Wrist and Hand Flashcards
(133 cards)
1
Q
Important conditions regarding Vascular?
A
cardiac referral, raynaud’s disease, and compartment syndrome
2
Q
What are the major symptoms of cardiac referral?
A
chest pain and sweating frequent in men and women, woman are more than 2x as likely to have pain between shoulder blades. woman can also experience nausea, vomiting, and short of breath
3
Q
what is raynaud’s disease?
A
arteriole small artery/arteriole constriction in hands and feet
4
Q
who is most likely to experience Raynaud’s disease?
A
F > M, 15-40 years old
5
Q
what are the symptoms of Raynaud’s disease?
A
typically bilateral, hands blanch, become cyanotic, turn red. usually last 15-20 mins, alleviate with warm water
6
Q
what is raynaud’s disease more common with?
A
RA, occlusive vascular disease, smokers, B-blocker use
7
Q
What are the 2 types of Raynaud’s and their cause?
A
Primary- vasospastic disorder
secondary- due to underlying cause
8
Q
What is Buerger’s disease?
A
vasculitis of arteries/veins in hands and feet
9
Q
what is their a high correlation of with buerger’s disease?
A
smoking or use of tobacco
10
Q
who is most likely to get Burger’s disease?
A
20-40 year old males
11
Q
what are the symptoms of Buerger’s disease?
A
pain from claudication/reduced flow leads to reduced oxygen. commonly digital, palmar and ulnar arteries most affected in hands. may also have edema, cold sensitivity, rubor, cyanosis, trophic skin changes and paresthesias
12
Q
what does acute compartment syndrome most commonly affect?
A
volar forearm and hand
13
Q
what is acute compartment syndrome caused by?
A
fracture, penetrating trauma/combat injuries, high pressure injection injury, and surgery
14
Q
what are the 5 p’s?
A
pain, paresthesia, paresis, pallor, pulselessness
15
Q
what is a normal compartment pressure?
A
0-10mmHg
16
Q
what is a compartment pressure indicating need for a fasciotomy?
A
greater than 30 mmHg
17
Q
about what percent of individuals with radiographic OA experience significant symptoms?
A
50%
18
Q
how do patients with osteoarthritis present?
A
pain, swelling, morning stiffness, muscle weakness with difficultly gripping and twisting objects, and osteophyte formation at dorsal aspect of IP joints
19
Q
what is the treatment for osteoarthritis?
A
NSAIDs, steroid injections, or arthroplasty
20
Q
what are Heberden’s nodes and where are they found?
A
osteoarthritic enlargement of DIP
21
Q
what are Bouchard’s nodes and where are they found?
A
osteoarthritis enlargement of PIP
22
Q
what is rheumatoid arthritis?
A
systemic disease, involved inflammation of synovial joints and tendon sheaths, autoimmune, wrist and hand biomechanics often adversely affected
23
Q
what are the two deformities of rheumatoid arthritis?
A
ulnar drift at MCP’s and RD at wrist
Bouchard’s nodes- swelling and thickening of PCP and PIP synovium
24
Q
what are signs of an infection?
A
temp >100ºF, Bp > 160/95 mmHg, resting pulse >100 bpm, resting respiration > 25 Bpm, fatigue, inflammation, and elevated lab values
25
what are the common spaces on the hand for infection?
mid-palmar space, web space, thenar space
26
signs of a hand infection?
swelling, pain, tender, redness, warmth, loss of motion, swelling can cause bone splaying
27
Risks with hand infections?
risk of osteomyelitis/septic arthritis, sepsis and amputation. immunosuppressed pts are at greatest risk
28
what are Kanavel's 4 cardinal signs of a flexor sheath infection?
finger/hand held in slight flexion
swelling
tenderness over tendon sheath
pain on passive extension
29
what is the earliest sign of flexor sheath infection?
pain on passive extension
30
what is ascending lymphangitis?
inflammation of the lymphatic channels that occur as a result of infection at a distal site
31
what is the visible cue for ascending lymphangitis?
a red line down the lymphatic pathway of the dorsal side of the arm into the 2nd and 3rd digit
32
what is a ganglion cyst?
a benign thin walled, cystic, synovial lined lesion containing thick, clear mucinous fluid
33
where are ganglions cysts usually found?
dorsum of the wrsit
34
what are the treatments for a ganglion cyst?
nothing, aspiration, surgical excision, DO NOT smack with book
35
what is a pancoast tumor?
a tumor of the pulmonary apex
36
what is the major risk factor responsible for pancoast tumors?
cigarette smoking
37
what is the average age and most common gender for a pancoast tumor?
