Wrist Hand (Carol's Lecture)

Question 1

Disadvantages to internal fixation?

Answer 1

1. Infection
2. Blood supply compromise
3. Nerve injury
4. Tendonitis / tendon rupture

Question 2

What is a Mallet finger?

Answer 2

tear or rupture of terminal tendon

Can lead to avulsion fracture

Question 3

How are distal phalanx fxs treated?

Answer 3

1. Usually treated closed
2. May need soft tissue repair & K-wire fixation
3. Nail bed repair
4. Extensor tendon repair

Question 4

Distal phalanx bony mallet injury = tuft fx. Describe three different treatment approaches:

Answer 4

1. 25% of articular surface-immobilize with splints for 8-12 weeks
2. Therapist checks splint and DIP position every 1-2 weeks
3. Greater than 1/3 articular surface requires ORIF

Question 5

What is the least common fx of the hand?

Answer 5

middel phalanx fx

Question 6

How soon before you can initiate AROM for midshaft middle phalanx fx?

Answer 6

6 weeks

Question 7

Cortical bone compromised with middle phalanx fractures takes ____ weeks to heal.

Answer 7

12-16 weeks

Question 8

What is the most common middle phalanx fx?

Answer 8

Volar plate avulsion fractures at the base of the proximal middle phalanx

Question 9

PIP fx dislocation treatment:

Answer 9

i. Mini-external fixator and K-wire for unstable PIP fx dislocation
ii. Stable: dorsal block splinting
iii. ORIF
iv. Tension band wiring
v. Kirschner wires

Question 10

What are complications with PIP fx disclocation?

Answer 10

a. Flexor or extensor tendon adhesions
b. Tightness / contractures at DIP and PIP joints
c. Extensor lag
d. Swan neck deformity

Question 11

What is swan neck deformity?

Answer 11

imbalance in stretching mechanism to volar plate; PIP in hyperextension and DIP in flexion

Question 12

Boxer’s fx affects which MCs?

Answer 12

4th or 5th

although true boxers usually break 2nd or 3rd

Question 13

Boxer’s fracture is usually angulated:

Answer 13

dorsally

Question 14

What presentation with boxers fxs must be repaired surgically in order to avoid functional problems?

Answer 14

rotation malalignment

must be corrected with surgery

Question 15

What questions are important to ask to understand etiology of wrist injury?

Answer 15

1. Single incident or over time?
2. Increased physical demands from work?
3. Increased productivity demands?
4. New sport or exercise routine?

Question 16

Which bones make up the Central column?

Answer 16

lunate, capitate, hamate (main flexion/ext unit)

*capitate is center of rotation

Question 17

The distal carpal row moves with the _____.

Answer 17

Capitate

Question 18

Which bones make up the radial column?

Answer 18

scaphoid and thumb axis

Question 19

Which bones make up the ulnar column?

Answer 19

triquetrum and lateral border, TFCC

Question 20

With the wrist in neutral, about ___% of the force is distributed across the radiocarpal joint

Answer 20

80%

Question 21

About ___% of the force is distributed across the ulnocarpal joint space

Answer 21

20%

Question 22

Approximately ___% of the midcarpal load is transmitted through the capitate

Answer 22

50%

Question 23

vi. Total wrist motion is the combination of small arcs of motion at each ______:

Answer 23

carpal articular surface

Question 24

What is De Quervain’s Tenosynovitis?

Answer 24

Inflammation of first Dorsal Compartment

AKA “washerwoman’s sprain” (new mothers)

Question 25

What are 3 differentials for De Quervain’s Tenosynovitis?

Answer 25

1. CMC arthritis 2. Wartenberg’s syndrome 3. Intersection syndrome

Question 26

What is basal joint arthritis?

Answer 26

OA of base of first MC

Question 27

What are key Sx of basal joint arthritis?

Answer 27

Pain with pinch, torque activities (i.e. opening a jar, turning a key)

Question 28

what is intersection syndrome?

Answer 28

tendinitis of 2nd dorsal compartment

Question 29

Scaphoid fxs comprise about ___% of all carpal fxs.

Answer 29

60%

Question 30

The TFCC receives about ____% of wrist axial load to the forearm

Answer 30

20%

Question 31

What is primary function of TFCC?

Answer 31

main stabilizer of ulnar side of wrist and the DRUJ (distal radio ulnar joint)

Question 32

What are symptoms of TFCC injuries?

Answer 32

i. Ulnar Wrist Pain ii. Tender on Ulnar side of wrist iii. Pain with forearm rotation iv. Pain with maximum gripping

Question 33

With positive ulnar variance, the load increases to ___% | With negative ulnar variance, the load decreases to ___%

Answer 33

42% | 4.3%

Question 34

Ulnar variance changes with forearm rotation. Pronation _____ ulnar variance. Supination _____ ulnar variance.

Answer 34

pro: increase sup: decrease

Question 35

Power grip _____ ulnar variance.

Answer 35

increases