MSK - Hand injury Flashcards Preview

► Med Misc 43 > MSK - Hand injury > Flashcards

Flashcards in MSK - Hand injury Deck (21):
1

How do you Ix & Rx a hand injury?

XR, US

Rx: rest (splint in position of function, elevation, compressoin, clean wounds, antibiotics, tetanus status, analgesia)

Referral/discharge

2

How do you examine a hand injury (3)?

Look, draw +/- take a photo
keep wounds moist with sterile dressing
test function to assess underlying structures (NOT by direct exploration of wound)

3

How do 2 ischaemias present with lack of inflow or outflow?

Lack of inflow: pale white
Lack of outflow: very red/purple

4

What is Allen's test?

Checking which artery is supplying the tissue

1. Ask pt to make a fist
2. occlude radial & ulnar artery
3. release whichever you're interested in & see if the hand is reperfused.

5

Contrast function of flexor digitorum superficialis form profundus

FDP flexes distal IP joint

FDS flexes the proximal IP joint

6

What allows a natural tendon cascade? Why is it important in examination of a hand injury?

Flexor tendon posture.

If a laceration to a tendon, the finger will stand out (extended) & drop out of the cascade.

If you press on the flexor tendons in the forearm, the cascade is exaggerated - indicating that the tendons are all intact.

Helpful examination esp in small children/uncooperative pts

7

When do you typically get a Mallet injury?

Cricket ball injury

Terminal tendon that extends the DIP joint is broken -> flexion at DIP.

8

What & how do you test median nerve?

- Abductor pollicis brevis
- FDS, FPL, radial half of FDP, FCR
- sensation

9

What & how do you test ulnar nerve?

- adductor pollicis (Froment's test)
- Interossei (abduction)
- Ulnar half of FDP, FCU
- Sensation

10

What & how do you test radial nerve?

- Long extensors
- Sensation

11

What is Froment's test?

Grab a piece of paper in b/w a thumb & the side of index finger.

If adductor pollicis is not strong enough, the thumb will flex to grab the paper. This is a positive Froment's test.

12

How do you test stability in a hand injury exam?

- stabilise proximal joint
- stress joint
- compare with other joints
- may have to use local anaesthetic for pain relief (by specialist)

13

Describe paediatric finger tip injury
- mechanism of injury
- anatomy
- Ix
- Rx
- Referral

- mechanism of injury: CRUSH e.g. door hinge
- anatomy: distal phalanx directly under nail bed
- Ix: XR
- Rx: clean wounds, compression, rest in splint in position of function, elevation, ABx, tetanus status, analgesia
- Referral: plastic surgery r/v; re accurate nail bed repair, suture finger tip & clean wound

14

How do you manage an animal bite?

- Tetanus
- ABx to include anaerobes e.g. Augmentin duo forte
- XR torsion causing #
- thorough and early debridement & lavage; Staph aureus is the most common organism in dog bite infection
- rest, splint, elevation
- refer to plastics

15

Describe a punch hand injury
- mechanism of injury
- anatomy
- Ix
- Rx
- Referral

- mechanism of injury: PUNCH
- anatomy: metacarpals
- Ix: XR
- Rx: clean wounds, compression, rest in splint in position of function, elevation, ABx, tetanus status, analgesia
- Referral: plastic surgery r/v; re accurate nail bed repair, suture finger tip & clean wound

16

Describe an amputated hand injury
- Ix
- Rx
- Care of the amputated part
- Referral

- Ix: XR of limb & part
- Rx: clean wounds, compression, rest in splint in position of function, elevation, ABx, tetanus status, analgesia
- Care of the amputated part: saline gauze into plastic bag next to ice (not in ice) to reduce the metabolic rate.
- urgent referral & nil oral

17

Would more distal or proximal amputation lead to a better functional outcome when reconnected?

The more distal the amputation, the more likely the better functional recovery

18

How does leech help correct a venous congested tissue that is not draining properly?

Creates an artificial venous outflow

Leech has heparin derivatives in its saliva thinning the blood & likes sucking out the congested venous flow.

19

Describe tenosynovitis
- definition
- 4 Px

infection within tendon sheath

Px with:
- fusiform swelling of digit
- partially flexed posture
- tender along sheath
- pain with passive extension

20

How do you Ix necrotising infections?

FBE
U&E
LFT
blood cultures
swabs

21

What are the principles of hand injury management?

ABC
Medical history (in general)
Age
Occupation
hand dominance
pain management

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