60s and male
38
what are the symptoms of pancoast tumors?
severe and unrelenting should and arm pain along with distribution of the 8th cervical and 1st and 2nd thoracic nerve trunks, horner's syndrome, atrophy of the intrinsic hand muscles
39
what is horner's syndrome?
ptosis (drooped eyelid), miosis (constriction of pupil), and anhidrosis (lack of sweating)
40
what is affected with neurapraxia?
myelin affected
41
what is affected with axonotmesis?
axon affected
42
what is affected with neurotmesis?
myelin and axon
43
what is demyelination?
reduction in the thickness of myelin, demyelinating neuropathies
44
what is lost in a grade 1 neurapraxia?
myelin
45
what is lost in a grade 2 axonotmesis?
axon
46
what is lost in a grade 3 neurotmesis?
endoneurium
47
what is lost in a grade 4 neurotmesis?
perineurium
48
what is lost in a grade 5 neurotmesis?
epi, peri and endoneurium
49
which grades are recoverable for nerve injuries?
grades 1 and 2
50
carpal tunnel syndrome is which nerve?
median
51
guyons canal is which nerve?
ulnar
52
wartnenberg syndrome is which nerve?
radial
53
which is the most prevalent entrapment neuropathy?
carpal tunnel syndrome
54
what are intrinsic risk factors for CTS?
BMI over 30, female, age over 50, DM and OA are most important
55
what is the main extrinsic risk factor for CTS?
forceful hand exertions
56
T/F: computer uses do have an increased risk of CTS when compared to the general population or industrial workers?
False they do not
57
symptoms of CTS?
Paraesthesia and/pain in palmar surface of thumb, index, middle and lateral border of 4th digit, nocturnal Paraesthesia, pain at wrist, weakness in thenar muscles, may have wasting or atrophy in thenar eminence
58
what are the commonly weak muscles due to CTS?
abductor pollicis brevis, opponens pollicis, and flexor pollicis brevis
59
what sensory signs that may arise from CTS?
decreased or absent sensation in thumb, index finger, middle finger and lateral border of 4th digit
60
why isn't there loss of sensation in the palm with CTS?
because the superficial branch doesn't go through carpal tunnel so it will still innervate the palm
61
what motor signs will someone with CTS have?
weakness and/or atrophy in ABP, OP, FPB
62
how will someone with CTS reflexes be?
normal
63
what is the number 1 management step of CTS?
splint/brace
64
what else can we do for CTS?
PT
65
what are the symptoms of guyon's canal nerve entrapment?
weakness and atrophy of ulnar intrinsic hand muscles, complaints of numbness on palmar aspect of hand as well as digits 5 and medial border of digit 4
66
why is there no sensory complaint on the dorsum of the hand with guyon's canal?
because there is a dorsal branch of the ulnar nerve that branches off before
67
what is a common group of people to experience guyons canal?
bike riders because the pinky rubbing up against the handle
68
what muscles are significantly weak with guyon's canal?
abductor digiti minimi, and fourth dorsal interosseous muscle
69
ulnar claw hand and wattenberg's sign are signs of?
guyons canal entrapment
70
are there normal reflexes with guyon's canal entrapment?
yes
71
wrist watch or handcuff neuropathy is a sign of?
wartenberg syndrome
72
symptoms of wartenberg syndrome?
Paraesthesia and/or pain along anatomic snuff box, thumb, and dorsum of digits 2-3 and lateral border 4, may be worse with gripping or use of hand
73
T/F there is no weakness with wartenberg syndrome
true because it is only a sensory nerve
74
are there any reflexes affected with wartenberg syndrome?
no
75
the radial nerve affected at the elbow and proximal describes which pathology?
wrist drop
76
what is wrist drop?
paralysis of the wrist and finger extensor muscles from temporary compression of the radial nerve
77
how long does ischemic wrist drop last?
minutes to hours
78
how long does demyelinating/axonal wrist drop last?
weeks to months
79
how much does nerve grow a day?
1mm
80
which reflex is diminished or absent with wrist drop?
brachioradialis
81
what is trigger finger?
thickening of flexor tendon sheath, as a patient flexes finger, tendon stick out. there is a palpable notch
82
what happened with trigger finger?
they are unable to extend finger actively, can flex actively and extend passively (snapping)
83
causes of trigger finger?
idiopathic, RA/DM, usually worse in morning
84
what is DeQuervian's tenosynovitis?
tenosynovitis of the first dorsal compartment usually from repetitive trauma with RD with thumb in grip
85
what two muscles are generally affected in DeQuervian's tenosynvitis?
extensor pollicis brevis and abductor pollicis longus
86
what is the common complaint with DeQuervian's tenosynovitis?
wrist pain radiating from the radial side of the wrist up the proximal forearm and distally into the thumb
87
what is the test for DeQuervian's Tenosynovitis?
finkelstein's test
88
what is the conservative treatment for DeQuervian's?
rest, NSAIDs, splint, modality, education and joint mobs
89
what is Duputren's contracture?
hyperproliferation of type 3 collagen scar tissue in the palms and digits. nodules or cords that can progress to contraction at the MCP and PIP joint with hyperextension of the DIP joints
90
T/F Duputren's contracture is painful?
