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Musculoskeletal Pathophysiology > Wrist & Hand (SY) > Flashcards

Wrist & Hand (SY) Flashcards

1
Q

What is a Colles fx?

A

Fx 1 1/2’ proximal to distal end of radius displaced dorsally

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2
Q

What other fx occurs in more than 50% of the cases of Collies fxs?

A

fx of radiocarpal joint or avulsion fx of ulnar styloid process

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3
Q

What are most complications due to in Collies fxs?

A

malalignment/malunion of fragments resulting in joint incongruity

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4
Q

What happens with residual dorsla tilting >5 degrees of the radius post collies fx?

A

lose inward tilt of articular surface of >3 degrees and poor functional results

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5
Q

What can happen to the wrist with shortening of the radius post Distal radius fx?

A

increased axial load to the ulnar shaft leading to DJD and pain in ulnar aspect of wrist

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6
Q

What are some presentations of RSD (reflex sympathetic Dystrophy?

A 
Burning pain
edema
discoloration
vasomotor/trophic changes
sudomotor changes
soft tissue contractures 
joint stiffness
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7
Q

What is a Smith Fx?

A

(reverse colles) fracture of the distal radius displaced ventrally (fall on flexed wrist or direct blow to forearm)

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8
Q

What is the major complication of a Smith fx?

A

Median Nerve injury

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9
Q

What is the medical management of a Smith’s fx?

A

Cast immobilization, pins and plate

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10
Q

What is normal wrist extension/flexion? Functional?

A

70/80. 40/40

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11
Q

What is normal radial/ulnar deviation? Functional?

A

15/30. 15/15

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12
Q

What is normal pronation/supination? Functional?

A

80/70. 50/50

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13
Q

How common are Scaphoid fxs?

A

60-70% of carpal fractures

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14
Q

Where do most Scaphoid fx’s occur?

A

in the middle of the bone

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15
Q

What affects the rate of healing of a Scaphoid fx?

A

Location of fx. Proximal scaphoid fxs hear slower than distal fxs

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16
Q

Are scaphoid fx’s typically present of radiograph early on?

A

Not always present early on

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17
Q

Where will you feel pain in a Scaphoid fx?

A

in the snuff box

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18
Q

What is a common cause of scaphoid fx?

A

high force hyperextension injury

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19
Q

What happens to pinch strength with a scaphoid fx?

A

Decreases

20
Q

Three things required in order to heal a scaphoid fx

A

Coaptation of fragments
adequate blood supply
early diagnosis and adequate Rx (immobilization from time of injury until union)

21
Q

What is the incidence of non-union in scaphoid fx’s?

A

high.

22
Q

What are some factors in non-union of the scaphoid?

A

delayed diagnosis
inadequate immobilization
displacement of fragments > 1mm
instability between proximal and distal carpal rows

23
Q

How long should you immobilize scaphoid if injury is proximal 1/3? Middle 1/3? Distal 1/3?

A

4-8 weeks. 6-12 weeks. 30 weeks

24
Q

are there always symptoms with a scaphoid fx?

A

Not always until DJD appears

25
Q

What are the symptoms of a scaphoid fx?

A

pain
swelling
decreased grip strength
limited ROM

26
Q

What part of the lunate usually gets fractured?

A

Volar pole of the bone

27
Q

Complications of a lunate fx?

A

Kienbocks disease- AVN of lunate resulting in collapse

28
Q

What are some predisposing factors of Keinbock’s AVN?

A

Pattern of intrinsic blood supply?
Negative Ulnar variance
Radial slope

29
Q

Who typically presents with Keinbock’s AVN?

A

Male:female-2:1 age 20-40

30
Q

What are some signs/symptoms of Keinbock’s?

A

Pain about lunate/swelling
Decreased grip strength
Decreased ROM

31
Q

How do you treat Keinbock’s AVN?

A

Primarily a surgical problem. Immobilization w/ external fixator
silicone arthroplasty is inserted and carpals are usually fused

32
Q

What is De Quervain’s Tenosynovitis?

A

Inflammation of the tendon sheath of the APL and EPB attributed to excessive friction between the two tendons

33
Q

What are associated factors with De Quervain’s Tenosynovitis?

A 
DM
Hypothyroidism
pregnancy 
RA 
gender (female?)
34
Q

What are some differential diagnoses for De Quervain’s Tenosynovitis?

A

Thumb CMC arthritis
Scaphoid fx
entrapment of superficial branch of radial n
radiocarpal dysfxn

35
Q

you will have a +/- Finkelstein’s test with De Quervain’s Tenosynovitis?

A

Positive. also have pain with resisted extension of thumb MCP joint

36
Q

What is some general Rx’s for De Quervain’s Tenosynovitis?

A

Splinting/rest
NSAIDS
Injection
Surgery

37
Q

What are some specific PT Rx’s for De Quervain’s Tenosynovitis?

A 
Pt education
Modalities
Manual Therapy
Tendon Gliding exercises
Strengthening
38
Q

What is Skier’s/Gatekeepers Thumb?

A

Injury of Ulnar Collateral Ligament of thumb

39
Q

What is the method of injury for Gatekeepers Thumb?

A

forced or repetitive radial deviation of the thumb

40
Q

What are some complications with an UCL injury?

A

Chronic laxity leading to DJD
Decreased pinch and grip strength
Pain

41
Q

How do you test for instability of the UCL?

A

> 15 degrees of valgus deformity with ulnar stress to the thump MCP joint as compared to the uninvolved side.
-Test done in 15-20 degrees of flexion and full flexion

42
Q

What do you do before stress testing the UCL?

A

X-ray done prior to detect avulsion fx of the MC bone

43
Q

What are the treatments of an UCL injury?

A

Splinting, Casting and surgery

44
Q

What are some indications to surgically repair an UCL?

A

UCL injury w/ Fx that is rotated, displaced or interarticular
Stener Lesion

45
Q

What is a Stener lesion?

A

aponeurosis of adductor pollicis muscle becomes interposed btwn the ruptured UCL and its site of insertion at the base of proximal phalanx.
-UCL cannot spontaneously heal

46
Q

When is prognosis worse with UCL surgical intervention?

A

With delayed repair of a complete UCL tear

Musculoskeletal Pathophysiology (14 decks)

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