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Conditions (2nd year) > Conditions Of Wrist, Hand & Fingers > Flashcards

Conditions Of Wrist, Hand & Fingers Flashcards

0
Q

What is the Triangular Fibrocartilage?

A

Disc overlying distal ulnar head
Disc binds end of distal radius & ulna together
Makes up a portion of TFCC complex which acts as a stabilizer of the distal radio-ulnar joint

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1
Q

Name all the Carpal Bones

A

Scaphoid Trapezium
Lunate Trapezoid
Triquetrum Capitate
Pisiform Hamate

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2
Q

What are the Joint of the Hand?

A 
Carpo-metacarpal (CM)
Inter-metacarpal 
Metacarpo-phalangeal (MCP)
Inter-phalangeal (IP)
   - digits numbered 1-5 w/first being thumb 
(Knuckles = MP joints)
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3
Q

Describe an Inter-phalangeal joint

A

Proximal (PIP) & distal (DIP) & IP are hinge joints

Reinforced by articulating capsule joined by volar & collateral ligaments

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4
Q

What is the Wrist Retinacula?

A

Very thick fascial tissue

Protective pathways through which tendons, nerves & blood vessels pass

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5
Q

What is the job of the Flexor Retinaculum?

A

Protects extrinsic flexor tendons & median nerve

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6
Q

What is the role of the Extensor Retinaculum?

A

Pasageway for extrinsic muscles on the dorsal side of the wrist

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7
Q

What are the 3 Nerves of the hand?

A

Median }
Ulnar } Brachial Plexus
Radial }

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8
Q

What does the Median Nerve Supply?

A

Supplies majority of flexor & intrinsic muscle on radial side of Palm
Cutaneous sensation lateral 2/3 of Palm

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9
Q

How does medial nerve entrapment happen?

A

Strenuous/repetitive elbow motion

Pronator Teres/FDS tightness

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10
Q

What does the Ulnar Nerve innervate?

A

Innervates FCU & ulnar FDP

Cutaneous sensation of 5th & 1/2 4th on dorsal & palmar sides

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11
Q

What does the Radial Nerve innervate?

A

Superficial- skin on dorsum of hand

Deep- Innervates extensor muscles of forearm

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12
Q

Wrist Sprain MOI

A 
Axial loading (FOOSH)
Most common btwn scaphoid & lunate
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13
Q

Wrist Sprain S&Sx

A

TOP dorsum of hand of radio-carpal joint

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14
Q

Wrist Sprain Management

A

PIER
R/O #
Pain in ‘snuff’ box, scaphoid # indicator
Tape to prevent movement

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15
Q

What are the primary movements of the thumb?

A 
Flexion
Extension
Opposition 
Abduction 
Circumduction
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16
Q

Game Keepers Thumb MOI

A

Tearing of UCL @ MP joint when MP near full ext & thumb forcefully abducted away from hand

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17
Q

Game Keepers Thumb S&Sx

A

Palmar aspect of thumb is swollen w/visible bruising & ⬆ ️pain or weakness w/pinching/opposition

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18
Q

Game Keepers Thumb Management

A

PIER
R/O #
Tape for instability
Valgus stress for MCP of thumb

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19
Q

Interphalangeal Collateral Ligament Sprain MOI

A

Excessive valgus/varus force/hyperextension

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20
Q

Interphalangeal Collateral Ligament Sprain S&Sx

A

Obvious deformity may or may not be present unless there is a # or a total rupture
Rapid swelling makes assessment difficult
Need to R/O dislocation or #

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21
Q

Interphalangeal Collateral Ligament Sprain Management

A 
PIER
Valgus/varus stress test
Budding taping (2&3/4&5)
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22
Q

Dislocation of MC & phalanges MOI (MCP)

A

Rare injury

Hyperextension/shearing forces cause anterior capsule to tear allowing proximal phalanx to move backward

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23
Q

Dislocation of MC & phalanges MOI (PIP)

A

Hyperxtension & axial compression (ball hits tip of finger)

