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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
Q

barton fx

A

interarticular space w/carpal bones radial fx

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26
Q

chauffer’s

A

oblique fx thru base of radial styloid

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27
Q

hx of distal radius fracture

A

FOOSH injury

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28
Q

PE distal radial fracture

A

inspect for deformities (dinner fork collet)
check for open fracture
**NV status at arrival, before splint, then prior to leaving and DOCUMENT **

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29
Q

tx distal radial fracture

A

reduction and immobilization
ortho referral
rx tx = analgesic x 3 days

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30
Q

what type of cast? distal radial fracture

A

minimally angulated/displaced = short arm

extreme angulation req. reduction = long arm x 4 weeks followed by short arm x 2 weeks

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31
Q

sites of scaphoid fracture

A

distal pole
middle/waist (MC)
proximal pole

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32
Q

common complication of scaphoid fracture

A

non union or avascular necrosis (only one artery supplies bone)

33
Q

scaphoid fracture PE

A

snuff box tenderness

34
Q

diagnostic test scaphoid fracture

A

XR (PA and Lateral)

MAY NOT show right away, re image in 10-14 days

35
Q

casting scaphoid fracture

A

negative XR = LATSC and re XR 2-3 weeks (continue LATSC 2-3 weeks then SATSC 2-4 wks)

36
Q

when to refer scaphoid fracture

A

ANY displacement > 1 mm

37
Q

scaphoid fracture and NSAIDS

A

NO NSAIDs (decreased healing)

38
Q

dupuytren contracture patho

A

flexor tendons contract and thicken idiopathically

39
Q

dupuytren contracture associated factors

A 
T1SDM 
epilepsy 
pulmonary dz
alcoholism 
smoking 
repetitive trauma
40
Q

dupuytren contracture PE

A

callous, cord like band, non tender

contraction of flexor tendons of 4th finger (MC)

41
Q

non rx tx dupuytren contracture

A

night splint
precutaneous aponeurotomy
collagenase injection
surgical release and debridement

42
Q

percutaneous aponeurotomy dupuytren contracture

A

multiple mini cuts in the tendon + nerve block

MIGHT have to do > 1 time

43
Q

flexor tendon sheath

A

start proximal to distal palmar crease and continue to distal DIP joint (has FDS and FDP)

44
Q

flexor tendon infection sheath

A

puncture wound to the infected finger OR local spread

45
Q

PE flexor tendon infxn

A

SAUSIGE-like (fusiform) swelling
tenderness of tendon sheath
pain with PROM
Kanavel signs

46
Q

kanavel signs

A

found in flexor tendon infxn

partial flexion of PIP and DIP at rest

47
Q

dx imaging flexor tendon infxn

A

plain film to r/o fracture or foreign body

48
Q

prevention of flexor tendon infxn

A

avoid injury
stiffness can persist
can progress rapidly and spread to deep palmar or forearm

49
Q

tx flexor tendon infxn

A

surgical I and D , IV abx

50
Q

trigger finger

A

flexor tendons become inflamed and enlarged at A1 pulley of tendon sheath

catch distal side when flexed or snap when extend

51
Q

associated conditions with trigger finger

A

T1DM or RA

women MC idiopathic

52
Q

PE trigger finger

A

pain and catching of affected finger when flexed

palpable nodule at distal palmar crease

53
Q

trigger finger tx

A

NSAID initial tx
corticosteroid injection into SHEATH (not tendon)

last resort = surgical release

54
Q

felon patho

A

infection of pulp/fat pad of distal phalanx of palmar surface

55
Q

hx felon

A

puncture wound to finger tip

MUST distinguish from herpetic whitlow

56
Q

dx felon

A

plain film to r/o osteomyelitis

57
Q

felon tx

A

surgical I&D

oral ABX

58
Q

paronychia

A

infection of soft tissue around fingernail

occurs after contamination or ingrown nail

59
Q

PE and dx paronychia

A

tenderness and redness around the nail

XR if suspect osteomyelitis

60
Q

prevention and tx paronychia

A

clean hands and proper nail trimming

I&D to remove pus then oral Abx to cover staph aureus

61
Q

flexor tendon injury patho

A

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
Q

hx of flexor tendon injury

A

disruption of the tendons via trauma, OA, RA

MC ring finger

63
Q

PE flexor tendon injury

A

inspect for injury palpate for lump

test AROM and strength against resistance

NC of EA digit

64
Q

flexor tendon injury prevention

A

medical control of RA/OA

avoid grasping injury

65
Q

flexor tendon injury tx

A

refer to ortho

complete disruption must repair early to prevent retraction

66
Q

extensor digitorium attachments

A

attached to base of dorsal distal phalanx of fingers

67
Q

mallet finger hx

A

injury via laceration, rupture, or avulsion

sudden flexion of DIP against resistance (DIP)

68
Q

mallet finger PE and Dx

A

unable to extend DIPJ

PA and Lateral plain film check for avulsion

69
Q

avulsed mallet finger

A

involves > 1/3 of joint surface and joint appears sublimed palmar = sx

70
Q

mallet finger Tx

A

splinting in slight hyperextension (6-8 wks)

avoid NSAIDs and ASA

71
Q

bennett’s fx

A

fx at base of thumb metacarpal leaves small fragment attached to trapezium with sublux of thumb

72
Q

bennett’s fx hx

A

axial load to partially flexed thumb

CMCJ, MC men (boxing, football, rugby)

73
Q

bennett’s fx PE and dz

A

swelling and redness _ tenderness and limited ROM

AP, lateral, oblique films of thumb/hand

74
Q

bennett’s fx prevention and tx

A

surgical fixation (CRPP, ORIF) non narcotics

75
Q

boxers fx

A

5th MC head exposed and fractured if improper punch

76
Q

PE boxers fx

A

edema and deformity, no rotation of MC, test for extension lag

77
Q

boxers fx tx

A

application of utter case (4-6 weeks)

non narcotic analgesic

78
Q

metacarpal fx

A

not covered in soft tissue but more prone to trauma

blunt force trauma to MT, esp/ due to axial loading

79
Q

metacarpal fx diagnosis

A

PA, lateral. oblique plain films

if displaced, angulated and rotated = ortho referral

MSK 1 (9 decks)

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