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Flashcards in MSK Wrist Deck (44):
1

Normal ROM for wrist
Flexion:
extension:
Ulnar deviation
radial deviation

F: 80
E: 70
UD 30
RD 20

2

Name the carpal bones radial ---> ulnar

proximal - scaphoid, lunate, triquetrum, pisiform
Distal - trapezium, trapezoid, captitate, hamate

3

Name the 6 wrist flexors

1. FCR (median from MC/LC C6/7)
2. FCU (ulnar from MC C8/T1)
3. Palmaris longus (Median from MC/LC C7/8)
4. FDS (Median from MC/LC C7-T1)
5. FDP (median from MC/LC C7-T1 2nd and 3rd digit; ulnar from MC C7-T1 to 4th and 5th digit)
6. Flexor Pollicis longus (median from MC/LC C8/T1)

4

name the 7 wrist extensors

1. ECR-L (radial from PC C6/7)
2. ECR-B (radial from PC C6/7)
3. ECU (radial from PC C7/8)
4. Ext dig communis (radial from PC C7/8)
5. Ext Dig Minimi (ulnar from MC C8/T1)
6. Extensor indicis (radial from PC C6-8)
7. Extensor pollicis longus (radial from PC C6-8)

5

Name the two muscles responsible for ulnar deviation of the wrist

1. FCU (ulnar from MC C8/T1)
2. Ext Carpi ulnaris (radial from PC C7/8)

6

Name the two muscles responible for radial deviation of the wrist

1. FCR (median from MC/LC C6/7)
2. ECR-L (radial from PC C6/7)

7

Name the six tendon sheath compartments of the dorsal wrist

from radial to ulnar

1st - Abductor pollicus longus, Extensor pollicis brevis
2nd - ECR-L, ECR-B
3rd - Extensor pollicus longus
4th - Extensor digitorum communis, extensor indices proprius
5th - extensor digiti minimi
6th Extensor carpi ulnaris

8

OA is common in ______ of the thumb

1st Carpal-metacarpal joint of the thumb (CMC joint)

9

In the hand
OA affects ____ and ____
RA affects ____ and ____

OA affects DIP (heberden) and PIP (Bouchard)

RA affects MCP and PIP joints

10

in RA
____ wrist deviation occurs
____ MCP deviation occurs
____ subuluxation of the ulna
____ at end stage

radial deviation at the wrist
ulnar deviation of the MCPs
Dorsal subluxation of the ulna
erosion of the ulnar styloid at end stages

11

Describe swan neck deformity (4)

1. shortening an dcontracture of intrinsic muscles of the hand
2. Flexion at MCP
3. hyperextension of PIP
4. Flexion at DIP

12

describe boutonniere deformity (4)

1. tearing of extensor hood
2. hyperextension of MCP
3. Flexion at PIP
4. Hyperextensino of DIP

13

_____ is repetitive or direct trauma to the sheath of the extensor pollicis brevis and abductor pollicis longus tendons, causing a tenosynovitis and inflammation

de quervains tenosynovitis - will have pain and tenderness in radial side of wrist

involves tendons of the 1st compartment of the wrist

14

what is the provocative test for de quervains tenosynovitis

finkelsteins test - flex the thumb into the palm of the hand with the fingers, making a fist over the thumb. Then passively ulnar deviate the wrist. test is positive if pain is elicited. May also be positive in RA

15

Treatment of De Quervains tenosynovitis (3)

1. thumb spica splint to immobilize the thumb
2. NSAIDs
3. CSI

surgical release of the tight sheath eliminates the friction that worsens the inflammation, thus restoring the tendon's smooth gliding capability

16

ganglion cyst is a fluid filled cyst which arises from ____

synovial sheath of the joint space - typically a small smooth mass on the dorsal or volar aspect of the wrist that occurs on the dorsal apsect in 60% of cases

