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MSK 1 > D/O of wrist > Flashcards

D/O of wrist Flashcards

1
Q

carpal tunnel

A

site of passageway where Median nerve passes thru along with flexor tendon of fingers

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2
Q

carpal tunnel syndrome epidemiology

A

middle aged or pregnant women

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3
Q

carpal tunnel syndrome hx

A

pain or numbness in the first 3 fingers of hand (not palm) esp. at night

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4
Q

carpal tunnel syndrome PE

A

weak abduction of thumb

Phalen’s test
Tinel’s test
Thenar atrophy (bad sign)

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5
Q

diagnostic test carpal tunnel syndrome

A

EMG/NCV study

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6
Q

double crush syndrome

A

proximal compression at two levels

decrease ability of nerve to tolerate a second, more distal compression

therefore, lighter compression will cause more severe symptoms

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7
Q

tx of carpal tunnel syndrome (non Rx)

A

wrist splint
adjust environment
Sx IF atrophy of thenar muscles or intolerable pain

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8
Q

RX tx carpal tunnel syndrome

A

NSAIDS, oral steroids or steroid injection

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9
Q

ganglion of wrist

A

cystic structure that arises from synovial sheath of joint city

clear, jelly like fluid

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10
Q

ganglion cyst epi

A

MC soft tissue tumor of wrist

MC between 15-45

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11
Q

ganglion hx

A

aching pain aggravated by extreme flexion/extension or may be painless

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12
Q

ganglion PE

A

palpable mass +/- tender

transilluminated on exam

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13
Q

ganglion cyst on palmar caution

A

if on RADIAL side

don’t I&D bc risk of radial artery rupture

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14
Q

ganglion cyst non rx

A

reassure and aspirate (90% reoccurrence rate)

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15
Q

when do you refer a ganglion cyst?

A

failure of conservative tx
significant pain
irregular mass

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16
Q

what tendons are in the radial 1st dorsal compartment?

A

APL

EPB

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17
Q

deQuervein’s tenosynovitis

A

tendons over 1st dorsal compartment on radial. side of wrist become irritated and inflamed - sheath to thicken and tendons “catch”

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18
Q

deQuervein’s tenosynovitis clinical symptoms

A

pain and swelling over radial styloid

aggravated with moving thumb or wrist

may c.o thumb locking/sticking

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19
Q

deQuervein’s tenosynovitis PE

A

swelling and tenderness over 1st Doral compartment

+ finklestein test

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20
Q

diagnostic test deQuervein’s tenosynovitis

A

XR to rule out bone pathology

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21
Q

non rx tx deQuervein’s tenosynovitis

A

immobilization

referral (no improvement after 3 injections)

