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A: MSK UQ > Lecture 14B: Hand And Wrist Examination, Evualtion, And Treatment > Flashcards

Lecture 14B: Hand And Wrist Examination, Evualtion, And Treatment Flashcards

(116 cards)

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1
Q

What other complex would u need to assess with wrist and hand

A

Spine and elbow

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2
Q

What is the main difference between tendinopathy and instability

A

Tendinopathy has pain with activities

Instability has been after activities

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3
Q

What is the examination flor

A
  • patient hx
  • system review
  • observation
  • UQ/LQ scan if needed
  • AROM , PROM , flexibility
  • mm performance
  • joint play
  • palpation
  • special test
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4
Q

What are common fx to the hand and wrist

A

• Distal radius (Colles’ & Smith)
• Scaphoid (most common)
• Hook of hamate

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5
Q

What are common wrist sprains

A

• TFCC lesions
• Radioscapholunate ligament
• Lunotriquetral ligament

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6
Q

What is a medical emergency in the wrist and hand

A

V olkmann’s ischemic contracture

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7
Q

Where can u have tendinopathy in the wrist and hand

A

• de Quervain’s tenosynovitis
• EPL, EI, ECU
• FCR, FCU

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8
Q

Where can u have intercarpal instabilities in the wrist and hand

A
  • dorsal
  • volar
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9
Q

For traumatic wrist injuries when it is usually worse

A

If a lot of swelling

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10
Q

90% of wrist traumat happens 2/2 what

A

Fall or collision with wrist extended reseisting external forces

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11
Q

What are the 2 distal radius fx’s

A
  • colles
  • smith
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12
Q

What is the colles’ distal radius fx

A

Extension fx w dorsal displacement

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13
Q

What does a colles fx result in

A

Shortening of forearm

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14
Q

What is a smiths fx

A

Flexion fx w volar displacement

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15
Q

What is the most common fx of the carpal bone

A

Scaphoid fx

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16
Q

What is the MOI of a scaphoid fx

A

FOOSH

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17
Q

Where is there pain in the scaphoid fx

A

Anatomical snuffbox

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18
Q

What is the treatment scaphoid fx

A

Cast x 6-8 weeks or surgical pining

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19
Q

What is the healing times for the scaphoid fx

A

8 weeks - 4 months

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20
Q

____ side of wrist including scaphoid bears
~ 80% of all forces translated through hand
during functional activities

A

Radial

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21
Q

What is the MOI of hook of hamate fx

A

Stress fx from repetitive torque stresses in bat, racket , club type sports

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22
Q

Where is there pain for the hook of hamate fx

A

Wrist pain on ulnar side w gripping

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23
Q

Where is there TTP for hook of hamate fx

A

Over hamate bone

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24
Q

Patient with a hook of hamate fx will have pain with what

A

Resisted 4th/5th finger flexion

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25
What is the tx for **hook of hamate fx**
Cast x 12 weeks or sx excision
26
What is the MOI for TFCC tear
FOOSH , repetitive axial loading , ulnar distraction of wrist
27
Where is there wrist pain for a TFCC tear
Wrist pain on ulnar side w click/crepitus during forearm rotation and gripping
28
What is the MOI for **Radioscapholunate ligament sprain**
FOOSH
29
What is the MOI of **Lunotriquetral ligament sprain**
Forced wrist ext, radial deviation
30
What is the general tx for wrist sprains
Splinting/bracing x 4-6 weeks w activity modifications
31
What is the MOI for **volkmann’s ischemic contracture**
Major trauma ( crush injury or fx)
32
What kind of emergency is the volkmann’s ischemic contracture
Medial
33
What happens during volkmann’s ischemic contracture
