Upper Extremity Injuries - Hand

Question 1

common mechanisms of injury of metacarpal fxs

Answer 1

• fall
• high speech MVC
• assault
• crush
• etc

Question 2

PE of metacarpal fx

Answer 2

• swelling, tenderness, possible deformity

- assess neurovascular status

Question 3

Boxers fx

Answer 3

• metacarpal fx of 4th or 5th metacarpal
• angulation of distal fragment
• d/t clinched fist striking object
• assess for angulation, rotation, or displacement

Question 4

bennetts fx

Answer 4

• fx or dislocation of the base of 1st metacarpal
• proximal fragment maintains ulnar attachement to trapezium
• distal aspect is supinated and dislocated radially by adductor pollicis

Question 5

rolandos fx

Answer 5

• comminuted version of Bennett’s

- fragments may form “T” or “Y” pattern at base of metacarpal

Question 6

tx of metacarpal fxs

Answer 6

• splint above and below injury site

- ORIF if indicated

Question 7

phalangeal fxs

Answer 7

• more common than metacarpal fxs

- can occur in multiple locations (proximal, middle, distal phalanx)

Question 8

Gamekeepers / skiers thumb

Answer 8

• UCL injury
• forced abduction and hyperextension of the MCP joint
• MCP joint tenderness localized to ulnar aspect w/ swelling
• loss of integrity of UCL

Question 9

radiology for gamekeepers thumb

Answer 9

-XR of 1st MCP can show avulsion fxs at insertion site of UCL

Question 10

tx of gamekeepers thumb

Answer 10

• surgical referral
• thumb spica
• PT/OT

Question 11

two common extensor tendon injuries

Answer 11

• mallet finger

- boutonniere

Question 12

MC tendon injury of the finger?

Answer 12

mallet figer

Question 13

mallet finger

Answer 13

• most often occurs in workplace or ball-handling sports

- damage to the terminal slip of extensor tendon at the DIP

Question 14

mechanism of injury of mallet finger

Answer 14

direct blow to the tip of finger causing sudden forceful flexion of distal phalanx

Question 15

PE of mallet finger

Answer 15

• inability to fully extend DIP

- swelling, ecchymosis, deformity

Question 16

radiology of mallet finger

Answer 16

• XR to assess for fx of distal phalanx

- avulsion fx MC

Question 17

non-surgical tx of mallet finger

Answer 17

• full time DIP splinting w/ extension/hyper extension for 6 wks
• then part-time splinting for 4-6 more weeks

Question 18

surgical repair of mallet finger is indicated when?

Answer 18

complex tendon lacerations

Question 19

boutonniere

Answer 19

flexion deformity of PIP joint w/ hyperextension of DIP

Question 20

mechanism of injury of boutonniere

Answer 20

tear or avulsion of the middle slip of the extensor mechanism which allow PIP to flex and DIP to extend

Question 21

PE of boutonniere

Answer 21

• limited extension of PIP and DIP

- DIP stuck in flexion

Question 22

tx of boutonniere

Answer 22

splint w/ full extension for 6 weeks

Question 23

common flexor tendon injuries

Answer 23

• jersey finger

- trigger finger

Question 24

jersey finger

Answer 24

rupture of the flexor digitorum profundus tendon from its distal attachment

Question 25

mechanism of injury of jersey finger

Answer 25

- when a flexed DIP joint is suddenly and forefully hyperextended - like grabbing a jersey

Question 26

PE of jersey finger

Answer 26

- pain and swelling over DIP | - may be able to palpate part of retracted tendon

Question 27

what is the pathognomonic finding in jersey finger?

