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MSS Conditions > Acute Elbow, Wrist, Hand Injuries > Flashcards

Acute Elbow, Wrist, Hand Injuries Flashcards

1
Q

Hx of Elbow Dislocation

A
  • Severe elbow pain and deformity after fall on outstretched hand
  • Inability to move elbow
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2
Q

PE of Elbow Dislocation

A
  • Swelling
  • Inability to move elbow
  • Prominent boney structures like olecranon
  • Shortened and flexed extremity
  • Neurovascular examination crucial—possible compromise with dislocations
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3
Q

What imaging is needed for an Elbow dislocation?

A

X-ray: AP & Lateral

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4
Q

What are the 2 MC types of elbow dislocations?

A

Anterior & Posterior (MC)

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5
Q

What structures are torn with dislocations?

A

Collateral Ligaments

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6
Q

Tx for Elbow dislocation

A
  • Document neurovascular exam 1st
  • Closed reduction
  • IV or local anesthesia
  • Traction and correction of medial or lateral displacement
  • ROM after reduction
  • Splint in flexion and pronation
  • Post reduction x-rays
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7
Q

What is the hx of an Olecranon fx?

A
  • Fall directly on elbow
  • Pain
  • Don’t want to move elbow
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8
Q

What imaging is dx for Olecranon fx?

A

X-ray: AP & Lateral

Determine fracture pattern→ usually transverse or oblique

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9
Q

Tx for Olecranon fx

A

Nonoperative
Non-displaced
Few weeks in long arm splint/cast

Operative
Displaced fractures
Most adult fractures
Screws, plates, or wires

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10
Q

Hx of Radial Head fx

A
  • Fall on outstretched hand (FOSH)
  • Pain with motion of elbow
  • Swelling of elbow
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11
Q

What will you see on X-ray of a Radial head fx?

A

May only see fat pad & no fracture line (occult fracture)

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12
Q

What is the nonop tx for Radial head fx?

A

Nondisplaced & no block to ROM → Early ROM

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13
Q

What are the indicates for surgery in Radial head fx?

A
  • >3 mm displaced
  • Blocked motion, esp R
  • Complicated injury pattern w/ injury to interosseous mem
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14
Q

What is the hx of a distal biceps tendon rupture?

A
  • Felt pop around elbow
  • Bruising distal arm
  • Arm in flexed position & some eccentric load was forced onto the forearm making the pt fire the biceps
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15
Q

Who do distal biceps tendon ruptures usually occur in?

A

Middle ages 40-60’s

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16
Q

What will be found on PE of a distal biceps tendon rupture?

A
  • Ecchymosis in distal arm/forearm
  • Popeye arm**
  • Weakness w/ supination & elbow F
  • Hook sign: feel a gap in the antecubital fossa
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17
Q

What imaging is used to confrim a distal biceps tendon rupture?

A

MRI

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18
Q

What is the tx of a distal biceps tendon rupture?

A
  • Surgical treatment especially for a younger or very active patient
  • Both heads have been “disconnected” so it is critical to have repaired
  • Early repair is very important because the longer wait the less likely primary repair is possible
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19
Q

Where does the long head of the biceps tedon attach?

A

Supraglenoid tubercle

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20
Q

Where does the short head of the biceps tedon attach?

A

Coracoid process

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21
Q

What do both biceps tendons attach to?

A

Radial tuberosity

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22
Q

What action will weaken in a pt w/ a distal biceps tendon rupture?

A

Weakness of supination (40% loss) and flexion (30% loss)

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23
Q

What are the two MC types of Radial head fx?

A
  • Colles: MC**, extension fx, FOSH
  • Smiths: Flexion fx, bones move anterior
24
Q

How are dislocations named?

A

Distal segment in relation to proximal segment

25
Q

How are distal radius fx dx?

A

X-ray: AP, lateral, oblique, scaphoid

26
Q

What is the tx for a distal radius fx?

