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T OCS > Wrist and hand > Flashcards

Wrist and hand Flashcards

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1
Q

Dequervains Tenosynovitis

A

Anatomy involved” Brevis sandwich”

  • Extensor pollocis longus/Brevis, Abductor pollicis longus
  • (+) Finkelsteins test
  • most common overuse injury at wrist
  • stenosing 1st compartment (EPB, APL)
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2
Q

Treatment for Dequervains

A
  1. Rest during initial stage (25-72% cure rate)
  2. Thumb spica splint- leave IP free to move
  3. Cortisone injection
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3
Q

Intersection syndrome

A
  • Inflammatory condition of 1st and 2nd compartments, where they intersect ( APL/EPB (1st) and ECRL and ECRB)
  • 4-6 cm proximal to RC joint

Dx: extended wrist, circumduct thumb

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4
Q

Treatment for intersection syndrome

A
  1. Rest
  2. Activity modification
  3. Splinting
  4. NSAIDS
  5. injection
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5
Q

1st compartment

A
  1. Extensor Pollicis brevis

2. Abductor Pollicis longus

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6
Q

2nd compartment

A
  1. Extensor Carpi radialis longus

2. Extensor Carpi radialis brevis

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7
Q

Stener Lesion

A
  • UCL displaced under the adductor aponeurosis, healing cannot occur.
  • consult with Orthopedist
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8
Q

bennets fracture

A
  • Most common fx of 1st MC
  • MOI: axial compressive load on a flexed thumb
  • get proximal displacement of 1st metacarpal due to APL tendon attachment
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9
Q

Jersey Finger

A

Flexor digitorum profundus avulsion fx

  • MOI: forced hyperextension against active flexion (going to grab jersey)
  • most common at 4th MCP, sometimes 5th
  • Loss o AROM at DIP joint- “make a fist”- fingertip cant touch palm
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10
Q

Volar plate avulsion fx

A
  • volar plate fibrocartilage that reinforces joint capsule of MCP, PIP and DIP
  • prevents hyperextension– MOI extension
  • x-ray shows “V sign”
  • > 40% articular surface involved in fx, surgica stabilization needed.
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11
Q

6 criteria to dx wrist fx in ER

A
  1. Swollen
  2. Pain with palpation
  3. Pain with AROM flex or ext
  4. Pain with PROM flex or ext
  5. Pain with gripping
  6. Pain with supination
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12
Q

Most common carpal fx *

A

Scaphoid

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13
Q

Scaphoid fx *

A
  • x-ray usually negative, want MRI, CT, bone scan
    Special test: Axial load of thumb
  • palpate scaphoid in snuffbox with one hand, with other, take thumb and compress into snuffbox +LR of 49- Excellent! to rule in and out
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14
Q

Hook of hamate fx

A

MOI: abutment of hook of hamate on an object (golf club handle etc)

  • common in racket sports
  • cant use standard x-rays need carpal tunnerl and supinated oblique views
  • dx with CT and bone scan
  • EXCISION HAS BETTER OUTCOME THAN ORIF (7-10 week return to sport vs 12 weeks for cast)
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15
Q

AVN of lunate

A

AVN of lunateKienbocks disease

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16
Q

Scapholunate injury

A

MOst common wrist ligament injury
MOI: fall on pronated wrist, excessive wrist ext/ulnar dev
Special Test: Watson/scaphoid shift test
- palpate scaphoid on volar aspect of hand and give dorsal pressure
- extend and ulnarly deviate wrist and let go
- (+) for clunk/pain- because no lig integrity, no spring back and once pressure released, scaphoid flexes into radius

Tx: surgery primary

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17
Q

Lunotriquetrial injury

A

MOI: Foosh
Sx: ulnar sided wrist pain
Special test: Lunotriquetrial Shear test
- give dorsal pressure to triquetrium to shear lunate dorsally. (+) painful click with instability
x-ray usually normal,
Tx: conservative, immobilization 2/2 not usually progressing to arthritis
- persistent pain –> surgery

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18
Q

DRUJ and TFCC

A

TFCC primary stabilizer of DRUJ

  • consists of
  • dorsal and palmar radioulnar ligament
  • ulnolunate lig
  • ulnotriquetrial lig
  • disc

MOI: acute trauma (fall) FOOSH or sport related

Special tests: Supination lift test, press test (100% sen),
piano key sign, DRUJ ap/pa hypermobility, grind test

Tx: brace (wrist widget, compression tape to DRUJ, surgery)

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19
Q

Distal Radius Fx

A

Can be Smith, Colles or Barton Fx

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20
Q

Smith’s fx

A
  • “Dinner fork deformity”
  • volar displacement of distal radius
    Tx: ALL NEED REDUCTION
    Non-op- splint until swelling goes down then cast
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21
Q

Colles fx

A
  • fx of distal radius in a DORSAL direction (vs volar for smith’s)
  • also extraarticular fx (vs Barton’s)
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22
Q

Barton’s fx

A

Fx of distal radius in either a dosal or volar direction but it is an INTRAARTICULAR fx (vs smiths and colles)

