Upper Extremity Injuries - Wrist

Question 1

what is the MC fx site of the upper extremity?

Answer 1

-distal radius fx

Question 2

other names for distal radius fx

Answer 2

• Colles fx
• dinner fork deformity
• smith fx

Question 3

what population is a distal radius fx most common in ?

Answer 3

• young athletes

- elder geriatric population

Question 4

MC mechanism of injury for distal radius fx

Answer 4

FOOSH w/ wrist in extension

Question 5

PE of distal radius fx

Answer 5

• swelling, pain, decreased ROM
• must assess neurovascular status
• dinner fork deformity is common

Question 6

radiology of distal radius fx

Answer 6

-3 view XR of wrist

Question 7

radiology specific to colles fx

Answer 7

-transverse extraarticular fx of distal radius w/ DORSAL displacement of distal fx segment

Question 8

radiology specific to Smith fx

Answer 8

• transverse fx of distal radius w/ VOLAR displacement of distal fx segment
• garden spade deformity

Question 9

chauggeur fx (hutchnison fx)

Answer 9

intraarticular fx of the base of the radial styloid process

Question 10

tx of a displaced distal radius fx

Answer 10

• closed reduction prior to ortho referral
• finger traps and traction/counter traction
• after reduction, splin w/ sugar-tong and refer

Question 11

parameters for closed reduction of distal radius fx

Answer 11

• greater than 20 deg of dorsal angulation

- fx displacement greater than 2/3 width of radial shaft

Question 12

criteria for adequate reduction of distal radial fx

Answer 12

• no dorsal tilt
• <5mm of radial shortening
• <2cc of displacement of fx segments

Question 13

tx of non-displaced distal radius fx

Answer 13

can be splinted in ER w/ sugar-tong and referred to ortho

Question 14

distal ulnar fx

Answer 14

• not as common as radius fx
• same mechanism as radial fx
• on XR: look at ulnar syloid
• tx sugar tong splint w/ ortho referral

Question 15

what is the MC carpal bone fx?

Answer 15

scaphoid

Question 16

main blood supply to scaphoid bone

Answer 16

• dorsal branch of radial a.
• enters at dorsal rdige and flows in retrograde fashion toward proximal pole
• can be interupted by fx = necrosis and non union

Question 17

mechanism of injury of scaphoid fx

Answer 17

-direct axial compression or hyperextension of wrist secondary to fall

Question 18

PE of scaphoid fx

Answer 18

• swelling, pain, decreased ROM

- pain to palpation at anatomical snuff box*****

Question 19

radiology of scaphoid fx

Answer 19

• 3 view XR wrist and scaphoid views

- MC fx sites: waist, then proximal pole and tubercle

Question 20

what increases the risk of avascular necrosis in scaphoid fx

Answer 20

the more proximal the fx line is, the greater incidence of avascualr necrosis

Question 21

what to do if XR is negative but suspicious of scaphoid fx?

Answer 21

MRI

Question 22

tx of scaphoid fx

Answer 22

• initial tx for any wrist injury w/ anatomical snuff box tenderness = placement of a THUMB SPICA SPLINT**
• refer to ortho
• if displaced, ORIF

Question 23

what is the second MC carpal bone fx?

Answer 23

triquetrum

Question 24

mechanism of injury of triquetrum fx

Answer 24

-FOOSH w/ wrist in extension and ulnar deviation

Question 25

PE of triquetrum fx

Answer 25

usually point tenderness dorsally, or along the ulnar border of wrist, 1-2 cm distal to distal aspect of unla

Question 26

radiology for triquetrum fx

Answer 26

- 3 view of wrist - usually dorsal surface - if fx segment is present, best visualed in lateral or pronated oblique positions

Question 27

tx of triquetrum fx

Answer 27

-immobilization w/ volar splint w/ wrist in slight extension

Question 28

what is the MC dislocation of carpal bones?

Answer 28

lunate dislocation

Question 29

radiology of lunate dislocation

Answer 29

- loss of congruity of the carpal arcs - abnl triangular configuration of lunate - lateral XR shows all other carpal bones posterior to lunate - "spilled teacup" sign

Question 30

carpal tunnel syndrome

Answer 30

-complex s/s brought on by compression of MEDIAN n. as it goes through carpal tunnel

Question 31

risk factors of carpal tunnel syndrom

Answer 31

- obesity - female - DM - RA - connective tissue disorders - sustained wrist/palm pressure - prolonged wrist extension/flexion - repetitive hand/wrist use (keyboard, drilling, etc) - work with vibrating tools

Question 32

what is the hallmark on PE for carpal tunnel syndrome

Answer 32

pain/paresthesia in the distribution of the median nerve w/ varying degrees

Question 33

special tests for carpal tunnel syndrome

Answer 33

- phalens (reverse prayer) - tinel (tapping) - hand elevation test (1 min)

Question 34

when is radiology indicated for carpal tunnel syndrome?

Answer 34

-if worried about tumore, deformity or joint dz

Question 35

non-surgical tx of carpal tunnel syndrome

Answer 35

- wrist splinting to maintain wrist in neutral position - worn at night or day and night - steroid injections - NSAIDs

Question 36

surgical decompression for carpal tunnel sydrome

Answer 36

carpal tunnel release involves cutting the transverse carpal ligment

Question 37

ulnar tunnel syndrome

Answer 37

-compression of the ULNAR n. at the Guyon canal

Question 38

what is the MC cause of ulnar tunnel syndrome?

Answer 38

ganglion cyst

Question 39

tx of ulnar tunnel syndrome

Answer 39

same as for carpal tunnel

Question 40

cubital tunnel syndrome

Answer 40

-pressure on the ulnar n. at the elbow

Question 41

ganlgion cyst

Answer 41

- one of the MC soft tissue swellings in that hand and wrist - benign - fluid filled swelling over joint or tendon sheath

Question 42

MC site of ganglion cyst

Answer 42

dorsal side of wrist

Question 43

non-surgical tx of ganglion cyst

Answer 43

- reassurance and observation | - cyst aspiration (will likely come back)

Question 44

surgical tx of ganglion cyst

Answer 44

-cyst removal including the stalk (or will come back)