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22
Q

rx tx deQuervein’s tenosynovitis

A

NSAIDS x 2 weeks OR steroid injection into tendon sheath

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23
Q

colles fracture

A

MC

dorsal aspect radial fracture

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24
Q

smith fracture

A

volar angulated radial fracture

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25
barton fx
interarticular space w/carpal bones radial fx
26
chauffer's
oblique fx thru base of radial styloid
27
hx of distal radius fracture
FOOSH injury
28
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 ***
29
tx distal radial fracture
reduction and immobilization ortho referral rx tx = analgesic x 3 days
30
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
31
sites of scaphoid fracture
distal pole middle/waist (MC) proximal pole
32
common complication of scaphoid fracture
non union or avascular necrosis (only one artery supplies bone)
33
scaphoid fracture PE
snuff box tenderness
34
diagnostic test scaphoid fracture
XR (PA and Lateral) MAY NOT show right away, re image in 10-14 days
35
casting scaphoid fracture
negative XR = LATSC and re XR 2-3 weeks (continue LATSC 2-3 weeks then SATSC 2-4 wks)
36
when to refer scaphoid fracture
ANY displacement > 1 mm
37
scaphoid fracture and NSAIDS
NO NSAIDs (decreased healing)
38
dupuytren contracture patho
flexor tendons contract and thicken idiopathically
39
dupuytren contracture associated factors
``` T1SDM epilepsy pulmonary dz alcoholism smoking repetitive trauma ```
40
dupuytren contracture PE
callous, cord like band, non tender contraction of flexor tendons of 4th finger (MC)
41
non rx tx dupuytren contracture
night splint precutaneous aponeurotomy collagenase injection surgical release and debridement
42
percutaneous aponeurotomy dupuytren contracture
multiple mini cuts in the tendon + nerve block MIGHT have to do > 1 time
43
flexor tendon sheath
start proximal to distal palmar crease and continue to distal DIP joint (has FDS and FDP)
44
flexor tendon infection sheath
puncture wound to the infected finger OR local spread
45
PE flexor tendon infxn
SAUSIGE-like (fusiform) swelling tenderness of tendon sheath pain with PROM Kanavel signs
46
kanavel signs
found in flexor tendon infxn | partial flexion of PIP and DIP at rest
47
dx imaging flexor tendon infxn
plain film to r/o fracture or foreign body
48
prevention of flexor tendon infxn
avoid injury stiffness can persist can progress rapidly and spread to deep palmar or forearm
49
tx flexor tendon infxn
surgical I and D , IV abx
50
trigger finger
flexor tendons become inflamed and enlarged at A1 pulley of tendon sheath catch distal side when flexed or snap when extend
51
associated conditions with trigger finger
T1DM or RA women MC idiopathic
52
PE trigger finger
pain and catching of affected finger when flexed palpable nodule at distal palmar crease
53
trigger finger tx
NSAID initial tx corticosteroid injection into SHEATH (not tendon) last resort = surgical release
54
felon patho
infection of pulp/fat pad of distal phalanx of palmar surface
55
hx felon
puncture wound to finger tip MUST distinguish from herpetic whitlow
56
dx felon
plain film to r/o osteomyelitis
57
felon tx
surgical I&D | oral ABX
58
paronychia
infection of soft tissue around fingernail occurs after contamination or ingrown nail
59
PE and dx paronychia
tenderness and redness around the nail XR if suspect osteomyelitis
60
prevention and tx paronychia
clean hands and proper nail trimming I&D to remove pus then oral Abx to cover staph aureus
61
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
62
hx of flexor tendon injury
disruption of the tendons via trauma, OA, RA MC ring finger
63
PE flexor tendon injury
inspect for injury palpate for lump test AROM and strength against resistance NC of EA digit
64
flexor tendon injury prevention
medical control of RA/OA avoid grasping injury
65
flexor tendon injury tx
refer to ortho complete disruption must repair early to prevent retraction
66
extensor digitorium attachments
attached to base of dorsal distal phalanx of fingers
67
mallet finger hx
injury via laceration, rupture, or avulsion sudden flexion of DIP against resistance (DIP)
68
mallet finger PE and Dx
unable to extend DIPJ PA and Lateral plain film check for avulsion
69
avulsed mallet finger
involves > 1/3 of joint surface and joint appears sublimed palmar = sx
70
mallet finger Tx
splinting in slight hyperextension (6-8 wks) avoid NSAIDs and ASA
71
bennett's fx
fx at base of thumb metacarpal leaves small fragment attached to trapezium with sublux of thumb
72
bennett's fx hx
axial load to partially flexed thumb CMCJ, MC men (boxing, football, rugby)
73
bennett's fx PE and dz
swelling and redness _ tenderness and limited ROM AP, lateral, oblique films of thumb/hand
74
bennett's fx prevention and tx
surgical fixation (CRPP, ORIF) non narcotics
75
boxers fx
5th MC head exposed and fractured if improper punch
76
PE boxers fx
edema and deformity, no rotation of MC, test for extension lag
77
boxers fx tx
application of utter case (4-6 weeks) non narcotic analgesic
78
metacarpal fx
not covered in soft tissue but more prone to trauma blunt force trauma to MT, esp/ due to axial loading
79
metacarpal fx diagnosis
PA, lateral. oblique plain films if displaced, angulated and rotated = ortho referral

MSK 1 (9 decks)

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