KRS421E3Hand/Wrist Flashcards Preview

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Flashcards in KRS421E3Hand/Wrist Deck (86):
1

where's the volar plate?

in the PIP of fingers 2-5
located in between the joint space of the PIP and flexor tendons

2

trauma to ? can result in radiating symptoms into wrist & hand

Trauma to c-spine, shoulder, elbow, & forearm

3

Relevant sound &/or sensations:

Fractures, dislocations, & tendonous injuries may have an associated “pop” that is often accompanied by a snapping sensation

4

Nagging pain that does not decrease may indicate

scaphoid fracture & TFCC injury

5

“aching” or “throbbing”
Often associated with

trauma to invovled bone or soft tissue

6

“burning or “tingling”
may suggest

May suggest neurological or vascular invovlement

7

Systemic diseases often affect hand/fingers before rest of body

Rheumatoid arthritis, peripheral vascular disease, etc

8

Posture of hand
Natural position is that of

slight wrist flexion with a slight arch in palm

9

Abnormalities may indicate

injury (avulsion) of one or more finger flexors or atrophy of intrinsic hand muscles

10

Note any gross deformities, swelling, discoloration

Dislocations are often obviously deformed
Fractures often display protrusion or depression along the usually flat dorsal hand surface

11

Palmar creases

Swelling in wrist/hand can eliminate normal palmar creases

12

Areas of cuts/scars:
Tendons & nerves of wrist/hand are

superficial
Minor cuts/lacerations, previous surgeries may have perminantly injured underlying structures

13

Russel’s sign

Small cuts, abrasions, calluses over dorsal surface of MCP &/or IP joints
Outward sign of bulemia

14

Continuity of distal radius & ulna:

Observe symmetry of distal radius & ulna
Loss of continuity may indicate a fracture

15

Continuity of carpals & metacarpals

Observe for obvious deformities or gross discontinuity
Abnormal contour over lunate may indicate dislocation

16

Depressed or shortened “knuckle” may indicate

metacarpal fracture

17

Murphy’s sign

Difference between level of 3rd metacarpal compared to 2nd & 4th (knuckles)
Indication of lunate dislocation

18

Posture of wrist & hand:
Radial nerve injury =

drop wrist deformity

19

Ganglion cysts

Collection of fluid (synovial) due to chronic irritation of tendon sheath or joint capsule
-most common on dorsal side

20

Inspection of skin & fingernails

Subungual hematoma
Felon
Paronychia

21

Felon

hang nail
when edge of the nail grows into the skin

22

Paronychia

has fluid and pus, red
infection of the cuticle

23

jersey finger

flexor tendon get ripped off or avulsed off distal phalange and have inability to flex

24

mallet finger

extensor tendon at the Distal phalange, cant extend

25

boutonniere deformity

Extensor tendon has slipped off to one side, extend DIP while flexing PIP

26

carpals?

scaphoid, lunate, triquetrium, pisiform, trapezium, trapezoid, capitate, hamate

27

extrinsic flexors

FCU
FCR
PL
FDS
FDP

28

Extrinsic Extensors

ECU
ECRL
ECRB
ED

29

thenar eminence

OFA
opponens
flexor pollicis brevis
abductor pollicis brevis

30

hypothenar eminence

opponens digiti minimi
flexor digiti minimi
abductor digiti minimi

31

what is the action of the palmar interossei

PAD DAB
palmar
- adduction

32

what is the action of the dorsal interossei

PAD DAB
dorsal
-abduction

33

indication of positive valgus/varus stress test

Pain &/or laxity in comparison to uninvolved side

34

ulnar pain during valgus/varus stress test is

Triangular Fibro-cartilage complex

35

TFCC injury onset

acute, Compression load to ulnar side of wrist

36

signs and symptoms of TFCC

Pain distal to ulna along medial wrist
UCL may be tender
Possible diffuse wrist swelling although often acutely normal
AROM & PROM limited in extension & ulnar deviation
RROM/MMT’s typically only painful in resistance through motion
Positional strength usually normal

37

TFCC using varus/valgus test?

Pain with valgus stress, but no laxity
Ulnar pain with varus stress

38

Scaphoid Fracture onset

acute
Compression load to radial side of wrist

39

signs and symptoms of scaphoid fracture

Pain in proximal portion of snuff box
Swelling may be present
Compression of 1st metacarpal may be painful
AROM & PROM elicit pain at end-range of extension & radial deviation
Possible reduction in grip strength

40

test result in valgus/varus test for scaphoid fracture ?

Radial pain with valgus stress

41

1st MCP collateral sprains also called?

