Ch.38 Upper Extremity Wrist and Hand

Question 1

Hx of FCU tendonitis

Answer 1

volar wrist pain w/ wrist flexion & ulnar deviation (racquet sports, golf)

Question 2

What can be associated with FCU tedonitis?

Answer 2

Pisotriquetral compression sydnrome as pisiform bone embedded in FCU tendon

Question 3

Tx of FCU tendonitis

Answer 3

wrist hand orthoses in 25 deg flexion or surgery to resect pisiform bone w/or w/o Z-plasty lengthening of FCU tendon

Question 4

Hx of FCR tendonitis

Answer 4

Lateral wrist pain w/ wrist flexion, radial deviation and grip

Question 5

Tx of FCR tendonitis

Answer 5

wrist hand orthoses in 25 deg flexion

Question 6

Tendons involved in de Quervain’s syndrome

Answer 6

Abductor pollicis longus & extensor pollics brevis over radial styloid

Question 7

Tx of de Quervain’s syndrome

Answer 7

rest, thumb spica splint, first dorsal compartment steroid injection

Question 8

What is Intersection syndrome?

Answer 8

Friction b/w abductor pollicis longus & extensor pollicis brevis tedongs 4-6 cm proximal to Lister’s tubercle

Question 9

Who is Intersection syndrome seen in?

Answer 9

Oarsmen, racquet sports, wt lifters

Question 10

PE of Intersection syndrome

Answer 10

Dorsoradial distal forearm pain aggravated by wrist extension

Question 11

Tx of Intersection syndrome

Answer 11

neutral wrist-hand orthosis, steroid injection to point at maximal tenderness, rarely surgery

Question 12

Hx of extensor carpi ulnaris tendonitis

Answer 12

dorsoulnar wristpain w/ reptitive wrist extension & ulnar deviation in nondominant hand of tennis two-handed backhand

Question 13

Hx of ECU subluxation

Answer 13

pop after forceful volar wrist flexion & ulnar deviation w/ pain

Question 14

Tx of ECU tendonitis

Answer 14

neutral wrist-hand orthosis

Question 15

What should be assessed for if pt w/ ECU tendonitis does not get better with conservative therapy?

Answer 15

Triangular fibrocartilage complex injury

Question 16

Tx of ECU tendon subluxation

Answer 16

Acute: cast of wrist in pronated and dorsiflexion for 6 wk or surgery Chronic: sugrical reconstruction

Question 17

What is the MC wrist ligament injury?

Answer 17

Scapholunate instability

Question 18

Hx of scapholunate instability

Answer 18

Fall on hand in pronation, wrist extension & ulnar deviation

Question 19

What is the dorsal intercalated segemental instability (DISI) pattern?

Answer 19

scaphoid into flexed position, lunate and triqetrum become extended

Question 20

What test may indicate scapholunate instability?

Answer 20

Watson test

Question 21

What can be seen on X-ray in DISI pattern?

Answer 21

scapholunate angle >60 deg on lateral view or gap >3 mm b/w scaphoid and lunate on AP view

Question 22

Tx of scapholunate ligament injury

Answer 22

Surgery

Question 23

What hand fx is prone to AVN or nonunion?

Answer 23

proximal or middle scaphoid fx d/t disrupted BS

Question 24

Tx of middle or proximal scaphoid fx

Answer 24

6 wk in long arm thumb-spica cast w/ elbow 90 deg flexion & wrist in neutral w/ thumb in slight ext & ABD

Question 25

Tx of distal 1/3 scaphoid fx

Answer 25

short arm thumb spica cast w/ wrist in neutral & thumb in slight ext & ABD

Question 26

MC fx of the body

Answer 26

distal radius

Question 27

What is the classification system for distal radius fx?

Answer 27

Frykman

Question 28

MC distal radius fx

Answer 28

Frkyman type I or Colles fx

Question 29

What is a Colles fx?

Answer 29

fx 2 cm proximal to distal radius w/ dorsal angulation of distal segment & radial shortening

Question 30

Tx of Colles fx

Answer 30

Closed reduction & immobilization w/ sugar tong splint w/ wrist in slight flexion & ulnar deviation for 3 days then cast for 6 wks if non-displaced on xray

Question 31

What is Kienbock's disease?

Answer 31

Progressive collapse of lunate d/t repetitive compressive forces to wrist

Question 32

Hx of Keinbock's disease

Answer 32

Pain & stiffness of wrist

Question 33

PE of Keinbock's disease

Answer 33

Pain to palpation over dorsum of lunate

Question 34

Tx of Keinbock's disease

Answer 34

immobilization to allow revascularization, may need surgery to correct ulnar minus wrist

Question 35

What is the trianular fibrocartilage complex (TFCC)?

Answer 35

Avascular central articular disc & vascular dorsal & palmar radioulnar ligaments

Question 36

Hx of TFCC injury

Answer 36

Axial load to wrist w/ rotational stress l/t locking & catching

Question 37

PE of TFCC injury

Answer 37

Pain at hollow b/w FCU & ECU tendon distal to ulnar styloid process

Question 38

Tx of TFCC injury

Answer 38

Surgery

Question 39

What can rupture of the central slip of extensor tendon at base of middle phalanx result in?

Answer 39

Boutonniere injury

Question 40

What is a Boutonneire injury?

Answer 40

Inability to actively extend PIP joint

Question 41

MOI of central slip extensor tedon rupture

Answer 41

Crush injury, forced flexion or lateral volar PIP dislocation

Question 42

What causes a mallet finger?

Answer 42

Disruption of distal extensor tendon at insertion on dorsal proximal aspect of distal phalanx

Question 43

What is the MOI of a mallet finger?

Answer 43

Hyperflexion force to an extended DIP joint

Question 44

PE of a mallet finger

Answer 44

DIP joint in flexed position, pt unable to actively extend

Question 45

Tx of a mallet finger

Answer 45

Splint DIP joint 24hr/day for 6-8 weeks

Question 46

MOI of flexor digitorum profundus rupture (jersey finger)

Answer 46

Forced extension of flexed finger

Question 47

Which finger is most likely to be effected by FDP tendon rupture?

Answer 47

Ring Finger

Question 48

What is the MC dislocated joint in the hand?

Answer 48

PIP joint

Question 49

What is the MC direction of PIP dislocation?

Answer 49

Dorsal

Question 50

Tx of dorsal PIP dislocation

Answer 50

Reduction, Xrays, 45 deg extension block splint with 10 deg reduction in angle each week

Question 51

What is a gameskeeper's thumb?

Answer 51

1st metacarpophalangeal jointUCL sprain

Question 52

What is the MOI of a 1st MCP joint UCL sprain?

Answer 52

Radially directed force acrost 1st MCP joint

Question 53

What is a Stener lesion?

Answer 53

Interposition of adductor pollicis aponeurosis b/w proximal phalanx and UCL ligament

Question 54

Tx of 1st MCP joint UCL sprain

Answer 54

Partial: thumb spica splint; Rupture: surgery

Question 55

What is a jammed finger?

Answer 55

Collateral ligament sprains of DIP or PIP joints