Lack of blood flow to forearm → UE compartment syndrome → prolonged lack of blood flow → injury to mm and nerves causing them to shorten (scar down) → flexion contractures in wrist, hand and fingers
34
What are the 5 predictor variables **CPR of 1st CMC OA**
1. Hand pain or stiffness 2. Hard tissue enlargement of ≥ 2 joints (out of 10) AND * 2nd and 3rd DIPs, 2nd and 3rd PIPs, 1st CMCs 3. <3 swollen MCP joints 4. Hard tissue enlargement of ≥ 2 DIP joints 5. Deformity of ≥ 2 selected joints
35
What is **de quervain’s tenosynovitis**
Inflammation of synovial sheath surrounding abductor pol longus and extensor pol brevis (APL, EPB)
36
What is the MOI for **de Quervain’s Tenosynovitis**
Primarily Repetitive overuse problem but direct trauma can cause it
37
Where is there **TTP** for **de Quervain’s Tenosynovitis**
Over radial styloid
38
What is there **pain** w/ for **de Quervain’s Tenosynovitis**
Active thumb abd and passive add
39
What is the **tx** for **de Quervain’s Tenosynovitis**
Thumb spic splint, CS injection , sx relzease
40
If a patient has TTP over radial styloid process and pain w active thumb abd and pass add what do u thinks
de Quervain’s Tenosynovitis
41
What is the **most** commonly **dislocated** **carpal** bone
Lunate
42
What is the MOI for a **Scapholunate dissociation**
FOOSH
43
How do the **carpal shift** with a **Scapholunate dissociation**
Scaphoid shift volvarly Lunate shifts dorsally (blocks extension)
44
What will **Scapholunate dissociation** result in if not corrected
Dorsal and central intercarpal instability
45
What is the tx for **Scapholunate dissociation**
Immobilization for 6-12 weeks
46
What is the difference between **heberden’s nodes** and **bouchard’s nodes**
**Heberden’s nodes** * Enlargement at dorsal **DIP** w/ OA **Bouchard’s nodes** * Enlargement at dorsal **PIP** w/ OA
47
What is **swan neck deformity**
Flexion of MCP and DIP w extension of PIP
48
What is there a **contracture** of for **swan neck deformity**
Of intricincis or tearing of volar plate due to RA or trauma
49
MCP= DIP_
OA RA
50
What is boutonnière deformity
Extension of MCP and DIP w flexion of PIP (opposite of swan)
51
What **ruptures** for the **Boutonniere deformity**
Rupture of central tendon of extensor hood due to RA or trauma
52
What is **trigger finger**
* Thickening of flexor tendon sheath causing tendon to ‘catch’ * Eventually will not extend * Common w/ RA
53
What is **mallet finger**
Avulsion of distal slip of extensor tendon
54
What is the MOI of **mallet finger** and what is **decreased**
* MOI: forced flex of DIP * ↓ DIP extension, normal PIP extension
55
What is **jersey finger** , what is the **MOI** and what **finger** is **common**
* Avulsion of FDP tendon * MOI: Forced ext against active flex * Typically 4th digit
56
What is **ulnar drift** and what is the **MOI**
* Ulnar deviation of digits from weakening passive structures * MOI: RA
57
What is **APE hand**
* Wasting of **thenar** mm. * **Medial** n. palsy * Thumb falls in line w/ fingers * Unable to oppose or flex thumb
58
What **N** is **damaged** with **APE HAND**
Median
59
What is **boxers fx**
Fx of 4th and/or 5th MC bone
60
What is the **MOI** for **boxers fx**
* MOI: direct impact to MC shaft or head (i.e. incorrectly punching someone/something) * Typically see loss of MCP height
61
What is the tx for boxers fx
Casting or splinting
62
What is **Dupuytren’s contracture**
* Palmar fascia contraction w/ finger deformity in MCP and PIP joints * Most often 4th/5th digits (commone w diabetes)
63
What is **gamekeepers (skiers) thumb**
Sprain/tear of thumb UCL
64
What is the **MOI** and **TX** for **gamekeepers *skiers) thumb**
* MOI: Forced abd w/ hyperextension of thumb * Tx: thumb spica spling/cast x 6-10 weeks
65
What is the **most common ligament** to injure in the hand
THUMB UCL ( gamekeepers)
66
What are MOI for UE peripheral N injuries
• Traction/stretch • Compression • Laceration
67
What are **conditions** that **predispose** a **nerve** to **damage** (6)
* DM * Metabolic conditions * Auto immune diseases (RA, Sjogren’s, etc) * Infection * ETOH abuse * Meds/toxins
68
What are the 3 classification of peripheral n injures
* neurapraxia * axonotmesis * neurotmesis
69
What is **neurapraxia**
* Transient block * Non-degenerative
70
What is **axonotmesis**
* Lesion in continuity * Degenerative
71
What is **neurotmesis**
* Nerve damage * Degenerative w/ poorer outcomes
72
What are teh 2 most common proximal injury sites for UE peripheral nerves
* cervical radic * thoracic outlet syndrome
73
What is the **most common compression** sites for **TOS**
C8-T1
74
What is the most common type of TOS
