Common injuries/growths/biologic errors

Question 1

Colle’s fracture

Answer 1

• Fracture of wrist at distal end of radius, causing fragments to displace dorsally and radially
• Result of fall from outstretched hand
• “Silver fork” deformity results

Question 2

Scaphoid bone fracture

Answer 2

When someone braces fall with dorsiflexed hand

Question 3

Bennet’s Fracture

Answer 3

• Fracture through base of 1st metacarpal

- caused by force applied to end of thumb, involves dislocation of the metacarpal joint

Question 4

Boxer’s Fracture

Answer 4

• fracture through neck of 5th metacarpal

- obtained by striking an object with clenched fist

Question 5

Rheumatoid Arthritis

Answer 5

Deformaties involving the MCP and PIP joints

• Soft tissue inflammation with resulting muscle imbalance

Question 6

RA: Ulnar drift deformity

Answer 6

MCPs are first joints involved.

Synovitis around MCPs creates ligamentous instability

Extensor Digitorum loses its central pull and MCP flexors pull in an ulnar direction

Question 7

RA: Swan neck deformity

Answer 7

Hyperextension of PIP joint and flexion of DIP joint

Synovitis at MCP joint causes intrinsic muscles to shorten or weaken

Leads to excessive pull for hyperextension of PIP

Question 8

RA: Boutonniere Deformity

Answer 8

Hyperextension of DIP and flexion of PIP

Synovitis of PIP joint erodes the central slip of ED, thus no longer able to pull on middle phalanx

Question 9

Phalen test

Answer 9

Reproduce carpal tunnel sensation with sustain wrist flexion

Question 10

If ulnar nerve was severed at elbow, all of these would result:

Answer 10

• ulnar claw hand
• hypothenar eminence atrophy
• atrophy of interossei
• positive Froment’s Sign (inability to grasp paper between the thumb and radial side of palm)
• loss of sensation of the ulnar aspect of hand
• loss of power grip

Question 11

Common compression sites for Ulnar nerve?

Answer 11

• Cubital tunnel (where Ulnar nerve passes medial epicondyle)
• Guyon’s Canal (path between pisiform and hamate)

Question 12

This nerve is most commonly injured with mid-humeral fractures

Answer 12

Radial nerve

Question 13

Is radial nerve severed, these result:

Answer 13

• weakness in brachioradialis, all distal extensor musculature for wrist, finger, and thumb extension, and abductor pollicis longus
• Total “wrist drop”

Question 14

Compression of radial nerve is most common in the ________ and called “___________”

Answer 14

axilla; “saturday night palsy”

Question 15

Trigger finger

Answer 15

Finger lockes in flexed position, and can be extended with difficulty resulting in “popping” sound

Question 16

Dequervian’s Disease

Answer 16

Painful tenosynovitis affecting abductor pollicis longus and extensor pollicis brevis in their common sheath passing over the radial styloid to the thumb

Question 17

Test for DeQuervain’s Disease?

Answer 17

Finklestein’s Test - have patient make fist around thumb, flex elbow, and then passively ulnarly deviate fist. If positive, patient will experience pain

Question 18

Dupuytren’s Contractures

Answer 18

chronic hyperplasia of the palmar fascia and tending binding contractures in the hand