A

ORIF or Closed reduction w/ splinting

27
Q

What nerve can be irritated w/ distal radial head fx?

A

Median nerve

28
Q

What special tests are used for distal radial head fx?

A

Phalen maneuver & Tinel’s Sign

29
Q

What causes scaphoid fx?

A

FOSH

30
Q

What anaomtical area are scphaoid fx tender?

A

Anatomical snuff box

31
Q

What is the initial dx options for a scaphoid fx?

A
  • Thumb spica splint & repeat X-ray in 14-21 days
  • MRI w/in 24 hour
  • Bone scan in 72 hours
32
Q

Why are scaphoid fx susecptible to not healing?

A

Poor blood supply

33
Q

What are acceptable tx options for a scaphoid fx?

A
  • Long arm thumb spica cast
  • Peructaneous pinning
  • ORIF
34
Q

What is NOT an acceptable tx option for a scaphoid fx?

A

Removable splint

35
Q

What is the tx for most finger fx?

A

Early ROM to prevent stiffness

If immobilzation needed do for <3 weeks

36
Q

What is a Boxer’s fx?

A
  • Ametature: 5th metacarpal fx
  • Professional: 4th metacarpal fx
37
Q

What is the tx for a Boxer fx?

A

Immobilize for 3 weeks

38
Q

What is the MC fx finger bone?

A

Distal phalanx

39
Q

What is Mallet finger?

A

Extensor tendon injury

40
Q

How is Mallet finger tx?

A

Splint for 6-8 weeks

41
Q

How are PIP & DIP dislocations tx?

A

Closed reduction & immobilization in dorsal splint at 30° for 1-2 weeks

42
Q

Most common soft tissue tumor of hand/wrist

A

Ganglion cyst

43
Q

What cervical roots are tested w/ Biceps reflex?

A

C5 & C6

44
Q

What cervical roots are tested w/ Brachioradialis?

A

C5, C6, C7

45
Q

What cervical roots are tested w/ Triceps reflex?

A

C6 & C7

46
Q

How is Cubital Tunnel Syndrome dx?

A
  • Test ulnar nerve motor strength and Tinel’s sign
  • Elbow flexion test-Fully flexing elbow produces paresthesia in 4th and 5th fingers within 60 sec
47
Q

What is the conservative tx for Cubital Tunnel syndrome?

A

Elbow pad

48
Q

What causes Medial Epicodylitis or “Golfer’s Elbow”?

A

Occurs from repetitive activities requiring wrist flexion and forearm pronation putting stress on origin of pronator teres & forearm flexor muscle bundle

49
Q

What causes Lateral Epicondylits or “Tennis Elbow”?

A

Usually hx of repetitive gripping w/ or w/o wrist extension & gradual onset

Extensor carpi radialis brevis MC site of lesion

50
Q

What is the tx of Lateral Epicondylitis?

A
  • Correct causative factors**most imp!
  • RICE
  • NSAIDS
  • PT (strengthening)
  • Tennis elbow brace
  • OMT
51
Q

What is Trigger finger?

A

Flexor tenosynovitis

Pain & tenderness in palm at proximal edge of A1 pulley

52
Q

What causes Trigger finger?

A

Due to inflammatory nodule, finger “catches” and will not actively extend

53
Q

What causes DeQuervian Tenosynovitis?

A

Usually provoked by lifting with thumb flexed, forcing wrist into ulnar dev

*lifting a baby*

54
Q

Where are pt’s tender in DeQuervain tenosynoitis?

A

Radial aspect of wrist

55
Q

How is DeQuervain tenosynovitis dx?

A

Finkelstein’s Test

56
Q

What is the tx for DeQuervain tenosynovitis?

A
  • Splinting with thumb spica**
  • NSAIDS
  • Ice
  • Eliminating offending activities
  • PT with iontophoresis
  • Steroid injection-1st extensor compartment along course of ext. pol. Brevis

MSS Conditions (7 decks)

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