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HANDS > APPROACH TO HAND INJURIES > Flashcards

APPROACH TO HAND INJURIES Flashcards

1
Q

HPI

A

Location
Age (of wound)
Mechanism: shear, blunt, crush
Contamination
Foreign Body Sensation
Foreign Body Type

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2
Q

Associated Symptoms

A

r/o
Life threatening Injuries
Limb Threatening Injuries
Neurovascular compromise
Loss of function

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3
Q

PMHx: Risk Assessment

A

Extreme of Age
Hand dominance
Diabetes
Chr Renal Failure
Obesity
Malnutrition
Immunosuppression

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4
Q

Allergies

A

Latex
Anesthetic

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5
Q

Immunization

A

Tetanus Status

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6
Q

Social Hx

A

Occupation

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7
Q

Elements of physical exam

A

Inspection
Palpation
Motor testing
Sensory Testing
Tendon Assessment
Vascular Assessment
Compartment Syndrome Testing

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8
Q

Elements of the motor test

A

make a fist
straighten fingers
radial, ulnar, median nerve testing

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9
Q

Motor testing of the radial nerve

A

Dorsiflexion of the wrist
Thumbs up sign

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10
Q

Motor testing median nerve

A

Thumb interphalangeal joint flexion “Okay sign”

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11
Q

Motor Testing ulnar nerve

A

Abduction / Adduction of digits

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12
Q

Sensory assessment distal to the mid palm

A

Static 2 point discrimination
Normal < 6 mm apart
Inspect for loss of sweating ability and papillary ridges
Ten Test - rate affected area compared to unaffected area, rate on scale of 10
Test in radial, ulnar, median distributions

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13
Q

Sensory testing radial nerve

A

First dorsal web space

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14
Q

Sensory testing Median nerve

A

Volar tip of index finger

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15
Q

Sensory testing ulnar nerve

A

Volar tip of little finger

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16
Q

Tendon assessment

A

Extensor digitorum
Flexor digitorum profundus
Flexor digitorum superficialis

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17
Q

How to test Flexor digitorum superficialis

A

Hold all other digits in extension
Flex the proximal interphalangeal joint AGAINST RESISTANCE

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18
Q

How to test Flexor digitorum profundus

A

Hold proximal IP joint against resistance
Flex the distal interphalangeal joint AGAINST RESISTANCE

19
Q

How to test Extensor digitorum

A

Sequentially flex the MCP, PIP and DIP
Have patient extend the digit against gravity and AGAINT RESISTANCE

20
Q

Signs of partial tendon involvement

A

Weak, limited or painful movement

21
Q

Best Vascular Assessment

A

Allen’s Test

22
Q

Allen’s Test suspicious for significant vascular injury

A

Refill time > 3 seconds

23
Q

XRAY views

A

AP
Oblique
Lateral

24
Q

XRAY Indications

A

Bony injuries
Foreign Bodies
Joint penetration

25
Q

Indications for prophylactic antibiotics

A

Complicated hand lacerations
Mammalian bite wounds
Injuries > 12 hrs old
Contaminated wounds
Exposed bone
Concurrent medical problems affecting wound healing (DM, Renal disease, peripheral vascular disease, immunocompromise)

26
Q

Definition of complicated hand laceration

A

Human or animal bite
Burn
Fracture through bone or joint
Tendons, bones, large vessels or nerves
Severe tissue damage or maceration

27
Q

List the Special Tests

A

Snuffbox Tenderness
Grind Test
Finkelstein’s Test
Tinel’s Sign
Phalen’s Maneuver
Durkan’s Compression Test

28
Q

Snuffbox Tenderness

A

Tenderness with deep palpation between tendons of EPL and EPB just distal to the radial styloid

Scaphoid fracture

29
Q

Grind Test

A

Axial compression and rotation of the MCP joing of thumb

Degenerative arthritis

30
Q

Finkelstein’s Test

A

Grasp thumb and deviate ulnarly

Tenosynovitis of the EPB and ABL (de Quervain’s disease)

31
Q

Tinel’s Sign

A

Paresthesias after tapping over the course of the median nerve

Carpal Tunel Syndrome

32
Q

Phalen’s Maneuver

A

Flexion of the bilateral wrists for 1 minute. Paresthesias in the hand.

Carpal Tunel Syndrome.

33
Q

Durkan’s Compression Test

A

Direct median nerve compression at transverse carpal
ligament. Paresthesias.

Carpal Tunel.

34
Q

Flexor Pollicis Longus (FPL) Test

A

Bend tip of the thumb

35
Q

Flexor Digitorum Profundus (FDP) Test

A

Stabilize the PIP joint, isolate the DIP
Flex tip of the finger

36
Q

Flexor Digitorum Superficialis (FDS) Test

A

Isolate Affected Digit
Block other digits
Flex the PIP

37
Q

Abductor pollicis longus (APL) and extensor pollicis
brevis (EPB) Test

A

Abduct thumb out to the radial side

The examiner palpates the taut tendons over
the radial side of the wrist

38
Q

Extensor carpi radialis longus (ECRL) and
extensor carpi radialis brevis (ECRB)

A

Make a fist, Extend wrist back

The examiner then palpates the tendons over
dorsoradial aspect of wrist

39
Q

Extensor pollicis longus (EPL) Test

A

Placing hand flat on the table

Lift only the thumb off the table

40
Q

Extensor digitorum communis (EDC) test

A

Straighten fingers

41
Q

Extensor carpi ulnaris (ECU) test

A

instructing patient, “Pull your hand up and out to the side”

examiner palpates the tendon over the ulnar side of the wrist.

42
Q

Adductor pollicis (AdP) test

A

forcibly grasp a piece
of paper between the thumb and radial
side of the index P1

Froment’s sign = compensatory flexion at the IP joint

43
Q

Interosseous muscles test

A

applying resistance to the index and
small finger and instructing patient,
“Spread your fingers apart”

44
Q

Best sign of healing

A

No pain

HANDS (28 decks)

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