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wrist Flashcards

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1
Q

What is the wrist joint comprised of?

A

distal radius, ulna and carpal bones

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2
Q

What are the 3 joints that make up the wrist?

A

radiocarpal joint: distal radius and scaphoid & lunate bones
ulnocarpal joint: distal ulna and lunate & triquetral bones via articular disk
radioulnar joint

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3
Q

What is the name for the distal radial tubercle?

A

Lister’s tubercle

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4
Q

What is the ulnar styloid process the attachment site for?

A

UCL

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5
Q

Which carpal bone is embedded in a tendon and is not involved in wrist movement?

A

the Pisiform bone

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6
Q

Where is the triangular fibrocartilage

A

between the ulna and triquetral and lunate bones
allows forearm rotation

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7
Q

what mechanism is the dorsal wrist responsible for?

A

extensor mechanism for wrist, digits and thumb

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8
Q

What compartments is the snuff box made of?

A

compartment 1 and 3
(extensor pollicis brevis and extensor pollicus longus)

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9
Q

What 2 tendons are associated with De Quervain’s? (what is the compartment)

A

extensor pollicis brevis and abductor pollicis longus, compartment 1

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10
Q

what does compartment 2 contain?

A

extensor carpi radialis longus and brevis

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11
Q

what separates compartment 2 and 3?
what does compartment 3 contain?

A

Lister’s tubercle

extensor pollicis longus

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12
Q

When does the extensor pollicis longus commonly rupture?

A

in patients with rh arthritis due to the sharp radial deviation over Lister’s tubercle

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13
Q

what is contained within compartment 4 and 5?

A

4: extensor digitorum (superficial) and extensor indices (deep)
5: extensor digit minimi

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14
Q

what is contained within compartment 6?

A

extensor carpi ulnaris

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15
Q

what compartments are most commonly affected by tenosynovitis?

A

5th and 6th

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16
Q

what does the palmar wrist contain?
what tunnels does it contain?

A

flexor tendons, ulnar, median and radial nerve

contains the carpal tunnel and Guyon’s tunnel

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17
Q

What is contained within the carpal tunnel?

A

median nerve, flexor pollicis longus and eight flexor digitorum tendons (4 deep 4 superficial)

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18
Q

what forms the roof of the carpal tunnel?

A

flexor retinaculum?

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19
Q

what are the bony landmarks for the proximal carpal tunnel?

A

scaphoid on the radial side, and the pisiform on the ulnar side

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20
Q

what are the bony landmarks for the distal carpal tunnel?

A

trapezium on the radial size and hook of the hamate on the ulnar side

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21
Q

what is the Guyon’s tunnel and where is it?

A

on the ulnar side formed by the pisiform and hook of the hamate
contains the ulnar nerve and artery (nerve splits into superficial and deep branches)

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22
Q

what can cause most wrist pathologies?

A

tendon overuse or nerve compression

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23
Q

what systemic diseases can also cause wrist pathology?

A

rh arthritis
diabetes
lupus
osteoarthritis
psoriatic arthritis

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24
Q

what occurs with median nerve compression?

A

nerve paresthesia that causes burning/prickling sensation or numbness of the first 3 fingers