Answer 27

inability to actively flex DIP joint

Question 28

classifications of jersey finger

Answer 28

- type I: retraction of profundus tendon all the way to the palm - type IV: avulsion of profundus tendon from the fx site - both need surgical repair w/i 7 days

Question 29

radiology of jersey finger

Answer 29

CR to r/o avulsion

Question 30

initial tx of jersey finger

Answer 30

splinting in slight flexion

Question 31

definitive tx of jersey finger

Answer 31

surgical repair of tendon

Question 32

stenosing tenosynovitis aka trigger finger

Answer 32

- disparity of the flexor tendons and surrounding pulley systems at the A1 pulley (over MCP joint) - flexor tendon catches - most are idiopathic

Question 33

PE of trigger finger

Answer 33

- painless snapping, catching, locking of one or more fingers during flexion - pain sometime present on volar aspect of MCP - sometimes can be completely stuck

Question 34

initial tx of trigger finger

Answer 34

- splinting, activity restriction, NSAIDs | - steroid injections

Question 35

tx of trigger finger if conservative tx fails

Answer 35

surgery

Question 36

de quervain tenosynovitis

Answer 36

-tendinopathy affecting the abductor pollicis longus and extensor pollicis brevis tendons

Question 37

PE of de quervain tenosynovitis

Answer 37

- pain on radial side of wrist exacerbated by movement | - postive finkelsteins test

Question 38

tx of de quervians tendosynovitis

Answer 38

- splinting, NSAIDs, activity restriction | - steroid injections

Question 39

dupuytren contracture

Answer 39

- progressive fibrosis of the palmar fascia - bengin and slow - most pts: white males > 50 yo

Question 40

PE of dupuytren contracture

Answer 40

- complain of thickening or nodule in palm w/ loss of motion - difficultly extending 4th and 5th digits

Question 41

tx of dupuytren contracture

Answer 41

surgery w/ palmar fasciotomy and possible skin graft

Question 42

most common organisms causing infection d/t HUMAN bites

Answer 42

- group A strep - staph - e. corrodens

Question 43

tx of human bite

Answer 43

- debride and wash out - loose closure if necessary - augmentin

Question 44

most common organisms causing infection d/t ANIMAL bites

Answer 44

- staph - strep - pasturella specis

Question 45

tx of animal bites

Answer 45

- debride and wash out - loose closure if necessary - augmentin

Question 46

paronychia

Answer 46

- inflammation and infection involving proximal fingernail folds - can develop subsequent superficial abscess

Question 47

tx of paronychia

Answer 47

- warm compress - keflex - I&D

Question 48

infective tenosynovitis

Answer 48

- infection and spread of inflammation along tendon sheaths of flexor tendons in hand - can result in compartment syndrome

Question 49

mechanism of injury of infective tenosynovitis

Answer 49

- traumatic implantation (staph and strep are common) | - can be hematogenously spread from n. gonorrhea and mycobacteria

Question 50

PE of infective tenosynovitis

Answer 50

- tenderness along flexor sheath - symmetric or fusiform enlargement of affected digit - slightly flexed finger at rest - PAIN W/ PASSIVE TENDON EXTENSION

Question 51

tx of infective tenosynovitis

Answer 51

- surgical debridement - IV abx - vanc + cipro

Question 52

compartment syndrome

Answer 52

- occurs when increased pressure w/i a compartment compromises the circulation and function of tissues in that space - cellular anoxia d/t poor perfusion is the result

Question 53

mechanism of injury of compartment syndrome

Answer 53

- long bone fx - trauma w/o fx: - crush injury - burn - constrictive bandages - penetrating trauma - thrombosis - bleeding - nephrotic syndrome - animal bites - IV drug use

Question 54

2 MC long bone that can cause compartment syndrome when injured

Answer 54

- tibia MC | - forarm bones 2nd MC -- mainly supracondylar fx in children

Question 55

initial sx of compartment syndrome

Answer 55

- pain out of proportion to injury - persistent deep ache or burning pain - paresthesias

Question 56

later sx of compartment syndrome

Answer 56

- pain w/ passive muscle stretch - tense compartment w/ wood-like feeling - pallor - diminished sensation - muscle weakness

Question 57

lab finding in compartment syndrome

Answer 57

elevated CK

Question 58

at what pressure is capillary flow compromised in compartment syndrome?

Answer 58

- 25-30 mmHg | - 0-8 mmHg is nl

Question 59

tx of compartment syndrome

Answer 59

decompressive fasciotomy performed by surgeon