Neurogenic - 95% of time Can be vascular = more rare and more serious Dx of exclusion
75
What is the **TOS** bordered by
* 1st thoracic rib * Clavicle * Superior border of scapula * Interscalene triangle
76
What are 2 **major things** that pass thru the TOS
* Brachial plexus * Subclavian artery
77
What are the 3 most common sites of compression for TOS
• Interscalene triangle • Costoclavicular space • Retro- (sub-) pectoral space
78
What nerves are the **spinal accessory N**
( CN XI, C3-C4) q
79
What nerves are the **suprascapular N**
C5-C6
80
What nerves are the nusculocutaneous N
C5-C^
81
What nerves are the axillary N
C5-C6
82
How is there a spinal accessory N injury in the BP
• Lesion at GH joint • Often associated w/ clavicle and/or scapular fx’s as well as subclavian vascular lesions
83
What lesions causes an injury of the **suprascapular N** and what is it often associated with
* Lesion at scapular or spinoglenoid notch * Often associated w/ trauma (fall, fracture) and overuse motions
84
What lesions causes an injury of the axillary N and what is it often associated with
Lesions at posterior cord , anterio- inferior aspect of subscapularis, quadrilateral space , sub deltoid mm Often associated w/ GH dislocations, post-op shoulder surgery complications, blunt trauma to shoulder complex
85
If a patient has pain on flexing the fully extended arm , inability to flex the full extended arm or **winging of the scapular** at 90° of forward flexion what N is damaged
Long thoracic
86
If a pateint has the inability to **abduct the arm with neutral rotation** what N is damaged
Axillary
87
If a pateint has **weak elbow flexion with forearm supinated** what N is damaged
Musculocuanteous
88
What is the **largest branch** of the **BP**
Radial N
89
What is the most commonly injured peripheral N
Radial • Radial nerve entrapment • Posterior interosseous nerve syndrome • Radial tunnel syndrome • Radial sensory nerve entrapment
90
If the **impairment** of the **radial** **N** occurs **below** **brachioradialis** branch what is retained
Some supination
91
If the radial N impairment occurs in the forearm what mm groups may be affected
Thumb, index finger extensions , and ECU
92
If the **radial N impairments** occurs on the **posterior aspect** of the **wrist** what is lost
Sensory loss of the hand
93
What is Compression of deep branch of radial nerve as it passes b/t the heads of supinator (ie. arcade of Frohse)
Radial tunnel syndrome
94
there is **no invovlment** of what for **radial tunnel syndrome**
No sensory invovlement
95
What is the deep branch of the radial N supply
Deep extensor mm of the forearm
96
What mm should u use to test **weakness** if u **suspect** **radial tunnel syndrome**
Extensor indicis or Extensor pollicis longus
97
What are the **symptoms** for **radial tunnel syndrome**
Lateral elbow pain
98
What are the signs for radial tunnel syndrome
• Sensitivity to palpation just distal to lateral epicondyle • Deep extensor muscle weakness ( ECRB, ED, EDM, EPL, APB, EPB, EI)
99
100
What is trigger finger
Thickening of flexor tendon sheath causing tendon to catch Eventually wont extend
101
What is trigger finger common w
RA
102
What is mallet finger
Avulsion of distal slip of extensor tendon
103
What is the MOI and what is decreased with mallet finger
MOI: forced flex of DIP Decreased DIP extension , normla PIP extension
104
What is jersey finger
Avulsion of FDP tendon
105
What is the MOI of jersey finger and what digit is that most common
• MOI: Forced ext against active flex • Typically 4th digit
106
What is ulnar drift anf what is the MOI
X • Ulnar deviation of digits from weakening passive structures • MOI: RA
107
What is ape hand
Wasting of the thenar mm Median N palsy Thumb falls in line with fingers Unable to oppose or flex thumb
108
What is boxers fx
Fx of 4th and/or 5th MC bone
109
What is the MOI with boxers fx and what is typically seen
• MOI: direct impact to MC shaft or head (i.e. incorrectly punching someone/something) • Typically see loss of MCP height
110
What is the tx for boxers fx
Casting or splinting
111
What is Dupuytren’s contracture and what digits is most often affected
• Palmar fascia contraction w/ finger deformity in MCP and PIP joints • Most often 4th/5th digits (usually from diabetes)
112
What is gamekeepers (skiers) thumb
Sprain/tear of thumb UCL
113
What is the MOI for Gamekeeper’s (skier’s) thumb
MOI: Forced abd w/ hyperextension of thumb
114
What is the tx for Gamekeeper’s (skier’s) thumb
Thumb spica splinting/cast x 6-10 weeks
115
What is the most common ligament to injure in the hand
Thumb UCL * Gamekeeper’s (skier’s) thumb
116

A: MSK UQ (30 decks)

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