17

90% of ganglion cysts are treated by

aspiration of the cyst

18

____ is known as Kienbock's disease

osteonecrosis of the lunate

19

_____ is idiopathic loss of blood supply to the lunate, which causes avascular necrosis of the bone

Kienbocks disease

20

Name the stages of Kienbocks disease

osteonecrosis of the lunate

Stage 1 - no visible change in the lunate
Stage 2 - sclerosis of the lunate
Stage 3A - sclerosis and fragmentation of the lunate
Stage 3B - 3A with proximal migration of the capitate or fixed rotation of the scaphoid
Stage 4 - 3A or 3B with degenerative changes at adjacent joints

21

Risk factors for kienbocks disease - 2

1. poor vascular supply to the area
2. short ulnar variance

22

what will you see on MRI for kienbocks disease

osteonecrosis of the lunate - decreased signal intensity on T1 imaging

23

____ fracture is one of the most common fractures of the wrist. ____%

scaphoid fracture - 70%

24

The majority of scaphoid blood supply is to the ____ portion of the bone

distal 1/3 - middle and proximal portion have large non-union rate (1/3 develop necrosis)

25

What are the 4 anatomical locations of scaphoid fractures

1. Waist (65%)
2. Tubercle (2%)
3. Distal pole (10%)
4. Proximal pole (15%)

26

With scaphoid fractures will get what clinical finding

ROM will be painful in which two directions

swelling and tenderness over thumb/wrist (anatomical snuff box)

extension nd radial deviation

27

what are the borders for the anatomical snuff box

1. base - scaphoid bone
2. lateral - abductor pollicis longus and extensor pollicis brevis (1st wrist compartment)
3. madial - extensor pollicis longus (3rd wrist comparment)

28

XR views to order if concern for scaphoid fractrue

Posterior-anterior
oblique view of the wrist in ulnar deviation
- compare to other side

Repeat in 4-6 weeks if still symptomatic
CT scan can be done if question of fracture
bone scan can be positive as early as 24h after injury

29

Treatment of scaphoid fracture?

1. immobilize the wrist in thumb spica cast for 10-14 days (repeat Xrays; location of fracture (prox,mid,distal) will dictate how long immobilization with casting should occur

30

nondisplaced (<2mm) scaphoid fractures; immobilize for _____ with wrist in neutral position

6 weeks - then change to thumb spica if healing. If no healing, will need surgery

31

which two situations of scaphoid fractures should be referred to ortho

1. fracture of proximal 1/3
2. delayed presentation (2-3 weeks)

high risk of AVN

also displaced fractures >2mm

32

Healing time, scaphoid fractures:
1. distal 1/3
2. middle portion
3. proximal portion

1. 8 weeks
2. 3 months
3. 4 months or longer

33

hamate fractures:
1. body fractures usually due to ___
2. hook fractures usually due to____

1. trauma
2. end swing while holding a racquet, bat, or club

34

Hamate is located ____ and ___ to pisiform and forms radial border of _____

distal and radial
guyons canal

35

Pathology?

- ulnar and palmar wrist pain with racquet, bat or club swing
- pain worse with axial loading of 4th and 5th metacarpals
- pain just distal and radial to pisiform

hamate fracture

36

4 views to order if concerned for hamate fracture

PA, lateral, carpal tunnel, 45 degree supinated oblique view

CT may be required for base of hook fractures

37

in acute hook of hamate fractures _____% heal after prolonged casting (6 weeks to 4 months)

50% - optimal if immobilized immediately. older than 2 weeks may require excision

38

Typical method of trapezium fracture

typically when base of thumb metacarpal is forced by axial load into the trapezium

39

what are the 3 types of trapezium fractures

1. body
2. trapeziometacarpal
3. trapezial ridge

40

6 views if concerned for trapezium fracture

PA, lateral, oblique, carpal tunnel, Bett's view (thumb extended and abducted, wrist slightly pronated, beam centered on scaphotrapeziotrapezium area)

trapeziometacarpal

41

distal radius fractures are named for ____ and ___ of the distal bone

angulation and displacement

42

___ is the most common type of distal radius fracture. What is the displacement and angulation?

Colles fracture - dorsal displacement and angulation

43

Colles fractures are associated with ____ tears and ____ dissociation

TFCC - triangular fibrocartilage complex tear
scaphulolunate dissociation

44

Smith's fracture is a distal radius fracture with ____ displacement and angulation

volar
"reverse colles fracture"