Wrist and Hand Flashcards by Thomas Etue

Tenosynovitis / tendonosis of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB)

De Quervain’s syndrome

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Overuse of the thumb

De Quervain’s syndrome

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De Quervain’s syndrome occurs more in?

females

(less stability and smaller radial tunnel)

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Weak, painful grip
Weak thumb extension
- Finkelstein test

De Quervain’s syndrome

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Rest and immobilization are effective in _____ of patients and Corticosteroid injection help _____.

25 to 72%, ~60%

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“Squeaker” syndrome, AKA

Intersection syndrome

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d/t odd squeak-like crepitus

and “wet leather” crepitus on motion

Intersection syndrome

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Intersection syndrome involves tenosynovitis of the…

radial wrist extensors

extensor carpi radialis longus (ECRL)
extensor carpi radialis brevis (ECRB)

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Intersection syndrome

Weightlifters, Tennis players
and Skiers (Pole use)

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Out-pouching from carpal synovium, bursa or tendon sheath

Ganglion Cysts

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65% of Ganglion Cysts are over the

scapholunate ligament

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what % of cysts come back after aspiration?

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Genetic condition causing contracture of the deep fascia of the hand

Dupuytren’s Disease

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M>F, ages 40-60, ulnar side of the hand more commonly affected

Dupuytren’s Disease

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Associated with Northern European ancestry, chronic alcoholism, DM, epilepsy and chronic pulmonary disease.

Dupuytren’s Disease

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Gradual onset –> one ore more small tender lumps in the palm –> Tough bands of tissue form that cause one or more fingers to bend toward the palm.

Dupuytren’s Disease

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Dupuytren’s surgical treatment

Fasciectomy with zigzag stitch

local anaesthetic

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complications of Dupuytren’s surgery

Scar Mobility, Nerve damage, Infection / Skin Necrosis, Reflex Sympathetic Dystrophy, Pain and Stiffness

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traumatic disruption of terminal extensor tendon of DIP

Mallet Finger

Baseball/Drop finger

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treatment for mallet finger with Fx

K-wire (Kirschner) open fixation or button technique with interosseous wire

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treatment for mallet finger without Fx

splint in neutral or slight hyperextension

Stack, Aluminum, Sugar Tong Alumifoam, Custom Thermoplastic

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mallet finger can lead to what deformity?

swan neck

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Week 0-6 splinting timeline for Mallet finger

continuous splint; change tape a lot.

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Week 6-7 splinting timeline for Mallet finger

same as 0-6 but begin active flexion to 20-25 degrees.

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Week 7-8 splinting timeline for Mallet finger

same with up to 35 degrees of flexion.

Week 8-12 splinting timeline for Mallet finger

night splinting only (if no extension lag) and begin mild exercise.

Week 12 splinting timeline for Mallet finger

unrestricted use

Fibrous nodule, typically in a flexor tendon.

trigger finger

diabetics are at a high risk for?

trigger finger

In trigger finger the nodule slides under the

annular ligament

trigger finger pain is worse with

AROM and passive stretch of involved tendon

trigger finger pain on AROM

Conservative care

trigger finger Pain + “click”

Conservative care | Steroids

trigger finger Pain + “sticking”

Steroids

trigger finger Pain + “locking”

surgical

95% short term relief for trigger finger and 50% “cure” rate

Steroids

trigger finger surgical | complications include

tendon contracture

trigger finger spinlting for

7-21 days

Fracture-dislocation of the first metacarpal base where the metacarpal articulates with the trapezium.

Bennett's fracture

the fragment in Bennett's Fx remains intact with the carpometacarpal joint by the

volar anterior oblique ligament.

MOI for Bennets Fx

thumb forced backward (abduction) with partial flexion of the MCP

Common in basketball, skiers and fist fights.

Bennett's fracture

Bennett’s Fracture should be treated conservatively or referred out?

refer to hand specialist

Acute instability of the ulnar collateral ligament | Skier’s Thumb

Gamekeeper’s Thumb

most common soft tissue injury to the thumb

Gamekeeper’s Thumb

Gamekeeper’s Thumb occurs by forceful

abduction and extension of the MP joint

After a complete tear of the 1st MCP UCL, the adductor aponeurosis separates the proximal and distal stumps, preventing ligament healing

Stener lesion

tender fullness or lump on ulnar MCP head or neck is highly suggestive of a

Stener lesion

For Gamekeeper’s Thumb stress in full _______ (accessory ligament) and 30 degrees of _____ (UCL)

extension, flexion

hyper-extended PIP and flexed DIP

Swan Neck Deformity

at what stage of Swan Neck Deformity is operative reduction required?

Stage IV

Common extensor tendon is damaged and a palmar dislocation occurs

Boutonniere Deformity

flexed PIP and hyper- | extended DIP

Boutonniere Deformity

In Boutonniere Deformity the PIP slips through the

common extensor tendon

Boutonniere Deformity Treatment is

Extension splint (dynamic-late or static-early).

0-4 weeks Extension splint

PIP @ 0 degrees, others free 24 hours/day. Exercise passive PIP extension and DIP flexion.

4-8 weeks Extension splint

Gentle AROM as above in dynamic splint.

10-12 weeks Extension splint

Gentle full fist stretching for all joints. Continue bracing DIP flexion for up to 5 months.

Avulsion of Flexor Digitorum Profundus usually from hyper-extension of a flexed finger.

Jersey Finger | SURGICAL

after Dorsal dislocations the Inability to move the joint signifies

fracture or incomplete reduction

in-game Dorsal dislocations can be

buddy-taped

Complete collaterl l. rupture are those in which stressing the collaterals produces more than

20° of deviation.

After collateral reduction, it is critical to hold the PIP joint in full

extension.

Collateral l. injury taped in flexion will result in a

Boutonniere deformity

Hyperextension or dorsal dislocation

Volar Plate Injury

Volar Plate injury treatment

block splint - 4 ws - start at 30 deg flexion

Fracture of the metacarpal neck (usually fifth)

Boxer's Fx

Most common Fx of the carpals (70%)

Scaphoid Fx

Scaphoid Fx MOI

FOOSH (not sprain)

snuffbox pain and weak grip

Scaphoid Fx (FOOSH)

All suspected scaphoid Fx with negative initial films should be

splinted for 10-14 days and re-radiographed

% of properly treated scaphoids that go bad?

The m/c dislocated wrist bone and 3rd m/c fractured. | Xrays usually negative initially

lunate

if suspected lunate Fx

immobilize and re-xray in 2-3wks

associated with increased risk for TFCC injury (if positive) or Kienbock's avascular necrosis of the lunate (if negative)

"Ulnar variance"

avascular necrosis of the lunate

Kienbock's disease

njury to the TFCC is often seen in chiros who _________ during adjustments

“load and torque”

Conservative Rx for TFCC injury 0-6 weeks

Long arm cast or long arm splint

Conservative Rx for TFCC injury 6 weeks

ROM exercises and immobilization splint

Conservative Rx for TFCC injury 8 weeks

strengthening (not torsion)

Radial Styloid; tension forces sustained during ulnar deviation/supination

Chauffeur's Fracture

The distal fracture fragment is displaced volarly (ventrally).

Smith’s Fracture

"Garden Spade" deformity

Smith’s Fracture

m/c found after falling on to the back of the hand.

Smith’s Fracture

Any fracture of the distal radius that has dorsal displacement

Colle’s Fracture

"Silver fork deformity”

Colle’s Fracture

Wrist and Hand Flashcards

(86 cards)