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24
Dislocation of MC & phalanges MOI (DIP)
Usually occurs dorsally & may be associated w/an open wound | Individual often reduced their own dislocations
25
Dislocation of MC & phalanges S&Sx
Painful, swollen finger Pain present at joint line B/c of opportunity to entrap volar plates, no reduction it may lead to permanent disability
26
Dislocation of MC & phalanges Management
Immobilize in a wrist/finger splint in position found | When RTP, protect w/buddy taping
27
What is a STRAIN?
Occurs as a result of excessive overload against resistance/stretching of the tendon beyond its normal range
28
Jersey Finger MOI
Individual grips opponents jersey & opponent simultaneously twists to get away Jerking motion forces individual finger to rapid to extend; rupturing FDP Ring finger is most commonly involved
29
Jersey Finger S&Sx
Pain & swelling at DIP & report a popping sensation Flex tendon disruption is indicated w/1finger lying in complete extension while others are in slight flexion In avulsed tendon can be palpated at proximal aspect of involved finger
30
Jersey Finger Management
Standard acute care Refer to physician Tendon has retracted into Palm, surgical reattachment must happen 7-10 days post injury Typical RTP is 6-12 weeks post op.
31
Mallet Finger MOI
Object hits finger while extensor tendon is taut | Avulsed lateral bands of extensor mechanism the distal attachment
32
Mallet Finger S&Sx
Tendon usually does not retract Pain, swelling, lack of extensor at DIP If left untreated, complete tears lead to permanent DIP extensor lag
33
Mallet Finger Management
Standard acute care Refer to MD Split DIP in complete extension for 6-8 weeks
34
Boutonnière Deformity MOI
Blunt trauma to dorsal PIP/rapid powerful flex of the joint against resistance Central slip of extensor tendon ruptures at mid phalanx, leaving no active extensor mech. Intact over PIP
35
Boutonnière Deformity S&Sx
Not usually present immediately , develops over 2-3 weeks as the later slip moves in a palmar direction to cause hyperextension at MP flex at PIP & hyperextension of DIP
36
Boutonnière Deformity Management
Splint PIP in complete extension & refer
37
What is a tendonopathy?
Individual involved in strenuous/repetitive tasks often inflame tendon & tendon sheaths in wrist & hand Tendon injury can be acute or chronic Overuse can lead to derangement of both mechanical & physiological components of a normal tendon
38
Trigger Finger MOI
Snapping flexor tendon, multiple/severe traumas to palmar aspect of hand/indiv who perform repeated mov't/clenching of fingers Repeated trauma & inflam'n lead to thickening of tendon sheath Nodule can form & grow within thickened synovium
39
Trigger Finger S&Sx
Locking action Painful popping when flexed PIP jt. is passively returned to extension Palpable crepitus may indicate systemic disease
40
Trigger Finger Management
Resisting splinting when necessary | Find cause, treat cause
41
DeQuervain Tenosynovitus MOI
Indiv who uses forceful grasp, combined w/repetitive use of thumb k ulnar deviation Motion places high demand on AbPL & EPB These 2 tendons share a single sheath
42
DeQuervain Tenosynovitus S&Sx
Pain over radial styloid & ⬆️ w/wrist & thumb motion TOP over tendons Thumb motion & snapping (+ve) Finklesteins test
43
DeQuervain Tenosynovitus Management
Find cause, treat cause Thumb spica Surgery may be warranted
44
Dupuytren Contracture MOI
Idiopathic Nodules appear in palmar aponeurosis Limited finger extension & eventually causes a flex deformity
45
Dupuytren Contracture S&Sx
Fixed flexed deformity occurring on ring or 5th finger | Finger cannot be extended
46
Dupuytren Contracture Management
Surgical removal of nodule
47
Ganglion Cyst MOI
Benign tumor masses typically seen on dorsal aspect of wrist
48
Ganglion Cyst S&Sx
Cyst contains jelly like colourless fluid & is freely mobile & palpable Occurs spontaneously Discomfort from pressure may occur as ganglion ⬆️ in size
49
Ganglion Cyst Management
Rx is symptomatic | Surgical removal
50
Fingertip Injuries (subungual hematoma) MOI
Direct trauma to nail bed can result in blood under nail
51
Fingertip Injuries (subungual hematoma) S&Sx
⬆️ pressure under nail bed which can lead to throbbing pain
52
Fingertip Injuries (subungual hematoma) Management
R/O # Soak in ice water 10-15 mins to numb area If throbbing persists, draining may help MD for drainage
53
Paronychia MOI
Infection along nail fold | Seen w/hangnail
54
Paronychia S&Sx
Nail fold becomes red, swollen & painful | Can produce purulent drainage
55
Paronychia Management
Warm water soaks | Severe cases, MD may recommend antibodies
56
What is Carpal Tunnel Syndrome
- Formed by volar capsule w/roof formed by transverse retinacular lig't - accommodates median nerve, finger flexors - irritation of synovial sheath can produce swelling/edema that puts pressure on median nerve - repetitive movements/positions
57
Carpal Tunnel Syndrome S&Sx
Pain awakens individual at night, relieved w/'shaking' out hands Pain, numbness, burning sensation along median nerve distribution Pinch & grip strength limited (+ve) phalen, carpal tunnel compression & tinnel sign Diminished sensitivity to pain & weak thumb abduction
58
Carpal Tunnel Syndrome Management
Refer to MD Find cause, treat cause Night splint/brace
59
Ulnar Tunnel Syndrome MOI
Compression of ulnar nerve as it passes around hook of hamate Frequent w/Cyclist
60
Ulnar Tunnel Syndrome S&Sx
Motor sensory/mixed Sx Numbness along ulnar nerve distribution (+ve) pinch grip for thumb & index finger (+ve) Tinel sign over pisiform
61
Ulnar Tunnel Syndrome Management
NSAIDs & avoidance of activity
62
Cyclists Palsy MOI
Linked to ulnar nerve entrapment | Biker leans on handle bars for extended period of time
63
Cyclists Palsy S&Sx
Swelling in hypothenar eminence | Sx mimic ulnar nerve entrapment but disappears after ride
64
Cyclists Palsy Management
Properly padded handle bars Wearing padded gloves Varying hand positions
65
Scaphoid # MOI
70% of carpal # | FOOSH
66
Scaphoid # S&Sx
Pain in 'snuff box' | Pain ⬆️ w/extension & radial deviation
67
Scaphoid # Management
Standard acute care Immobilize Poor blood supply = ⬆️ healing time
68
Boxer # MOI
of distal metaphysis or neck of 4th & 5th MC
69
Boxer # S&Sx
Sudden pain, inability to grip | TOP over # site
70
Boxer # Management
Standard acute care | Refer to MD

Conditions (2nd year) (6 decks)

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