Wrist and Hand

Question 1

Why is the wrist and hand vulnerable to injury?

Answer 1

very little muscle or fat padding to protect structures;

Question 2

What are MOI for wrist and hand injuries?

Answer 2

Direct impact;

FOOSH

Question 3

What structures of the wrist and hand can be injured?

Answer 3

carpals, metacarpals, phalanges, ligaments, tendons

Question 4

How many carpal bones are there and what are they?

Answer 4

8: trapezoid, trapezium, hamate, capitate, triquetral, pisiform, lunate and scaphoid

Question 5

What bones are in the proximal row of carpals?

Answer 5

scaphoid, lunate, triquetrum, pisiform

Question 6

What carpal bones make up the distal row?

Answer 6

trapezium, trapezoid, capitate, hamate

Question 7

What are the articulations of the wrist?

Answer 7

distal radioulnar joint: immediately adjacent to radiocarpal joint;
radiocarpal joint: radius with scaphoid, lunate, and triquetrum
intercarpal joints
midcarpal joints

Question 8

What is the triangular fibrocartilage? (TFC)

Answer 8

cartilaginous disc that binds end of ulna and radius together

Question 9

What does the TFC complex do?

Answer 9

stabilizer of the distal radioulnar joint. also provides an articular surface for the carpal condyle.

Question 10

What are the gliding joints that have minimal contribution to wrist movement?

Answer 10

intercarpal joints

Question 11

What joints are between the rows of proximal and distal carpals?

Answer 11

midcarpal joints

Question 12

How many bones make up the hand?

Answer 12

19

Question 13

What are the digits made up of?

Answer 13

carpometacarpal joints, metacarpophalangeal joints.

3 phalanges per finger & interphalangeal joints
2 in thumb & 1 IP joint

Question 14

What are the hypothenar muscles?

Answer 14

opponens digiti minimi;
flexor digiti minimi brevis;
abductor digiti minimi

Question 15

What are the thenar muscles?

Answer 15

adductor pollicis
flexor pollicis brevis
abductor pollicis brevis
opponens pollicis

Question 16

What are the nerves of the wrist and hand?

Answer 16

median, radial and ulnar

Question 17

how is blood supplied to the hand?

Answer 17

ulnar and radial arteries with two arterial arches that are superficial and deep to the palmar arches

Question 18

What are common acute wrist and hand injuries?

Answer 18

contusions, sprains, strains (mallet finger, boutonniere deformity)
fractures (colle’s, scaphoid, metacarpals- boxers, bennett’s, phalanges)
dislocations- lunate, MCP, PIP, & DIP

Question 19

What is a chronic wrist injury?

Answer 19

wrist ganglion

Question 20

What are MOI for contusions?

Answer 20

direct impact via falling or being struck by and implement

Question 21

S&S of contusions of the wrist or hand:

Answer 21

pain on palpation, obvious bruising or swelling

Question 22

Management for contusions of wrist/hand:

Answer 22

PIER, protect with padding and follow up with physician if it does not resolve within couple of days

Question 23

What are the most common and poorly managed injuries of the wrist?

Answer 23

sprains

Question 24

MOI for wrist sprains? S&S of wrist sprains?

Answer 24

FOOSH,

pain over ligament & w AROM/PROM, generalized swelling, tenderness, inability to flex or deviate wrist.

Question 25

Management for wrist sprains?

Answer 25

PIER, NSAIDs, protect with splinting, taping or bracing, referral to physician to rule out fractures.

Question 26

What is gamekeepers thumb? What is the MOI?

Answer 26

a tear of the ulnarcollateral ligament of the MCP joint. | MCP in extension and forceful abduction

Question 27

S&S of gamekeepers thumb:

Answer 27

palmar aspect of the joint- pain and swelling and positive abduction stress.

Question 28

Management of a gamekeepers thumb sprain:

Answer 28

standard acute: instability: spica cast for 3-6 weeks. | severe: surgical repair

Question 29

What is the MOI for phalange sprains?

Answer 29

direct blow to the tip of the finger may injure the DIP, PIP or MCP joint capsule and/or ligaments

Question 30

S&S of phalange sprains:

Answer 30

swelling, pain, loss of ROM | - incapacitating to hand function in many cases

Question 31

management of phalange sprains:

Answer 31

Ice, splint, refer to medical care if fracture is suspected

Question 32

What are MOI for metacarpal fractures? What types of fractures are there?

Answer 32

direct trauma due to striking an object or being struck by implements. Boxers or Bennett's fracture.

Question 33

S&S of metacarpal fractures:

Answer 33

Pain, deformity, crepitus, swelling & abnormal mobility

Question 34

Management for metacarpal fractures:

Answer 34

PIER, splint & refer to physician for x-ray and casting (~4-6 weeks)

Question 35

What is a boxer's fracture?

Answer 35

unstable distal metaphysis or neck of the fourth or fifth metacarpals.

Question 36

What fracture has S&S of sudden pain, inability to grip, rapid swelling, and deformity. With point tenderness; crepitus and increased pain with axial compression and percussion

Answer 36

Boxer's

Question 37

what is the management for boxer's fracture?

Answer 37

standard acute; splint and immediate physician referal.

Question 38

What is a bennet fracture?

Answer 38

a fracture dislocation to the proximal end of the 1st metacarpal at the carpometacarpal joint

Question 39

What are MOI for phalange fractures?

Answer 39

direct blow or FOOSH

Question 40

S&S for phalange fractures:

Answer 40

possible deformity, severe pain, crepitus, swelling and loss of function (lack of AROM/PROM)

Question 41

management for phalange fractures?

Answer 41

ice, splint, refer to physician

Question 42

What is the MOI for a scaphoid fracture?

Answer 42

FOOSH

Question 43

What are S&S of scaphoid fractures?

Answer 43

point tenderness in anatomical snuff box, pain with inward pressure along long axis, increased pain with wrist extension and radial deviation?

Question 44

management for scaphoid fracture:

Answer 44

standard acute-splint with physician referral

Question 45

what kind of concern is attached to a scaphoid fracture?

Answer 45

avascular necrosis

Question 46

What are MOI for phalange dislocations?

Answer 46

direct blow to tip of finger - what joints are involved? DIP, PIP, MCP possible tissue damange to capsule, ligaments, nerves, blood vessels and bone

Question 47

What are S&S for phalange dislocations?

Answer 47

obvious deformity, severe pain, rapid swelling and loss of function. inability to flex or extend fingers

Question 48

management for phalange dislocation:

Answer 48

splint, ice, refer to physician for reduction. | splint for 3 weeks max; longer will lead to severe tissue contracture

Question 49

What is a wrist ganglion?

Answer 49

rupture of the tendon sheath or joint capsule

Question 50

What are treatments for wrist ganglions? past and present?

Answer 50

breaking them without rupture of skin as many as 50% may go away on own, closed rupture with multiple needle punctures; surgery to remove cyst.