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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

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 medial 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 g
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
• 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 TOA
• 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 pina on flexing the fully extended arm , inability to flex the full extende 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
What 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 (29 decks)

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