What is the Finkelstein test?
De Quervain syndrom – flex the thum into the palm and close the fingers, ulnar deviate – positive if produces pain in the first dorsal compartment
CPR for De Quervain syndrome 5 of 7
Finkelstein, tenderness over APL and EPB tendons, pain over the radial styloid, swelling, thickening, pain on the resisted thumb ext, and pain in the first extensor compartment with wrist movement (tendinosis of the tendon sheath)
Describe the first CMC grind test
OA of the first CMC first metacarpal into the trapezium using an axial load and rotate the metacarpal – positive if it reproduces pain
An athlete jams his finger and has immediate pain along with being unable to extend his DIP joint. He has full flexion and skin intact. What is his likley Dx? A) boxer's fx B) Flexor digitroum profundus tendon avulsion (jersey finger) C) mallet finger D) neurotmesis
C – mallet finger
Tx for a mallet finger for direct access?
splint joint in hyperext and refer him to MD for an x-ray for possible avulsion
If x-rays are negative then tx of mallet finger includes:
splinting the distal interphalengeal joint in slight hyperext for 6-8 wks
For mallet finger what is the primary criterion for exercise progression after 8 wks of immobilization?
no ext lag
A fall onto the wrist causing hyperext and ulnar deviation may cause injure to what?
scapholunate ligament, may pain with lifting and dorsal side pain, pain with WB'ign
What landmark is useful to palpate scapholunate?
anatomical snuff box
What is the scaphoid shift or Watson test?
tests for scapholunate dissociation, by shifting the scaphoid ant and then post
A scapholunate dissociation on x-ray whill likley reveal?
Dorsal intercalated segemental instability (DISI deformity)
On x-ray what might a TFCC disorder present with?
Positive ulnar variance
Scapholunate dissociation can result in what if not caught early?
degenerative changes in the wrist leaving few Tx options
When seeing a patient for carpal tunnel what else should be rule out?
C7 nerve root involvement
Early on in carpal tunnel what type of splint is indicated?
Volar wrist cock up splint with the wrist positioned at 0 degrees ext/flex
What tests are useful for Dx carpal tunnel?
Tinel test, phalen test, and Semmes-Weinstein monofilament, abductor pollicis atrophy
What education should be provided to carpal tunnel patient regarding sleeping?
appropriate use of night splints to keep the wrist in a neutral position
If carpal tunnel conservative tx is failing how quickly should surgical intervention be discussed?
After 3 months
After a patient receives a nerve decompression for carpal tunnel what is should be performed at the first visit for Tx?
cScar management including compression and gentle mobilizaition, prolonged stretching and aggravating postures should be avoided early to allow the nerve to heal
When is surgical fixation of the fifth metacarpal fracuture indicated?
Angulation > 50 degrees
Post op postioning after 5th metacarpal fixation should hold the MCP joints in?
60-80 degrees flexion keeps the ligaments taut and maintains there length during healing
When should tendon involvement be consider as restricting movement in the hand?
When passive motion exceeds active motion by more 20 degrees