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Clin Med I > hand, wrist, and ortho infections > Flashcards

hand, wrist, and ortho infections Flashcards

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1
Q

boxer’s fx

A
  • fx through base of 5th metacarpal neck
  • occurs when closed fist strikes hard surface
  • volar angulation up to 40 degrees acceptable
  • rotational deformity cannot be accepted
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2
Q

treatment of boxers fx

A
  • volar angulation > 45 degrees then reduce fx
  • unlar gutter cast for 3-4 weeks then splint
  • surgical repair
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3
Q

bennett fx

A
  • two part intra-articular fx and dislocation of the base of the 1st metacarpal
  • d/t forced abduction
  • common thumb fx
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4
Q

xray findings for bennett fx

A
  • 2 piece intraarticular fx at base of thumb
  • dorsolateral dislocation
  • sm fragment of 1st mc continues to articulate with trapezium
  • lateral reduction of 1st mc shaft by abductor pollicis longus
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5
Q

rolando fx

A
  • comminuted bennett fx dislocation
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6
Q

bennett fx treatment

A
  • CRPP fixation
  • thumb spica for 4-6 weeks
  • if reduction not possible then ORIF with cortical screw
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7
Q

scaphoid fx

A
  • most frequently fx carpal bone
  • usually in waist of scaphoid
  • cannot miss these fx- can cause necrosis
  • usually d/t foosh
  • time for union takes longer in proximal fx
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8
Q

major blood supply to scaphoid

A
  • retrograde flow from dorsal carpal branch of radial artery
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9
Q

clinical findings for scaphoid fx

A
  • TTP over anatomical snuff box
  • TTP over scaphoid tuberosity
  • limited wrist flex/ext
  • radial and ulnar deviation cause pain on radial side
  • forced dorsiflexion= very painful
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10
Q

treatment for scaphoid fx

A
  • nondisplaced- thumb spica cast for 6 weeks then short thumb spica until signs of union
  • immobilization 16 weeks- 6 months
  • cast changes q10-14 days for 1st 6 weeks
  • if displaced ORIF then thumb spica
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11
Q

basal joint arthritis

A
  • more common in post-menopausal women
  • insidious onset radial thumb pain worsens with use
  • decrease ADLs, strength, dexterity
  • pain with thumb opposition
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12
Q

clinical presentation of basal joint arthritis

A
  • dorsoradial prominence of thumb mc base secondary to subluxation
  • TTP at trapexiometacarpal joint and scaphtrapezial joint
  • crepitus
  • grind test -> pain
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13
Q

treatment of basal joint arthritis

A
  • NSAIDs
  • splinting
  • ice
  • intraarticular cortisone inj
  • total joint replacement via anchovy technique
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14
Q

carpal tunnel syndrome

A
  • most common compressive neuropathy of UE
  • median nerve compressed by transverse ligament
  • d/t decreased canal size or increased volume of soft tissue
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15
Q

diagnosis for carpal tunnel

A
  • tinel sign- tap over transverse ligament

- phalen sign- have pt press backs of hands against each other for a few min

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16
Q

treatment for carpal tunnel

A
  • wrist splint- 20 degrees ext
  • pt
  • ergonomics
  • steroid injection
  • surgery
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17
Q

dequervain’s syndrome

A
  • stenosing tenosynovitis of 1st dorsal compartment
  • abductor pollicis longus and extensor pollicus brevis
  • most common in women on dominant hand
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18
Q

clinical presentation of dequervain’s syndrome

A
  • pain
  • swelling
  • TTP over dorsal radial aspect of wrist
  • worse with activity
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19
Q

diagnosis of dequervain’s sydnrome

A
  • finkelstein test- fist made with thumb inside fingers then ulnar deviate
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20
Q

treatment for dequervain’s syndrome

A
  • rest/ activity modification
  • thumb spica
  • NSAIDs
  • PT
  • steroid inj
  • surgical decompression
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21
Q

gamekeeper’s thumb

A
  • injury to ulnar collateral ligament of them at MCP joint
  • instability of MCP joint and decreased grip strength
  • aka skier’s thumb
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22
Q

diagnosis of gamekeeper’s thumb

A
  • plain films may not show deviation
  • perform stress test
  • MRI for surgical planning
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23
Q

treatment of gamekeeper’s thumb

A
  • conservative for partial tear- thumb spica for 4-6 weeks
  • surgical repair for full tears
  • surgery required for stener lesion
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24
Q