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23
Q

Boxers fracture

Study These Flashcards
A

fx of 5th MCP

Tx: splinting, non op > 90% success rate

24
Q

Bunnell Littler

Study These Flashcards
A

Tests for intrinsic muscle tightness (lumbricles) vs joint capsular tightness

  • Test PIP flexion in both MCP flexion and ext
  • if there is more flexion with MCP flexed (lumbricles on slack) then intrinsic tightness (lumbricle)tightness is indiated
  • if there is the same ROM with MCP flexed or ext, think capsular tightness
  • normal is more PIP flexion with MCP ext
25
Swan neck deformity
- PIP hyperextension, DIP flexion | Tx: usually surgery
26
Boutenniere's
- PIP flexion, DIP hyperextended Rupture of central band, puts tension on distal phalanx causing it to hyperextend Tx: conservative. Splinting and exercise
27
OA at the hand CPR (5)
1. Hand pain, aching or stiffness 2. hard tissue enlargement of 2 or more of 10 selected joints 3. < 3 cm swollen MCP joints 4. Hard tissue enlargement of 2 more more DIP joints 5. deformity of 2 or more of 10 selected joints
28
Mallet Finger
- avulsion of distal slip of extensor tendon - cant fully extend DIP actively - can passively extend DIP MOI: tip of finger into rapid forced flexion
29
Compartment 3
Extensor Pollicis longus
30
Compartment 4
Extensor digitorum, and extensor indices
31
Compartment 5
Extensor digit minimi
32
Compartment 6
Extensor carpi ulnaris
33
What passes through the carpal tunnel
4 tendons of flexor digitorum superficialis 4 tendons of flexor digitorum profundis 1 tendon of flexor hallicis longus 1 median nerve
34
Safe position for splinting of the hand
wrist extended MCP slightly flexed IP joints extended thumb palmarly abducted
35
Distal row vs proximal carpal row
distal row stable, very litte movement. Proximal row more mobile.
36
Heberdens nodes
osteophyte that forms at DIP jt
37
bouchards nodes
osteophytes that form at PIP joint
38
Gamekeepers thumb
disruption of UCL at thumb; complete tear can lead to a steners lesion
39
Carpal mechanics
- proximal row moves opposite motion (with radial deviation, proximal row moves ulnarly) - Distal row moves in that same direction (with radial deviation, the distal row moves radially)
40
concave/convex distal radius and carpal
CONCAVE distal radius on convex carpal
41
Finger pulleys
``` Either cruciate (3) or annular (5) - they keep the tendons close to the bone (like traveling through a tunnel), if a pulley is ruptured tendon bowstrings A2 and A4 pulleys MOST imPORTANT at the levels of the proximal and middle phalanges ``` Trigger finger can be at A1
42
OK sign
AIN - anterior interosseus nerve lesion- brings pulp of fingers (tear shape) vs tip to tip circular shape
43
2 strand flexor tendon repair
early passive protocol (Kleinert, duran)
44
4, 6, 8 strand repair
active ROM protol early
45
flexor tendon immobilization
slight wrist flexion, MP flexion, IP Ext
46
VISI and DISI
Volar/Dorsal intercollated carpal instability- can lead to midcarpal row subluxation (lunate)- tilted in a dorsal direction (DISI)
47
Depuytren's disease
contracture of distal palmar crease fascia --> flexion contractures at MP or PIP joints
48
Ape hand
Median nerve injury
49
Claw hand
Ulnar nerve injury
50
sign of benediction
high median nerve injury- ACTIVE test- looks like claw hand but claw hand is resting position. You ask pt to make a fist and then they go and present like claw hand., resting they look normal
51
Carpal Tunnel prediction rule
1. age > 45 2. shaking hands relieves symptoms 3. CTQuestionaire score > 1.9 4. decreased thumb sensation 5. Wrist ratio AP/ML > .67
52
DISI injury
dorsal intercollated segmental instability - Scapho-lunate lig injury (think in relation to lunate) - scaphoid normally wants to move volarly - if there is a disruption to SL lig, the scaphoid will keep going volarly and the triquetrium are DORSAL in relation
53
VISI injury
volar intercollagted segmental instability - triquetrial-lunate lig injury - normally triquetrium wants to keep moving dorsally - if there is damage to the TL lig, the SL lig still intact which wants to move volarly, Triquetrium moves dorsally, but all in relation to lunate
54
Ligament of struthers injury
Pronator teres WEAKNESS to differentiate bw PT syndrome - pain at elbow - because its proximal to PT, PT is affected! weakness of PT and pain at elbow think L of struthers injury not PT!
55
Recurrent branch of median N
2 LOAF 2 lumbricles Opponens pollicus Abductor pollicus brevis Flexor pollicus brevis
56
Froment's sign
ULNAR NERVE ISSUE! - KEY CHUCK GRIP! (+) flexion of IP at thumb due to ADD pollicus weakness
57
AIN innervations
think OK sign - flexor digitorum profundus - flexor pollicus longus - pronator quadratus

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