UCL (“skier’s thumb” / “gamekeepers thumb”) much more common than RCL

42

causes of 1st MCP sprain

Caused by tensile load of affected ligament

43

signs and symptoms of 1st MCP sprain

Localized swelling, possible ecchymosis
Pain over ligament
Crepitus may indicate avulsion fx

44

AROM and PROM result for 1st MCP sprain

AROM & PROM painful when tension placed on ligament

45

1st MCP sprain valgus/varus stress test result

Valgus Stress Test – positive
Varus Stress Test – negative but with pain

46

lunate dislocation cause

Forced hyperextension of wrist may disasociate lunate from rest of carpals

47

perilunate dislocation

Lunate remains in position relative to radius, while capitate dislocated posterioraly

48

lunate dislocation

Lunate dislocated anterior to radius, while other carpals remain aligned

49

lunate dislocation inspection

Prominent anterior bulge
Murphy’s sign

50

scaphoid fracture often coupled with

lunate injury

51

Repetitive occurrence of lunate dislocation may result in osteochondritis or

Kienböck’s disease

52

MCP & IP Dislocations

Often obvious deformity
Loss of function of joint
NEVER REDUCE

Fracture concerns
Distal neuro & vascular function concerns

53

what's the first to be affected for carpal tunnel syndrome

Four tendons of the flexor superficialis and profundus, median nerve is first to get affected

54

cause of carpal tunnel syndrome

Compression of median nerve do to inflammation of finger flexor tendons
Insidious onset

55

what ligament wraps around the radial head

annular ligament

56

possible weakness of what muscles during carpal tunnel syndrome

Possible weakness of APB, FPB, or OP (thenar eminance muscles)

57

what do test do you use for carpal tunnel syndrome

phalan's test

58

DeQuervain’s Syndrome

Tensosynovitis of EPB & AbPL tendons as they pass under retinaculum

59

DeQuervain’s Syndrome signs and symptoms

Insidious onset
Pain over length of tendons
Possible swelling over snuff box

60

DeQuervain’s Syndrome can be found with what test?

Finkelstein’s test

61

ulnar nerve affects what part of the hand

palmar - pinky and half of ring finger down to wrist
dorsal - same and half of hand

62

radial nerve affects what part of hand

palmar - small portion of radial side of thenar eminence
dorsal - bottom half of middle and pointer finger, and rest of hand

63

median nerve affects what part of hand

palmar - the rest of the hand after radial and ulna
dorsal - top of middle, pointer, and half of ring finger

64

vascular tests

Capillary Refill
Digital Allen’s Test
- pressure is applied to nail bed until turns white
- blood returned to tissue

65

ape hand

weakness of the thenar emanence, brings thumb parallel to fingers, opposition/flexion weak-damage to medial nerve

66

bishop's deformity

weakness of hypothenar emanence, interossi, some lumbricals, medial fingers are in flexed position, extension is limited

67

claw hand

weakness of intrinsic hand muscles, flexion of DIP/PIP, extension of MCP

68

deputyren's contracture

invloved fingers assume excessive flexion, hereditary condition mostly affects 4th and 5th fingers, cannot actively or passively extend fingers

69

Swan-Neck Deformity

Flexion of MCP and DIP, Extension of PIP, many causes included RA, Volar plate injury, malunion of fractures of middle phalanx.

70

Volkman’s Ischemic Contracture

Flexion contracture – result of decreased blood supply to forearm following fracture, elbow dislocation, or compartment syndrome
-need to go to emergency room

71

Rotational Finger Malalignment

Possible indication of phalanx or metacarpal fracture (spiral)

72

valgus stress test positive

Pain &/or laxity in comparison to uninvolved side

73

valgus stress test implications

UCL pathology

74

valgus stress test, radial pain may indicate

scaphoid fracture

75

varus stress test positive

Pain &/or laxity in comparison to uninvolved side

76

implication of varus stress test

RCL pathology

77

varus stress test with ulnar pain may indicate

TFCC sprains

78

colles' fracture

Dorsal displacement of radius following fracture
“upside down fork” on x-ray

79

Boxer’s Fracture

Fracture of 5th metacarpal
Often due to closed fist, blunt force trauma

80

Bennett’s Fracture

Fracture of 1st metacarpal extending into articular surface
Significant impact to CMC joint
Often internally or externally fixated

81

Phalen’s Test

Passive wrist flexion
Hold for 1 minute

82

phalan's test positive test

Neuro symptoms along median nerve

83

implication of phalan's test

Median nerve compression (carpal tunnel)

84

finkelstein's test

Tuck thumb & actively ulnar deviate wrist

85

positive of finkelstein's test

Positive test
Pain over tendons

86

implication of finkelsteins test

Tenosynovitis