D/O of wrist Flashcards
carpal tunnel
site of passageway where Median nerve passes thru along with flexor tendon of fingers
carpal tunnel syndrome epidemiology
middle aged or pregnant women
carpal tunnel syndrome hx
pain or numbness in the first 3 fingers of hand (not palm) esp. at night
carpal tunnel syndrome PE
weak abduction of thumb
Phalen’s test
Tinel’s test
Thenar atrophy (bad sign)
diagnostic test carpal tunnel syndrome
EMG/NCV study
double crush syndrome
proximal compression at two levels
decrease ability of nerve to tolerate a second, more distal compression
therefore, lighter compression will cause more severe symptoms
tx of carpal tunnel syndrome (non Rx)
wrist splint
adjust environment
Sx IF atrophy of thenar muscles or intolerable pain
RX tx carpal tunnel syndrome
NSAIDS, oral steroids or steroid injection
ganglion of wrist
cystic structure that arises from synovial sheath of joint city
clear, jelly like fluid
ganglion cyst epi
MC soft tissue tumor of wrist
MC between 15-45
ganglion hx
aching pain aggravated by extreme flexion/extension or may be painless
ganglion PE
palpable mass +/- tender
transilluminated on exam
ganglion cyst on palmar caution
if on RADIAL side
don’t I&D bc risk of radial artery rupture
ganglion cyst non rx
reassure and aspirate (90% reoccurrence rate)
when do you refer a ganglion cyst?
failure of conservative tx
significant pain
irregular mass
what tendons are in the radial 1st dorsal compartment?
APL
EPB
deQuervein’s tenosynovitis
tendons over 1st dorsal compartment on radial. side of wrist become irritated and inflamed - sheath to thicken and tendons “catch”
deQuervein’s tenosynovitis clinical symptoms
pain and swelling over radial styloid
aggravated with moving thumb or wrist
may c.o thumb locking/sticking
deQuervein’s tenosynovitis PE
swelling and tenderness over 1st Doral compartment
+ finklestein test
diagnostic test deQuervein’s tenosynovitis
XR to rule out bone pathology
non rx tx deQuervein’s tenosynovitis
immobilization
referral (no improvement after 3 injections)
rx tx deQuervein’s tenosynovitis
NSAIDS x 2 weeks OR steroid injection into tendon sheath
colles fracture
MC
dorsal aspect radial fracture
smith fracture
volar angulated radial fracture
barton fx
interarticular space w/carpal bones radial fx
chauffer’s
oblique fx thru base of radial styloid
hx of distal radius fracture
FOOSH injury
PE distal radial fracture
inspect for deformities (dinner fork collet)
check for open fracture
**NV status at arrival, before splint, then prior to leaving and DOCUMENT **
tx distal radial fracture
reduction and immobilization
ortho referral
rx tx = analgesic x 3 days
what type of cast? distal radial fracture
minimally angulated/displaced = short arm
extreme angulation req. reduction = long arm x 4 weeks followed by short arm x 2 weeks
sites of scaphoid fracture
distal pole
middle/waist (MC)
proximal pole
common complication of scaphoid fracture
non union or avascular necrosis (only one artery supplies bone)
scaphoid fracture PE
snuff box tenderness
diagnostic test scaphoid fracture
XR (PA and Lateral)
MAY NOT show right away, re image in 10-14 days
casting scaphoid fracture
negative XR = LATSC and re XR 2-3 weeks (continue LATSC 2-3 weeks then SATSC 2-4 wks)
when to refer scaphoid fracture
ANY displacement > 1 mm
scaphoid fracture and NSAIDS
NO NSAIDs (decreased healing)
dupuytren contracture patho
flexor tendons contract and thicken idiopathically
dupuytren contracture associated factors
T1SDM epilepsy pulmonary dz alcoholism smoking repetitive trauma
dupuytren contracture PE
callous, cord like band, non tender
contraction of flexor tendons of 4th finger (MC)
non rx tx dupuytren contracture
