Week 6 Masterclass

Question 1

Where is the TFCC located?

Answer 1

On the distal radioulnar joint (between the lunate, triquetrum, and ulnar head)

Question 2

What direction is radial deviation

Answer 2

Moving the hand towards the radius

Question 3

What direction is ulnar deviation

Answer 3

Moving the hand towards the ulnar

Question 4

What 4 ligaments make up the TFCC

Answer 4

Ulnotriquetral Ligament
Ulnolunate Ligament
Plamar Radioulnar Ligament
Dorsal Radioulnar Ligament

Question 5

What movement creates a TFCC injury

Answer 5

Forceful ulnar deviation (e.g hitting golf club into the turf, hitting a ball in tennis, Goalkeepers saving a powerful shot, Tricep dips)

Question 6

Where is pain most common in TFCC injuries

Answer 6

ulnar side

Question 7

What ADL is often painful in TFCC injuries

Answer 7

Turning a door key

Question 8

What movements cause pain in TFCC injuries

Answer 8

Ulnar deviation or
Supination + TFCC compression (supinating with force)

Question 9

What profession often gets TFCC injuries from overuse

Answer 9

Waiters due to the position of their hand when they’re carrying shit out

Question 10

What ligament often tears in TFCC

Answer 10

radioulnar

Question 11

What is positive ulnar variance

Answer 11

Ulnar is longer than the radius creating more compression through the TFCC

Question 12

Why does positive ulnar variance lead to increased liklihood of TFCC injury

Answer 12

More compression through the TFCC as more load shifts over to the ulnar side

Question 13

Special test for TFCC injury

Answer 13

Ulnar Fovea Sign

Question 14

Scapholunate ligament injury position

Answer 14

Wrist positioned in ext, ulnar dev and sup. Usually from a fall or MVA

Question 15

Is Scapholunate ligament injury diffused or localised pain

Answer 15

Diffused throughout the whole hand

Question 16

Clinical features of Scapholunate ligament injury

Answer 16

Pain in mechanical loading
Decreased grip strength
Localised scapolunate tenderness

Question 17

Initial management of Scapholunate ligament injury

Answer 17

Splinting and casting for 4 weeks

Question 18

Is an MRI needed with a suspected Scapholunate ligament injury

Answer 18

No. but after splinting/casting for 4 weeks and there are still persistent symptoms, then MRI should be conducted

Question 19

What does a scapholunate reconstruction entail

Answer 19

Tendon graft is threaded through scaphoid and lunate and a knot is tied. Similar to achilles rupture

Question 20

Is scapholunate ligament injury on the ulnar or radial side

Answer 20

Radial

Question 21

Differentiate between scapholunate ligament and TFCC injury based on pain location

Answer 21

TFCC - ulnar side
Scapholunate - Radial side

Question 22

What can be observed in scapholunate ligament injury

Answer 22

Swelling of anatomical snuffbox

Question 23

What sort of scaphoid fracture heals quickly

Answer 23

Distal pole fracture due to greater blood supply

Question 24

What should happen if a scaphoid fracture is suspected but there is nothing evident in imaging

Answer 24

Put thumb in cast for 2 weeks and then go for another x-ray. This is due to bone reabsorption along the fracture line making the injury more visible after 2 weeks

Question 25

Why is a proximal pole scaphoid fracture considered to be 'scary'

Answer 25

It has poor blood supply leading to longer rehab time and possible avascular necrosis of the scaphoid bone

Question 26

What 3 tendons are in the anatomical snuffbox

Answer 26

Abd Pollicis Longus (Thena) EPB EPL (Hypothena)

Question 27

How to find the anatomical snuffbox

Answer 27

Make a starfish. Snuffbox appears at distal wrist

Question 28

What injuries are found in the anatomical snuffbox

Answer 28

De Quervians synovitis Scaphoid fracture

Question 29

What movement is a bony avulsion (finger) pt unable to do

Answer 29

flex distal phalanx

Question 30

If your hand is relaxed, what position will your fingers be in? How is this different to Jersey finger

Answer 30

Relaxed - fingers are in flexion Jersey finger will be in ext when relaxed

Question 31

What causes a bony avulsion in fingers

Answer 31

hyperextension. Common in footy when your finger gets caught in someones jersey bending it backwards

Question 32

What is mallet finger

Answer 32

Disruption of the common extensor tendon on distal interphalangeal joint

Question 33

What causes mallet finger

Answer 33

Forced flexion to then IP joint

Question 34

What is the immediate treatment for mallet finger

Answer 34

Splint

Question 35

What is a common observation in mallet finger pt

Answer 35

Unable to extend distal IP joint

Question 36

What direction does a dorsal proximal dislocation move

Answer 36

Middle phalanx dislocates dorsal

Question 37

What are other names for ulnar collateral ligament sprains (finger)?

Answer 37

skiers thumb or gatekeepers thumb

Question 38

What finger is affected in ulnar collateral ligament sprain?

Answer 38

thumb

Question 39

What observations can be made for skiers thumb

Answer 39

Weak pinch grip Joint instability Excessive thumb abduction due to lack of ligament

Question 40

How to first line management of a partial UCL tear (thumb)?

Answer 40

Splint for 3-6 weeks

Question 41

How to first line management of a full UCL tear (thumb)?

Answer 41

Surgery

Question 42

After immobilisation, what exercises should UCL (finger) focus on

Answer 42

Pinching

Question 43

What sort of fracture is common in adolescents in the arm

Answer 43

Distal radial fracture due to ongoing growth plate maturation

Question 44

What are the nine tendons that run through the carpal tunnel

Answer 44

Flexor digitorum superficialis (4) Flexor digitorum profundus (4) Flexor carpi radialis (1)

Question 45

Management of carpal tunnel syndrome

Answer 45

Education Activity modification Night splint Nerve gliding exercises

Question 46

What is De Quervain's Tenosynovitis

Answer 46

Inflammation and increase of fluid in the synovial sheath in abductor policis longus and extensor pollicis brevis at the radial styloid

Question 47

Is De Quervain's Tenosynovitis a tendinopathy

Answer 47

No

Question 48

Are the tendons in De Quervain's Tenosynovitis healthy

Answer 48

Yes

Question 49

What movement aggravates De Quervain's Tenosynovitis

Answer 49

Ulnar deviation

Question 50

What is De Quervain's Tenosynovitis often known as

Answer 50

Mothers thumb due to picking up newborns constantly

Question 51

Management of De Quervain's Tenosynovitis

Answer 51

Prevent thumb flexion by putting them in a brace/splint for 2-4 weeks

Question 52

What does TFCC stand for?

Answer 52

Triangular Fibrocartilage Complex

Question 53

What is a TFCC injury

Answer 53

a tear or damage to the cartilage and ligaments on the ulnar side of the wrist, which helps stabilize the joint.