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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
How are distal radius fx dx?
X-ray: AP, lateral, oblique, scaphoid
26
What is the tx for a distal radius fx?
ORIF or Closed reduction w/ splinting
27
What nerve can be irritated w/ distal radial head fx?
Median nerve
28
What special tests are used for distal radial head fx?
Phalen maneuver & Tinel's Sign
29
What causes scaphoid fx?
FOSH
30
What anaomtical area are scphaoid fx tender?
Anatomical snuff box
31
What is the initial dx options for a scaphoid fx?
* Thumb spica splint & repeat X-ray in 14-21 days * MRI w/in 24 hour * Bone scan in 72 hours
32
Why are scaphoid fx susecptible to not healing?
Poor blood supply
33
What are acceptable tx options for a scaphoid fx?
* Long arm thumb spica cast * Peructaneous pinning * ORIF
34
What is NOT an acceptable tx option for a scaphoid fx?
Removable splint
35
What is the tx for most finger fx?
Early ROM to prevent stiffness If immobilzation needed do for \<3 weeks
36
What is a Boxer's fx?
* Ametature: 5th metacarpal fx * Professional: 4th metacarpal fx
37
What is the tx for a Boxer fx?
Immobilize for 3 weeks
38
What is the MC fx finger bone?
Distal phalanx
39
What is Mallet finger?
Extensor tendon injury
40
How is Mallet finger tx?
Splint for 6-8 weeks
41
How are PIP & DIP dislocations tx?
Closed reduction & immobilization in dorsal splint at 30° for 1-2 weeks
42
Most common soft tissue tumor of hand/wrist
Ganglion cyst
43
What cervical roots are tested w/ Biceps reflex?
**C5** & C6
44
What cervical roots are tested w/ Brachioradialis?
C5, **C6**, C7
45
What cervical roots are tested w/ Triceps reflex?
C6 & **C7**
46
How is Cubital Tunnel Syndrome dx?
* 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
What is the conservative tx for Cubital Tunnel syndrome?
Elbow pad
48
What causes Medial Epicodylitis or "Golfer's Elbow"?
Occurs from repetitive activities requiring **wrist flexion** and forearm **pronation** putting stress on origin of **pronator teres** & forearm **flexor muscle** bundle
49
What causes Lateral Epicondylits or "Tennis Elbow"?
Usually hx of repetitive gripping w/ or w/o wrist extension & gradual onset **Extensor carpi radialis brevis** MC site of lesion
50
What is the tx of Lateral Epicondylitis?
* **Correct causative factors**\*\*most imp! * RICE * NSAIDS * PT (strengthening) * Tennis elbow brace * OMT
51
What is Trigger finger?
Flexor tenosynovitis Pain & tenderness in palm at proximal edge of A1 pulley
52
What causes Trigger finger?
Due to inflammatory nodule, finger “catches” and will not actively extend
53
What causes DeQuervian Tenosynovitis?
Usually provoked by lifting with thumb flexed, forcing wrist into ulnar dev \*lifting a baby\*
54
Where are pt's tender in DeQuervain tenosynoitis?
Radial aspect of wrist
55
How is DeQuervain tenosynovitis dx?
Finkelstein’s Test
56
What is the tx for DeQuervain tenosynovitis?
* **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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