular cartilage

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21
Q

Bony nodules at DIP = Heberden’s
Bony nodules at PIP = Bouchard’s

Tests:
→ AP/lat/oblique XR
→ blood test: RH factor, CRP, ESR

A

arthritis

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22
Q

osteoarthritis can be present in the — while rheumatoid arthritis is more present in the phalanges only

A

thumb

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23
Q

How do you treat rheumatoid arthritis?

A

systemic treatment (enbrel, remicade), NSAIDs, splinting, injections, therapy, no cure

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24
Q

How do you treat osteoarthritis?

Study These Flashcards
A

NSAIDS, splinting, surgery

25
Swelling, discoloration, pain, instability around thumb
ulnar collateral ligament tear
26
“gamekeeper/skier’s” thumb → forced radial deviation (exact incident occurs)
ulnar collateral ligament tear
27
XR: AP + lat + oblique views to rule out fracture Stress views of MP joints w/ comparison >30 degree angulation = complete tear
ulnar collateral ligament tear
28
How do you treat an ulnar collateral ligament tear?
Incomplete = splint Complete = surgery
29
Pain + swelling around thumb
bennett's fracture
30
Oblique fracture of base of thumb metacarpal Small fragment remains attached to carpal - metacarpal fragment dislocates
bennett's fracture
31
You treat bennett's fracture with
surgery
32
Pain over snuffbox, with gripping Men 20-40 MC fractured carpal bone Concern for avascular necrosis
scaphoid fracture
33
>--mm displacement means a high nonunion rate
1mm
34
How do you treat a scaphoid fracture?
Negative XR = thumb spica cast 1-2 weeks, then re-XR Positive XR = thumb spica cast x 6 weeks w/ evidence of healing, continue until healed If widening/resorption, refer for surgery
35
Pain, stiffness, swelling on back of hand, Osteonecrosis of lunate, often from lunate fracture
kienbock disease
36
You will see waht on a kienbock disease imaging?
increased density of lunate
37
How do you treat keinbock disease?
Immobilize + NSAIDs
38
Catching of finger, nodule palpable in palm at distal palmar crease Diabetes, rheumatoid Kids = thumb
trigger finger
39
Inflammation of flexor tendon/pulley of thumb, ring, long fingers
trigger finger
40
How do you treat a trigger finger?
splinting/casting Injection surgery
41
Unable to extend DIP joint Tender, swollen
mallet finger
42
MC extensor tendon injury → rupture of extensor tendon at base of distal phalanx
mallet finger
43
XR: avulsion off dorsal side of distal phalanx
mallet finger
44
How do you treat mallet finger?
Splint to keep DIP joint in extension for 6-8 weeks Full time
45
Tear of central portion of extensor ligament at PIP joint Flexes from unopposed pull of tendon + DIP joint extends
boutinerre deformity
46
How do you treat boutinerre deformity?
Splint PIP joint in extension 6 weeks for young 3 weeks for elderly
47
Pain, swelling, ecchymosis around pinky → check for shortening, knuckle depression, rotation
boxer's fracture
48
Fracture of 5th metacarpal neck Hitting someone or a wall
boxer's fracture
49
document ---- in a boxer's fracture
angulation
50
How do you treat a boxer's fracture
Cast (ulnar gutter) Surgery if displaced >40 degrees
51
Pain, swelling, deformity "dinner fork"
Colle's
52
MC distal radius fracture - “dinner fork”, fall onto extended wrist Distal radius fragment tilted upward or dorsal
colle's
53
With colle's and smith's fractures around the wrist, ALWAYS check --
neurovascular exam
54
How do you treat a colle or smith fracture?
reduction, cast, surgery
55
Reverse colle’s – distal fragment tilted downward or volarly Fall onto flexed wrist
smith's
56
animal bites are 90% --
dogs
57
only 5% cats but more associated with --
infection (pasturella)
58
How do you treat animal bites?
Irrigation + debridement Prophylaxis required in high risk bites + patients All cats Hand bites by animals or human amox/clav Tetanus, rabies prophylaxis Admit all infected + bites + deep bites

Clinical Medicine II (50 decks)

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