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Medicine II: Orthopedics > Hand & Wrist > Flashcards

Flashcards in Hand & Wrist Deck (67)
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1

Carpal tunnel syndrome presentation

Compression of the median nerve at the wrist. It is the most common peripheral nerve entrapment.

2

Diagnosing Carpal tunnel syndrome

Tinels, Phalens, Reverse Phalens, +/- thenar wasting and electrodiagnositic studies

3

Tx of Carpal tunnel syndrome

Activity modification, splints, NSAIDS, B12, cortisone injections.

Surgical: open vs endoscopic carpal tunnel release (open- cut the extensor retinaculum.

4

Risk Factors for Carpal Tunnel Syndrom

Pregnant, DM, hypothyoid, RA, repetitive use

5

DeQuervain tendonitis

Inflammation of the 1st dorsal compartment. Abductor Policis Longus and Extensor Policis Brevis.

6

Cause of DeQuervains tendonitis

from repetitive use, insidious onset

7

Presentation of DeQuervains tendonitis

Pain with thumb extension, abduction or flexion, thumb with ulnar deviation.

8

Diagnosis of DeQuervains tendonitis

Redness, swelling, crepitus, RSN injections

9

Tx of DeQuervains tendonitis

Non-surgical: Ice, thumb sicca splint, rest, injection

Surgical: surgical release of 1st dorsal compartment

10

Finkelstein test

Fist and go down

11

Trigger finger presentation

irritated tendon- swelling, can form nodule causing finger to catch or lock in flexion or extension.

12

Cause of Trigger Finger

Excessive Use

13

Tx of Trigger finger

Non-surgical: Resting, splinting, NSAIDS, injections;

Surgical: Release of Pulley (A1 pulley most common site)

14

Ganglion cyst presentation

Most common soft tissue tumors of the hand (benign). Cysts are filled with mucin.

15

Cause of ganglion cysts

obscure

16

Tx of Ganglion cyst

Reassurance, Aspiration (high recurrence, not recommended for volvar), surgical excision

17

Locations of Ganglion Cysts

Dorsal (most common)- from SLJ, volvar, radial, retinacular (flexor tendon), mucous cysts (DIPJ)

Occult Ganglion- not visible- SLJ, usually more symptomatic.

18

Gamekeeper’s thumb labs/tests

Get an X-ray, may see Steners Lesion.

19

Infectious flexor tenosynovitis presentation

Infection of flexor tendon sheath usually from a puncture. Usually caused by S. aureus.

20

Infectious flexor tenosynovitis labs/tests

Kanavel Signs

21

Tx of Infectious flexor tenosynovitis

Requires I&D

22

Kanavel signs

4 signs of flexor tenosynovitis:
1. tenderness along the whole tendon sheath (late sign).
2. finger held in flexion.
3. fusiform swelling (sausage digit).
4. pain with passive extension (earliest finding).

23

Smith Fractures

Fracture of the distal radius from a PALMAR flexion injury. (Inward).

24

Colles Fracture

Fracture of the distal radius with DORSAL displacement from a FOOSH.

25

Boxers Fracture

Fracture of the 5th MC neck as a result of axial load, usually from punching wall, head or mouth. Check for lacerations/cuts on hand for a foreign object (may require removal and I&D)

26

Risk factors for osteomyelitis

Infection of bone by bacteria or fungus, resulting in bony changes and destruction. Develops by spread of infection from contiguous structures or hematogenous spread.

27

Etiologies for osteomyelitis

Most common cause is S. Aureus

28

Clinical presentation of osteomyelitis

Pain at site, warmth, swelling, erythema

29

Appropriate diagnostic studies for osteomyelitis

Radiographs early in course are normal, later will show bone demineralization, periosteal elevation, late lytic lesions.

Bone biopsy confirms diagnosis/ S. aureus is most common. Blood cultures can help too. Necessary for abx guidance.

30

Treatment for osteomyelitis

Abx