night splint
precutaneous aponeurotomy
collagenase injection
surgical release and debridement
percutaneous aponeurotomy dupuytren contracture
multiple mini cuts in the tendon + nerve block
MIGHT have to do > 1 time
flexor tendon sheath
start proximal to distal palmar crease and continue to distal DIP joint (has FDS and FDP)
flexor tendon infection sheath
puncture wound to the infected finger OR local spread
PE flexor tendon infxn
SAUSIGE-like (fusiform) swelling
tenderness of tendon sheath
pain with PROM
Kanavel signs
kanavel signs
found in flexor tendon infxn
partial flexion of PIP and DIP at rest
dx imaging flexor tendon infxn
plain film to r/o fracture or foreign body
prevention of flexor tendon infxn
avoid injury
stiffness can persist
can progress rapidly and spread to deep palmar or forearm
tx flexor tendon infxn
surgical I and D , IV abx
trigger finger
flexor tendons become inflamed and enlarged at A1 pulley of tendon sheath
catch distal side when flexed or snap when extend
associated conditions with trigger finger
T1DM or RA
women MC idiopathic
PE trigger finger
pain and catching of affected finger when flexed
palpable nodule at distal palmar crease
trigger finger tx
NSAID initial tx
corticosteroid injection into SHEATH (not tendon)
last resort = surgical release
felon patho
infection of pulp/fat pad of distal phalanx of palmar surface
hx felon
puncture wound to finger tip
MUST distinguish from herpetic whitlow
dx felon
plain film to r/o osteomyelitis
felon tx
surgical I&D
oral ABX
paronychia
infection of soft tissue around fingernail
occurs after contamination or ingrown nail
PE and dx paronychia
tenderness and redness around the nail
XR if suspect osteomyelitis
prevention and tx paronychia
clean hands and proper nail trimming
I&D to remove pus then oral Abx to cover staph aureus
flexor tendon injury patho
flexor digitorum profundus attaches to base of palmar side of distal phalaz
flexor digitorum superficialis inserts on palmar side of base of middle phalanx
hx of flexor tendon injury
disruption of the tendons via trauma, OA, RA
MC ring finger
PE flexor tendon injury
inspect for injury palpate for lump
test AROM and strength against resistance
NC of EA digit
flexor tendon injury prevention
medical control of RA/OA
avoid grasping injury
flexor tendon injury tx
refer to ortho
complete disruption must repair early to prevent retraction
extensor digitorium attachments
attached to base of dorsal distal phalanx of fingers
mallet finger hx
injury via laceration, rupture, or avulsion
sudden flexion of DIP against resistance (DIP)
mallet finger PE and Dx
unable to extend DIPJ
PA and Lateral plain film check for avulsion
avulsed mallet finger
involves > 1/3 of joint surface and joint appears sublimed palmar = sx
mallet finger Tx
splinting in slight hyperextension (6-8 wks)
avoid NSAIDs and ASA
bennett’s fx
fx at base of thumb metacarpal leaves small fragment attached to trapezium with sublux of thumb
bennett’s fx hx
axial load to partially flexed thumb
CMCJ, MC men (boxing, football, rugby)
bennett’s fx PE and dz
swelling and redness _ tenderness and limited ROM
AP, lateral, oblique films of thumb/hand
bennett’s fx prevention and tx
surgical fixation (CRPP, ORIF) non narcotics
boxers fx
5th MC head exposed and fractured if improper punch
PE boxers fx
edema and deformity, no rotation of MC, test for extension lag
boxers fx tx
application of utter case (4-6 weeks)
non narcotic analgesic
metacarpal fx
not covered in soft tissue but more prone to trauma
blunt force trauma to MT, esp/ due to axial loading
metacarpal fx diagnosis
PA, lateral. oblique plain films
if displaced, angulated and rotated = ortho referral