False painless
91
which digit is Duputren's contracture usually in?
4th
92
what is the etiology of duputren's contracture
no single etiology, older men of north european descent (55 yo) associations include alcohol, smoking, manual labor, diabetes, and epilepsy medications
93
what is the medical management of duputrens contracture?
surgical excision of all abnormal palmar fascia
94
when is surgery indicated for duputrens contracture?
>30 degrees MCP flexion deformity and 10 degrees of DIP flexion deformity
95
what is keinbocks disease?
avascular necrosis of lunate. the isolated collapse of the lunate due to vascular insufficiency
96
T/F there is a low incidence of Keinbocks disease?
true
97
what is the age range for keinbocks disease?
young adults 15-40
98
what is the cause of keinbocks disease?
single injury or multiple compression forces distributing blood supply
99
what is the gold standard for keinbocks disease?
MRI
100
what is preiser's disease?
avascular necrosis of scaphoid
101
what percent of scaphoid fractures do we see Presisers disease and which pole fracture has a higher rate?
15-30%, proximal pole fractures have higher incidence of AVN
102
what is the clinical presentation of Preisers disease?
wrist pain at rest and motion, tenderness over scaphoid, decreased strength common, collapse common as bone becomes more necrotic
103
what is the common treatment for preisers disease?
immobilization and surgical debridement
104
what is gout
a metabolic disorder of uric acid leading to hyperuricemia
105
when do we see damage in the hand with gout?
in the chronic phases of the disease
106
acute phase of gout
seen in the big toe 50% of all initial attacks
107
what are the three phases of gout?
acute, recurrent, and chronic
108
what is syndactyly?
webbing of the fingers most commonly 3rd and 4th
109
what is the treatment for syndactyly?
surgical repair before 1 year old
110
what is radial club hand?
radius missing
111
how does radial club hand present?
radial deviation of hand, shortening and/or curvature of ulna
112
what is the MOI for mallet finger?
unexpected passive flexion of the DIP joint causes avulsion or rupture of the extensor mechanism as it attaches to the distal phalanx
112
what is the MOI for mallet finger?
unexpected passive flexion of the DIP joint causes avulsion or rupture of the extensor mechanism as it attaches to the distal phalanx
113
what is the clinical picture for mallet finger?
flexion of DIP joint at rest, unable to actively extend DIP joint
114
treatment of mallet finger?
rigid splint used to immobilize DIP splint. placed in slight hyperextension for 6 weeks. if splinting doesn't work then surgery
115
T/F you should always get an xray with mallet finger
TRUE
116
what can ensure a better outcome. ofmallet finger?
if avulsion vs tendon rupture
117
what is boutonniere deformity result from?
a rupture of central tendinous slip of extensor hood
118
what is the observed boutonniere deformity?
extension of MCP and DIP joint and flexion of PIP joint
119
what does boutonniere injury commonly occur with?
trauma, RA-degeneration of central extensor tendon
120
where will the point of maximal tenderness be for boutonniere injury?
dorsally where the tendon insertion is torn
121
what is the treatment for boutonniere injury?
splinting of PIP in an extension splint for 6 weeks. acetaminophen and NSAIDs for pain and inflammation
122
what is gamekeeper thumb?
aka skiers thumb. Degeneration of the ulnar collateral ligament of the MCP joint of the thumb
123
which is the most common ligamentous injury of the hand?
gamekeepers thumb -UCL
124
how does a patient with gamekeepers thumb present?
with pain, tenderness, ecchymosis, and swelling near medial MCP of thumb, may have instability of the joint and weakness with grasping objects
125
why should xrays or MRI be ordered for gamekeepers thumb?
to rule out existence of fracture or dislocation, MRI to rule out complete tear- if completely torn need surgery
126
treatment of gamekeepers thumb?
immobilization for 6 weeks in thumb spica splint
127
which side of the hand is the OR side for tendon laceration and what does it mean?
palmar side- means need to get surgery
128
how many hours after post op of flexor tendon repair should you wait to do passive finger flexion and active extension?
48-72
129
which is initiated first with flexor tendon repairs: active flexion or extension
active extension
130
finger sprains
“I jammed my finger”
First rule out fracture/dislocation
Then make sure it is not a boutonniere
All the rest can be buddy taped
131
how and where do colles fractures occur?
distal radius fracture with posterior displacement from FOOSH
132
how do patients with a colles fracture present?
dinner fork deformity, distal and dorsal wrist pain, swelling of the wrist, increased angulation of the distal radius, inability to grasp objects