stener lesion

A
  • piece of first metacapral gets avulsed off with a gamekeeper’s thumb
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25
treatment for finger dislocations
- reduce - volar alumafoam splint - buddy tape with gauze between fingers - tylenol, NSAIDs - ice - follow up with hand surgeon
26
mallet finger
- disruption of ext mechanism of finger at DIP joint - occurs when DIP undergoes sudden flexion - often when ball strikes tip of finger - can cause bony avulsion injury or tendinous injury
27
clinical presentation of mallet finger
- inability to extend DIP | - slight flexion at rest
28
treatment for mallet finger
- stax splint for 6-8 weeks with DIP in 10 degrees hyperextension to be worn AT ALL TIMES
29
jersey finger
- avulsion of flexor digitorum profundus from insertion at base of distal phalanx - results from sudden hyperext of actively flexed finger - mainly seen in ring finger
30
clinical presentation of jersey finger
- inability to flex finger at DIP - TTP over volar aspect of distal finger - xrays usually normal - may have bony avulsion fragment at distal phalanx - MRI- disruption of FDP at volar vase of distal phalanx
31
treatment for jersey finger
- conservative for partial tear | - surgical intervention for all complete tears
32
trigger finger
- stenosing flexor tenosynovitis - d/t repetitive micro-injury from frequent flexion or extension - causes thickening of flexor tendon/ sheath and A1 pulley - common in adult women 50-60
33
clinical presentation of trigger finger
- difficulty straightening or bending affected finger - transiently locked into flexed position - with a painful snap can go into extension - often have to manually extend finger
34
treatment for trigger finger
- NSAIDs - splinting - steroid injection - surgery to release A1 pulley- very successful and is an OP procedure
35
Dupuytren's contractures
- palmar fibromatosis -> firm nodule on volar surface of hand - results in loss of full ext of hand and fingers - usually in older males
36
associated diseases of Dupuytren's contractures
- DM - epilepsy - alcoholism - keloids - plantar fibromatosis
37
clinical presentation of dupuytren's contractures
- thickening or nodules on palm - painless at first -> eventually inflamed and painful - ulnar side of both palms frequently involved - 4th and 5th digits affected earliest
38
treatment for dupuytren's contractures
- cortisone inj into sheath - collagenase inj - prophylactic external beam radiation to slow progression - surgery with open fasciotomy
39
ganglion cyst
- most common soft tissue tumor of hand - usually dorsal aspect of wrist - fluid filled swelling over a joint or tendon - gelatinous or mucinous fluid - d/t over use near the affected joint
40
clinical presentation of ganglion cyst
- swelling - joint pain +/- tenderness - smooth, firm, rounded
41
treatment for ganglion cyst
- splinting - needle aspiration- apply jelly like appearance - surgical removal - may reoccur with needle aspiration and surgery
42
mucous cysts
- benign cyst usually at DIP on dorsal surface - associated with OA - dev later in life
43
clinical presentation of mucous cysts
- visible swelling on dorsal side of finger - translucent nodule that may be painful - groove in finger nail d/t pressure on matrix
44
treatment for mucous cysts
- steroid injection- triamcinolone | - surgical excision only when really necessary
45
nail bed injuries/ lacerations
- most nailbed injuries also involve DIP fx - usually d/t crush injury - can have simple lac or stellate lac - simple lacs dont extend into peripheral tissue
46
treatment for nail bed injuries
- repair, can be complex - anesthesia- finger block or sedation - NO epi - adhesives may be used instead of stitches - subungual hematomas require trephination - if nail elevation dont remove nail - suture distal portion of nail bed
47
complex stellate nail bed repair
- need to remove nail plate - any free tissue put back into place - suture nail bed and plate back - small absorbable sutures used - trephination of nail
48
crush injuries to nail bed
- can cause tuft fx or distal phalanx fx - repair nail bed and replace nail plate - if displaced then reduce and suture
49
missing nail plate repair
- repair nail bed - reinforce silicone or sterile petroleum gauze - new nail will eventually grow
50
compartment syndrome
- muscle fascia prevents expansion of tissue - surgical emergency in acute setting- limb threatening - usually assoc with closed injuries of extremities - can occur in casted extremity - venous outflow decreases as arterial flow increases
51
common sites for compartment syndrome to occur
- leg and forearm - radius - ulna - proximal tibia - especially when casted
52
what causes acute compartment syndrome
- usually trauma
53
what causes chronic compartment syndrome
- usually in athletes
54
what causes nontraumatic compartment syndrome
- animal bite - IVDU - prolonged compression of a limb i.e. after a fall when pt cannot get up - thrombosis vascular disease
55
five P's of compartment syndrome
- pain*** out of proportion to injury - pallor - pulselessness - paresthesias - paralysis
56
treatment for compartment syndrome
- fasciotomy of each compartment | - return to OR for closure at later date
57
what are the most common organisms involved in ortho infections?
- staph - strep - MRSA
58
imaging for ortho infections
- xray affected area- FB or periosteal thickening - early septic arthritis shows joint space widening - US if suspect abscess
59
what does periosteal thickening plus boney erosions indcate
- osteomyelitis
60
treatment for ortho infections
- empiric abx - I&D - splint - elevate hand/ extremity - moist hot pack - pain control - tetanus if needed
61
hand infections
- can be limb threatening - often from cat bite, human bite, puncture wounds - always xray IVDU to look for needle tip
62
what is the bacteria associated with cat bites?
- pasturella
63
kanavel's four cardinal signs of infective flexor tenosynovitis
- swelling of entire finger - partially flexed position - tenderness limited to course of flexor tendon sheath - disproportionate pain on passive ext of finger
64
tx for hand infections
- IV abx for specific pathogens - pain mgmt - surgical wash out - keflex, cefazolin, clinamycin, unasyn, vanco
65
herpetic whitlow
- caused by HSV - intensely painful finger tip - usually distal phalanx - toddlers more susceptible d/t thumb sucking
66
clinical presentation of herpetic whitlow
- painful, edematous finger tip with vesicular lesion - often on thumb and index finger - clinical dx
67
treatment of herpetic whitlow
- generally self limited - symptomatic - unroof tense vesicles - acyclovir either PO or topical
68
felon
- infection of fingertip pulp - thumb and index finger most common - can lead to ischemic necrosis and osteomyelitis - can be d/t untreated paronychia
69
clinical presentation of felon
- throbbing pain - tension - edema - erythema - dx clinically
70
treatment of felon
- I&D - abx for staph and MRSA coverage - cephalexin, bactrim, clinda, dicloxacillin, doxycycline

Clin Med I (16 decks)

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