Upper Extremity part 1

Question 1

What area of the hand does the median nerve encompass?

Answer 1

1st 3.5 fingers

Question 2

What area of the hand does the ulnar nerve encompass?

Answer 2

Last 2.5 fingers

Question 3

What area of the hand does the radial nerve encompass?

Answer 3

Pollicis

2nd and 3rd digits up to DIP joints

Question 4

Components of ganglion cysts

Answer 4

MC soft tissue tumors of the hand
Dorsal and volar (palm) wrists
Fluctuates in size

Question 5

PE of ganglion cyst

Answer 5

Fluid-filled
Transilluminated
Mild tender to palpation

Question 6

Tx for ganglion cysts

Answer 6

Splint
NSAIDs
Aspiration
Surgery
Aspiration does not fix the problem
When in doubt, choose the conservative option

Question 7

How does a mallet finger present?

Answer 7

Extension of MTP and PIP

Flexion of DIP

Question 8

When can a mallet finger be seen?

Answer 8

RA

Question 9

How does a boutinniere deformity present?

Answer 9

PIP flexion
(Hyper)extended DIP joint

Question 10

What is the pathology of boutinniere deformity?

Answer 10

Rupture of central slip of extensor tendon

Question 11

What is the cause of boutinniere deformity?

Answer 11

Jammed finger secondary to arthritis

Question 12

Tx for boutinniere deformity

Answer 12

8 wks full extension

8 wks nighttime extension

Question 13

How does swan neck present?

Answer 13

PIP hyperextension

DIP flexion

Question 14

What is the pathology of a mallet finger?

Answer 14

Terminal extensor tendon rupture
Bony or soft tissue
AKA baseball finger

Question 15

Tx for mallet finger

Answer 15

Stack splint

Question 16

Presentation of Dupuytren dz

Answer 16

Contraction of palmar fascia
"Viking" dz
Painless nodules
Progressive
Ring finger = mc

Question 17

What is a common complaint of someone with Dupuytrens?

Answer 17

Fingers “catching” on things and having trouble putting them in pockets

Question 18

RF for Dupuytrens

Answer 18

Older
Men
DM
Smoking
FHx

Question 19

Components of trigger finger

Answer 19

A1 pulley
Locking/catching
Painful nodule

Question 20

What is the definitive tx for Dupuytren?

Answer 20

Surgery

Question 21

What is the difference between Dupuytrens and trigger finger?

Answer 21

Dupuytrens is not painful
Dupuytrens is a cord, whereas trigger finger is a nodule
Trigger finger is not progressive

Question 22

Tx for trigger finger

Answer 22

Injection
NSAIDs
Surgery

Question 23

S/sx of carpal tunnel syndrome

Answer 23

Numbness/tingling
Drop things
Can't open jars/lids
Nighttime pain
Thenar atrophy

Question 24

Tests for carpal tunnel syndrome

Answer 24

Tinels test
Phalen’s test
EMG

Question 25

Tinels test

Answer 25

Tap over transverse carpal ligament | Pos if reproduce the pain

Question 26

How long should the Phalen's test be held for?

Answer 26

60 secs

Question 27

What is the purpose of the EMG?

Answer 27

Diagnostic procedure to help assess muscles/nerves | Reveal nerve dysfunction, muscle dysfunction or problems with nerve-to-muscle signal transmission

Question 28

Process of the EMG?

Answer 28

Uses electrodes taped to the skin (surface electrodes) to measure the speed and strength of signals traveling between two or more points Needle EMG, a needle electrode inserted directly into a muscle records the electrical activity in that muscle

Question 29

Components of CMC arthritis

Answer 29

Pain with pinch/grip Decreased strength Pos grind test

Question 30

What is seen on X-ray with CMC arthritis?

Answer 30

Cyst Loss of joint space White indicates sclerosis

Question 31

Tx of CMC arthritis

Answer 31

``` Thumb spica splint NSAIDs OT Injection Referral ```

Question 32

Where can de Quervain tenosynovitis be found?

Answer 32

First dorsal compartment - Abductor pollicus longus - Extensor pollicus brevis

Question 33

How does de Quervain tenosynovitis present?

Answer 33

Pain over radial styloid | Pos Finkelsteins test

Question 34

Tx for de Quervains

Answer 34

Thumb spica Injection NSAIDs Surgery

Question 35

Components of gamekeepers thumb

Answer 35

AKA skiers thumb Rupture of UCL Important stabilizer Pain/swelling in ulnar aspect of thumb

Question 36

How soon should one perform surgery for gamekeepers thumb?

Answer 36

Within first 3 wks of injury

Question 37

What is flexor tenosynovitis?

Answer 37

Flexor tendon sheath infection

Question 38

Components of flexor tenosynovitis

Answer 38

Fusiform swelling Tenderness along sheath Pain with passive stretch Flexed position when at rest

Question 39

How does a boxer fx occur?

Answer 39

With punching

Question 40

S/Sx of boxer fx

Answer 40

Pain/swelling

Question 41

Tx for boxer fx

Answer 41

Ulnar gutter splint | Refer PRN for sx or reduction

Question 42

Cause of scaphoid fx

Answer 42

Most commonly fxed carpal bone | Non-union and osteonecrosis

Question 43

Presentation of scaphoid fx

Answer 43

Snuff box tenderness

Question 44

Workup of scaphoid fx

Answer 44

Scaphoid views: X-ray

Question 45

Tx of scaphoid fx

Answer 45

Thumb Spica/refer | When in doubt- treat

Question 46

Colles fx

Answer 46

MC distal radius fx Dinner fork appearance Falling on outstretched hand

Question 47

PE of Colles fx

Answer 47

Pain Swelling Tenderness Deformity

Question 48

Tx for Colles fx

Answer 48

Casting vs open reduction in field...refer