1. Trauma/Overuse: Wrist/hand Flashcards
Five structrures you only need to know in TFCC
- Triangular Fibrocartilage (Articular Disc)
- Volar & Dorsal Radioulnar Ligaments
- Meniscus Homologue
- UCL
- Tendon Sheath of the UCU
Of the 5 structures you need to know in TFCC
Hand surgeons only really gives a shit about these 2:
Articular Disc and Radioulnar Ligaments
“TFC Proper” (Articular Disc) on MRI:
“TFC Proper” (Articular Disc) on MRI: will be dark on every sequence.
You can group TFCC injuries into these groups
“Class 1” Acute Injuries: Usually via fall onto extended wrist.
“Class 2” Chronic Degeneration: These are more common, and associated with positive ulnar variance and ulnar impaction.
What side of injuriy is relatively avascular and less likely to heal in a TFC injury?
Radial sided injuries are relatively avascular and less likely to heal.
Positive Ulnar Variance =
Negative Ulnar Variance =
Ulnar Impaction Syndrome (Ulnar Abutment)
Kienbocks
AVN of the lunate, seen in people in their 20s-40s
AVN of the lunate + Negatve ulnar variance =
Kienbocks
Distal Metaphysis Fx + Extra-articular + Dorsal angulation”
Colles fracture
“Dinner Fork Deformity ’
Colles fracture
Commonly Associated fracture with Colles
Ulnar styloid fracture
Distal Metaphysis Fx + Extra-Articular (usually ~ 85%)
+ Volar Angulation
Smth fracture
An Intra-Articular Smith Fracture (15%) is called
“Reverse Barton”
Which fracture can result in carpal tunnel syndrome?
Smith
Intra-Articular Dorsal Radius Fracture “Radial Rim” + Dorsal angulation
Barton
Intra-Articular Dorsal Radius Fracture “Radial Rim” + Volar angulation
Reverse Barton
“hallmark” of BArton fracture
Radial-Carpal dislocation
This is an intra- articular fracture of the radial styloid.
Hutchinson / Chauffeur Fracture
normal volar tilt
11 degrees
more common after a non-displaced fracture of the radius
Rupture of teh Extensor pollicis longus (EPL ruputre)
How many extensors are there?
5 fingers + 1 for good luck
What wrist tendons are affected by Dequervains?
APL and EPB
What conpartment of teh Extensor pollicis longus tendon courses beside the Lister’s tubercle?
Third
what does NOT go through the carpal tunnel?
-Flexor Carpi Radialis
-Flexor Carpi Ulnaris
-Palmaris Longus (if you have one)
-Flexor Pollicis BREVIS
WHat is not truly seen in the carpal tunnel?
Flexor Carpi Radialis
Median Nerve Distribution
Thumb-radial aspect of the 4th digit
Carpal tunnel syndrome
Carpal Tunnel Syndrome (CTS) is associated with what conditions?
DIALYSIS
Pregnancy
DM
Hypothyroidism
What is entrapped in Guyon’s Canal Syndrome?
Ulnar nerve as it passes the canal (pisiform + hamate)
handle bars ‘‘handle bar palsy.”
Guyon’s Canal Syndrome
This refers to a traumatic dislocation to the extensor carpi ulnaris
Sub-Sheath Tear / Dislocation
the direction of dislocation is medial.
Sequential Extensor Tendon Ruptures - seen with worsening Rheumatoid Arthritis of the Distal Radioulnar Joint (DRUJ)
Vaughan-Jackson Syndrome
An inflammation of the tendon manifesting as increased fluid seen around the tendon.
Tenosynovitis
What are the diffuse Tenosynovitis?
- Tuberculous or Nontuberculous Mycobacterial
- Rheumatoid Arthritis
What are the focal Tenosynovitis?
- Penetrating infection
- Overuse
What are the most common tendons affected in TB/Non TB mycobacterial tenosinovitis?
Hand and Wrist
Diffuse exuberant tenosynovitis
spares the muscles + immunocompromised + “RICE BODIES”
Tuberculous or Nontuberculous MycobacterialIsolated Extensor Carpi Ulnaris if early
Diffuse exuberant tenosynovitis
+ Isolated extensor Carpi ulnaris
Rheumatoid arthritis
Diffuse exuberant tenosynovitis + Vughan Jackson Syndrome (Sequential ruptures (5>4>3>2)
Rheumatoid arthritis
So called “Washer Woman’s Sprain” or “Mommy Thumb.”
De Quervain’s Tenosynovitis
Affected Tendon in De Quervain’s Tenosynovitis
First Extensor Compartment
(Extensor Pollicis Brevis and Abductor Pollicis Longus
De Quervain’s Tenosynovitis
Increased fluid within the first extensor tendon compartment
MRI: increased T2 signal in the tendon sheath
De Quervain’s Tenosynovitis
Pain on passive ulnar deviation.
Finkelstein Test in De Quervain’s Tenosynovitis
Occurs where the first extensor tendons, “intersects” the second extensor compartment tendons. The result is extensor carpi radialis brevis and longus tenosynovitis.
Intersection Syndrome
Tenosynovitis of the 3rd compartment (extensor pollicis longus - EPL).
Drummer’s Wrist
Commintuted fracture - base of teh first metacarpal
Rolando
Fracture at the bases of the 1st metacarpal
Bennet
what causes the dorsolateral dislocation in the Bennett
Fracture
The pull of the Abductor PoUicis Longus (APL)
Avulsion fracture at the base of the proximal first phalanx + ulnar collateral ligament disruption
Gamekeeper’s Thumb (Skier)
when the Adductor tendon aponeurosis gets caught in the tom edges of the UCL
Wont heal - requires surgery
“Stener Lesion.”
The idea is the overuse /
repetitive trauma causes scarring in the flexor tendon sheath.
Trigger Finger
