Wrist & Hand (SY) Flashcards Preview

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Flashcards in Wrist & Hand (SY) Deck (46):
1

What is a Colles fx?

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

2

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

fx of radiocarpal joint or avulsion fx of ulnar styloid process

3

What are most complications due to in Collies fxs?

malalignment/malunion of fragments resulting in joint incongruity

4

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

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

5

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

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

6

What are some presentations of RSD (reflex sympathetic Dystrophy?

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

7

What is a Smith Fx?

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

8

What is the major complication of a Smith fx?

Median Nerve injury

9

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

Cast immobilization, pins and plate

10

What is normal wrist extension/flexion? Functional?

70/80. 40/40

11

What is normal radial/ulnar deviation? Functional?

15/30. 15/15

12

What is normal pronation/supination? Functional?

80/70. 50/50

13

How common are Scaphoid fxs?

60-70% of carpal fractures

14

Where do most Scaphoid fx's occur?

in the middle of the bone

15

What affects the rate of healing of a Scaphoid fx?

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

16

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

Not always present early on

17

Where will you feel pain in a Scaphoid fx?

in the snuff box

18

What is a common cause of scaphoid fx?

high force hyperextension injury

19

What happens to pinch strength with a scaphoid fx?

Decreases

20

Three things required in order to heal a scaphoid fx

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

21

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

high.

22

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

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

23

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

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

24

are there always symptoms with a scaphoid fx?

Not always until DJD appears

25

What are the symptoms of a scaphoid fx?

pain
swelling
decreased grip strength
limited ROM

26

What part of the lunate usually gets fractured?

Volar pole of the bone

27

Complications of a lunate fx?

Kienbocks disease- AVN of lunate resulting in collapse

28

What are some predisposing factors of Keinbock's AVN?

Pattern of intrinsic blood supply?
Negative Ulnar variance
Radial slope

29

Who typically presents with Keinbock's AVN?

Male:female-2:1 age 20-40

30

What are some signs/symptoms of Keinbock's?

Pain about lunate/swelling
Decreased grip strength
Decreased ROM

31

How do you treat Keinbock's AVN?

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

32

What is De Quervain's Tenosynovitis?

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

33

What are associated factors with De Quervain's Tenosynovitis?

DM
Hypothyroidism
pregnancy
RA
gender (female?)

34

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

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

35

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

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

36

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

Splinting/rest
NSAIDS
Injection
Surgery

37

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

Pt education
Modalities
Manual Therapy
Tendon Gliding exercises
Strengthening

38

What is Skier's/Gatekeepers Thumb?

Injury of Ulnar Collateral Ligament of thumb

39

What is the method of injury for Gatekeepers Thumb?

forced or repetitive radial deviation of the thumb

40

What are some complications with an UCL injury?

Chronic laxity leading to DJD
Decreased pinch and grip strength
Pain

41

How do you test for instability of the UCL?

> 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

What do you do before stress testing the UCL?

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

43

What are the treatments of an UCL injury?

Splinting, Casting and surgery

44

What are some indications to surgically repair an UCL?

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

45

What is a Stener lesion?

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

When is prognosis worse with UCL surgical intervention?

With delayed repair of a complete UCL tear