Wrist

Question 1

Whats difference between a Colles and Smith Fracture?

Answer 1

COLLES is dorsal displacement, SMITH is volar displacement.

Question 2

What is most commonly fractured carpal bone?

Answer 2

Shaphoid Bone (sometimes missed on X-ray in first two weeks )

Question 3

If someone has a suspected scaphoid fracture what should you do ?

Answer 3

immobilize for 2 weeks then get another X-ray

Question 4

clinical signs of a scaphoid fracture?

Answer 4

• Tenderness in the anatomical snuffbox
• Pain with longitudinal compression of the thumb
• Tenderness over the scaphoid tubercle

Question 5

How would you treat scaphoid fracture before and after casting?

Answer 5

If in a cast that doesn’t limit elbow flexion, work on elbow ROM/MOBS, After cast if long cast, work on elbow ROM and ROM of other joints in hand.

Question 6

Why are metacarpal fractures usually casted with 70 deg of flexion ?

Answer 6

to prevent ligament contractors

Question 7

What is a boxers fracture?

Answer 7

5th MCP fracture

Question 8

What is a Bennet fracture? how’s it happen?

Answer 8

Fracture of 1st metacarpal (thumb), Jamming of thumb

Question 9

Where is OA mostly prevalent?

Answer 9

DIP joints > 1st CMC and PIP joints > MCP joints

Question 10

What interventions for OA?

Answer 10

NSAIDS (antiinflamatory), Steroid injection, Pain free ROM exercises, aerobic activity.

Question 11

What is leading cause of pain in hand??

Answer 11

1st CMC OA

Question 12

Whats a good special test for OA?

Answer 12

1st CMC grind test

Question 13

Difference between RA and OA?

Answer 13

RA morning stiffness, heat redness, resting wrist in radial deviation but fingers can severely move in ulnar deviation.

Question 14

What two deformities can happen with RA?

Answer 14

Swan neck deformity &
Boutonniere deformity

Question 15

Biggest ways to treat RA ?

Answer 15

Joint protection, balance rest and activity.

Question 16

How to treat swan neck and bountenners deformity?

Answer 16

special little splints, can be flipped over for each deformity.

Question 17

What tendons are affected with De Quarevians ?

Answer 17

APL, EPB (1st digit)

Question 18

What causes De quarvians?

Answer 18

Compression/entrapment of the tendons in the Extensor retinaculum. q

Question 19

History of patients with De Quarvians?

Answer 19

Overuse; cyclist, typist, machinist, new moms

Question 20

What movements are painful for someone with Dequarvians?

Answer 20

Radial wirst pain, pain with gripping, holding twisting

Question 21

Special test for De Quarvians?

Answer 21

Finkelstein test

Question 22

How to perform the Finklestein test?

Answer 22

Patient rests wrist on table (neutral) , sticks thumb inside hand and ulnarly deviates hand.

Question 23

Interventions for De Quarvians?

Answer 23

orthosis, NSAIDS, Thumb ROM, tendon gliding, eccentrics.

Question 24

What is Skiers (gamekeepers thumb)?

Answer 24

Tear of UCL of thumb (makes the radial deviate alot)

Question 25

Subjective/obj findings and for Skiers/gamekeepers thumb)?

Answer 25

Pain in webspace (between 1st and 2nd digit) pain with ROM of thumb

Question 26

Special test for Skiers/gamekeepers thumb); how to perform?

Answer 26

UCL test: grab thumb, and apply Valgus stress to UCL ligament. (compare to other side)

Question 27

What grade skiers thumb need surgery?

Answer 27

3

Question 28

How to treat grade 1-2 Skiers thumb?

Answer 28

Grade I * Thumb spica or tape x 3 weeks * AROM and strength at 3 weeks, avoid pinch * Grade II – follow protocol * Thumb spica or cast x 3 weeks * Soft spica/tape x 6 more weeks * AROM * Strength

Question 29

SUB/OBJ information to rule in TFCC injury?

Answer 29

Ulnar Wrist pain pain with gripping and rotation *pain with loading ***posible DRUJ hyper mobility

Question 30

Whats a common ligament injury to one of the carpal bones?

Answer 30

Scapholunate Instability

Question 31

Whats the test for Scapholunate Instability? how to do ?

Answer 31

Watsons; Place patient hand into slight extension and ulnar deviation Find scaphoid off end of radius and stabilize with thumb and index finger With free hand passively move wrist in flexion and radial deviation Release scaphoid Positive test: palpable/audible clunk or reproduction of pain

Question 32

What is the Most common compression neuropathy in UE?

Answer 32

Carpel tunnel syndrome

Question 33

What nerve is entrapped with carpel tunnel syndrome?

Answer 33

median nerve

Question 34

What causes carpal tunnel syndrome?

Answer 34

Thickened Flexor retinaculam sheath, synovial pressure, tendon tension

Question 35

Who is more likely to have carpal tunnel?

Answer 35

women age 45-59, smokers/alcohol, obesity.

Question 36

Special tests for carpel tunnel?

Answer 36

Tinnels sign, phalens sign, carpal compression test

Question 37

Subjective/OBJ findings for carpal tunnel?

Answer 37

numbness in median nerve distribution, atrophy of thenar musculature, loss of 2 point discrimination on monofilament testing, nocturnal numbness (when sleeping)

Question 38

What is Guyon canal syndrome?

Answer 38

Ulnar nerve muscle weakness or numbness (4th 5th digit) due to pressure or trauma on hook of hamate (this is where Ulnar/guyons canal is).

Question 39

Special tests for Guyons canal syndrome?

Answer 39

+ frontmen sign + waternburgs sign + tinnels + ULND test (ulnar nerve)

Question 40

What is AIN syndrome?

Answer 40

Purely motor neuropathy due to entrapment of (anterior interossus nerve)