2- Wrist/Hand Flashcards
What is the most commonly fractured carpal bone?
scaphoid
A jersey finger consists of a rupture of the ________ tendon resulting in immediate loss of flexion at the DIP joints.
flexor digitorum profundus
What is the mechanism of injury for a jersey finger?
occurs when flexed DIP is forcefully hyperextended
If you ask a patient to “make a fist” and they are unable to flex their ring finger what diagnosis does this clue you in on?
jersey finger
What is the treatment for jersey finger?
- place in aluminum splint in slight flexion
- refer to hand specialist for surgery
ALWAYS REQUIRES SURGERY MOST WITHIN 7-10 DAYS
A mallet finger is a rupture of the insertion of the ____ tendon at the base of distal phalanx.
extensor
What is the most common tendon injury of the finger?
mallet finger
What is the mechanism of injury for a mallet finger?
direct blow to tip of finger causing forceful flexion of DIP
If you see a DIP joint held in flexion with associated pain and swelling what diagnosis is this?
mallet finger
What is the treatment for mallet finger?
splint in full extension or slight hyperextension for 6-8 weeks
do not take splint off or else time restarts
In boutonniere deformity the PIP is ______ and the DIP is ______ .
PIP = flexed DIP = hyperextended
What is the treatment for boutonniere deformity OR swan-neck deformity?
splint in extension for 6 weeks + hand follow up
This is defined as a disruption of extensor tendon at DIP in addition to injury to central slip resulting in DIP flexion with PIP hyperextension
Swan-neck deformity
In swan-neck deformity the PIP is ______ and the DIP is ______ .
PIP = hyperextended DIP = flexion
A UCL injury of the hand also goes by these 2 names
Gamekeeper’s thumb OR Skier’s thumb
What is the mechanism of injury of an ULC tear?
forced abduction and extension of thumb
Pain and/or laxity with _____ stress is consistent with a UCL injury of the hand.
valgus
What is the treatment management for a UCL injury of the thumb?
- RICE/NSAIDs
- thumb spica splint
- refer to hand surgeon
What is the most common fracture site in the upper extremity?
distal radius fracture
Colles’ fracture most common
Wrist pain after a fall on outstretched hand is consistent with what fracture?
Colles’
Wrist pain after a fall on flexed hand is consistent with what fracture?
Smith
in a colles’ fracture the distal radius fragment is tilted _____ .
dorsally
in a smith’s fracture the distal radius fragment is tilted _____ .
volar (palmar)
What is the difference in management for a distal radius fracture it is non-displaced or displaced?
- non-displaced = sugar tong splint + pain management
- displaced = closed reduction or ORIF
Tenderness to palpation of the snuff box is consistent with what fracture?
scaphoid fracture
What part of the scaphoid is more at risk for avascular necrosis?
proximal
What is the treatment for a scaphoid fracture if there is no radiographic fracture but positive clinical findings?
treat as fracture
What is the treatment for a non-displaced scaphoid fracture?
immobilize in thumb spica splint and repeat radiographs every 2 weeks
What is the treatment for a displaced scaphoid fracture?
surgery
What is the duration of immobilization if the scaphoid fracture is located in the following areas:
a. distal pole
b. waist
c. proximal third
a. 4-6 weeks
b. 10-12 weeks
c. 12-20 weeks
A Bennet’s fracture is a fracture of the _____ metacarpal?
first
What is the treatment for a first metacarpal fracture?
- thumb spica splint
- refer to hand surgeon for surgery
What is the most common metacarpal fracture?
fifth metacarpal fracture
Deformity, swelling, and tenderness to the dorsum hand and loss of knuckle prominence is consistent with this diagnosis.
fifth metacarpal fracture
What is the treatment for a fifth metacarpal fracture?
- ulnar gutter splint
- refer to hand surgeon
You normally have ____ degrees of angulation of the metacarpals.
15 degrees
What is the “10,20,30,40” rule for a metacarpal fracture?
- first metacarpal can tolerate 10 degrees = 25
- second metacarpal = 20 degrees = 35
- third metacarpal = 30 degrees = 45
- fourth metacarpal = 30 degrees = 45
(15 degrees is normal SO ADD 15 degrees to 10,20,30,30)
Phalanx fractures are usually caused by this mechanism.
crush injuries
distal phalanx fracture are referred to as a what?
Tuft fracture
This is defined as blood trapped under fingernail after injury.
subungual hematoma
if hematoma involves > ___% of nail bed, fractures are more likely.
> 50%
What is the treatment for a subungual hematoma?
trephination
d/n need to give antibiotics unless diabetics
What is the most common type of finger dislocation?
dorsal
What is the first thing you should do if you suspect a finger dislocation?
a get plain films
b. do a digital block
c. reduction
d. splint
a. get plain films
In a LUNATE dislocation, the _____ stays in place but the _____ is displaced
- capitate stays in place
- lunate is displaced
In a PERILUNATE dislocation, the _____ stays in place but the _____ is displaced
- lunate stays in place
- capitate is displaced
A lunate and a perilunate dislocation is associated with what nerve injury?
median nerve injury
A volar/palmar swelling with palpable mass is consistent with:
lunate OR perilunate dislocations?
lunate dislocation
A dorsal swelling with palpable mass is consistent with:
lunate OR perilunate dislocations?
perilunate dislocation
lunate and perilunate dislocations are best assessed on what films?
lateral films
What is the treatment for a lunate OR perilunate dislocation?
- immediate reduction followed by sugar tong splint
- referral for surgical repair