also called carpal tunnel syndrome

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25
what is the most common entrapment syndrome of the upper limb?
CTS
26
what is the most common cause of CTS?
tenosynovitis of the flexor tendons also ganglions, masses, thrombosed median artery, or accessory muscles
27
what is the appearance of CTS?
3x bigger in one axis compared to the other loss of honeycomb appearance abrupt contour changes
28
What can happen to the flexor retinaculum from CTS?
it may bulge outward due to intracanal pressure, best seen distally if it extends more than 4mm above an imaginary line between the pisiform and scaphoid bone it is abnormal
29
what is the measurement for the carpal tunnel?
(CSA @ PQ) - (CSA @ CP) >2mm
30
what is a bifid median nerve associated with?
persistent median artery (important for sx) and with an increased association of CTS
31
what are the symptoms of ulnar nerve compression? how can you recreate these symptoms?
paresthesia in last 2 windows reproduced with probe pressure over hook of hamate (Guyons tunnel syndrome)
32
what is the most common cause of ulnar nerve compression in the wrist?
trauma also chronic compression from long distance cycling or mass lesions
33
how does Guyon's tunnel syndrome appear?
loss of honeycomb appearance caliber change as it enters the tunnel
34
where is the radial nerve often compressed and assessed? what is it called?
level of mid forearm where the nerve passes between the forearm muscles during pronation Wartenburgs syndrome
35
how does joint fluid appear in the wrist?
anechoic distention of joint space representing simple fluid collapses with pressure or movement, no internal flow**
36
how does synovial hypertrophy appear? (compared to joint fluid distention)
distention of the sheath around the tendon will not collapse, has some flow with power doppler
37
what is rheumatoid tenosynovitis?
the immune system attacks the tendon sheaths in the wrists that causes inflammation of the synovium
38
what is the appearance of rheumatoid tenosynovitis?
hypoechoic pannus with fluid in the sheath hypervascularity with power doppler of the pannus thickened and heterogenous tendon with jagged edges (if involved)
39
what is the most affected tendon from rheumatoid tenosynovitis?
extensor carpi ulnaris
40
what causes general tenosynovitis of the wrist tendons? what is seen?
overuse and friction large amounts of fluid is seen around the tendons, increased CD signal if infected
41
What is the most common tendinopathy of the wrist? (what else is it called?)
De Quervain's tenosynovitis (stenosing tenosynovitis) involving tendons in compartment 1
42
what setting is useful in identifying the inflammatory process of De Quervain's?
colour doppler
43
what is the appearance of De Quervains?
swollen synovium with trace fluid around tendons and sheath, with restricted movement colour doppler signals bulge of the extensor retinaculum
44
What is intersection syndrome?
is a form of tenosynovitis involving where the 1st compartment tendons pass over the 2nd compartment tendons
45
how does intersection syndrome appear?
inflammation of the synovial sheath of the 2nd compartment
46
what is the triangular fibrocartilage complex?
dense connective tissue between the lunate and triquetrum carpal bones and ulnar head
47
how does a tear of the TFCC present? (symptoms)
ulnar sided wrist pain, clicking with wrist movement and point tenderness
48
how does a TFCC tear appear?
hypoechoic, thinned or absent
49
what is the most common tendon in the wrist/hand to tear?
flexor digitorum longus
50
what causes tears of the extensor tendons?
usually from rheumatoid tenosynovitis most commonly extensor pollicis longus and extensor digit minimi
51
what can cause a retinaculum tear?
after traction injuries leads to instability
52
what causes a tear of the extensor retinaculum specifically?
occurs after a punch or from chronic inflammation
53
which tendon is prone to subluxation in the elbow?
extensor carpi ulnaris diagnosed if >50% of the tendon moves out of the ulnar groove
54
how do rheumatoid nodules appear?
palpable, compressible masses on the fingers with NO vascularity small, oval, well defined and hypoechoic
55
what is the most common expansible lesion of the wrist?
ganglion cyst filled with gelatinous, mucoid thick fluid that may have septations and is non-compressible communicates with the tendon sheath
56
where is the most common site for a ganglion?
dorsal wrist, from the scapholunate ligament and radiocarpal joint
57
what is a "dorsal occult ganglion"?
occurring dorsally to the lunate bone, very small (prevents detection), causes pain from compression on radial nerve
58
where does a palmar ganlgia arise from?
radioscaphoid joint, usually between radial artery and flexor carpi radialis
59
how does a palmar ganglion appear?
usually large, painless and can have transmitted pulsatility from radial artery
60
what can a palmar ganglion be mistaken for?
pseudoaneurysm
61
what is the 2nd most common mass of the wrist/hand?
giant cell tumor from the tendon sheaths progessively enlarge and are benign
62
how do giant cell tumors appear?
solid hypoechoic masses WITH internal flow cause pressure of bone and tendon displacement
63
what causes a pseudoaneurysm?
traumatic injury to blood vessel wall that can become thrombosed
64
how does a pseudoaneurysm appear?
anechoic mass with internal echoes, ying yang flow pattern on colour doppler that is continuous with vessel

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