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Musculoskeletal > Elbow, Hand and Wrist I-IV > Flashcards

Elbow, Hand and Wrist I-IV Flashcards

1
Q

Proximal Carpal Row

A

Scaphoid, lunate, triquetrum, pisiform

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2
Q

Distal Carpal Row

A

Trapezium, trapezoid, capitate, hamate

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3
Q

Carpal Motion in Flexion

A

Scaphoid flexes further, rest of proximal row remains straight

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4
Q

Radial Deviation

A

Scaphoid moves more vertically on lateral x-ray (flexes out more)
Pulls lunate with causing flexion also
Proximal row flexes

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5
Q

Ulnar Deviation

A

scaphoid has less than 45 degree angulation
pulls lunate into extension
Trequitrum drops under hamate (extends)
Entire proximal row extends

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6
Q

DISI

A

Disruption of sorsal portion of the scapho-lunate interosseous ligament and radioschophocapitiate ligament
Pathologic gapping between scaphoid and lunate
Lunate twisted dorsally
Test integrity placing thumb over scaphoid tubercle and index finger on dorsum of hand
Scaphoid will move vertically and be felt by index finger

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7
Q

VISI

A

disruption of dorsal portion of the luno-triquetral interosseous ligament
longitudinal metacarpal arch, pull of interosseous, tendon insertions proximally

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8
Q

Phalanges

A

Pull of lumbrical and interosseous muscles provide a deforming force on fractures of the proximal phalanx

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9
Q

Thumb Metacarpal

A

Carpal fracture due to tendons

Avulsion caused by APL

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10
Q

Extrinsics

A

MP joint extension

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11
Q

Intrinsics

A

Flex MP joints

Extend IP joints

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12
Q

Swan Neck Deformity

A

PIP joint hyperextension
DIP joint flexion
Dorsal subluxation of lateral bands

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13
Q

Rheumatoid Arthritis

A

PIP synovitis with dorsal displacement of lateral bands

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14
Q

Mallet Injury

A

Proximal retraction of lateral bands due to loss of distal anchor (terminal tendon)
Extensory band shifts proximally (increasing resting tone of extensors) and over time wears out restraining the ligaments
Causing swan neck to develop, ligaments can wear out restraining ligaments, swan neck develops

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15
Q

Bouonierre Deformity

A

PIP flexion
DIP Hyperextension
Injury to central slip with volar subluxation of lateral bands
Tender to palpation over the middle phalanx-presume boutinierre splint in extension
With rhematoid arthritis PIP joint synovitis with central slip rupture or volar subluxation

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16
Q

Boutonierre Trauma

A

Axial load injury

Triangular ligament tear or central slip extensor tear

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17
Q

Cubital Tunnel Syndrome

A

Tinels sign, elbow hyperflexion test (hyperflex elbow 1 minute, look for tingling, 1st dorsal interosseous and FCU weakness when severe
Nerve conduction velocity NCV and EMG usually negative except when advanced stage

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18
Q

Capal Tunnel Syndrome

A

Thumb/middle finger paresthesias
Symptoms worse at night
Drop things/hand clumsiness
Paresthesias while driving

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19
Q

Carpal Tunnel Exam

A 
Tinels
Pgalens
Carpal tunnel compression test
APB strength
NCV/EMG usually positive
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20
Q

Carpal Tunnel Etiology

A 
Metabolic diabetes
Hypothyroidism
Pregnancy
Idiopathic/multifactorial
Occupational
Flexor tenosynovitis
21
Q

Carpal Tunnel Findings

A

Weakness of abductor pollicis brevis

22
Q

Carpal Tunnel Treatment

A 
Cock up splint
Activity modification/ergonomics
NSAID
Injection
Surgical release of TCL
23
Q

Flexor Tenosynovitis

A

Highly repetivie finger motions
Prolonged gripping
Thyroid disorders
Diabetes

24
Q

Trigger Fingers

A

Flexor tendon swells and is too big to get under pulley band
Flexor pulley system
Tucking fingers in tight when flexing
Patient unable to extend affected finger

25
Q

Trigger Finger History

A

Diabetes, hyper extension strain, contusion, overuse of digit

26
Q

Treatment

A

NSAID, injection, release of A-1 pulley

27
Q

De Quervain’s Disease

A

1st dorsal compartment DC1 tenosynovitis/impingement

Caused by trauma, overuse, retinacular ganglion cystm radial styloid spur

28
Q

De Quervain’s Pt. History

A 
2 hands lifting with forearms in neutral rotation
New mother
Trauma to radia lwrist
Ulnar deviation strain
Tingling/burning dorsal thumb and index
29
Q

De Quervain’s Disease PE

A

Finkelstein’s maneuver
Pain with resisted APL, EPB
Palpatory tenderness over DC1

30
Q

De Quervain’s Treatment

A

Long opponenes (forearm based thumb spica) splint
NSAD
Injection
Release of DC

31
Q

Thumb CMC Joint Pathology

A

Pain at base of thumb and thenar palm
Worse with pinching
Synovitis, laxity of anterior oblique ligament, women&raquo_space;men, degenerative disease

32
Q

Thumb CMC Joint Pathology History

A

Pain with pinching/holding

Manipulates small parts all day

33
Q

Thumb CMC Clinical Findings

A 
Palpatory joint tenderness
Grind test
Distraction-torque test
Laxity of CMC joint
Radiographs (static stress more common in nondominant hand)
34
Q

Thumb CMC treatment

A 
Modify activity
Short opponens splin
NSAD
Injection
Surgery (reconstruct ligament, excise trapezium)
35
Q

Tests for Radial, MEdian and Ulnar Nerves

A
  1. Make OK sign (median nerve)

2. Cross fingers (radial (extends fingers), ulnar (cross them))

36
Q

Dupuytren’s Disease

A

Overuse of wrist and hand muscles
Progressive fibro-proliferative disease leads to characteristic cord and nodule formation in palm and fingers
Collagen deposition thickens the cords which contracts the tissue tightly, pulling fingers into flexion

37
Q

Ulnar Claw Hand

A

Clawing of ulnar digits (4-5)
Ulnar nerve impingement in cubital tunnel
Pt. presents with clawing (hyperextension of MP joints 4/5, flexing of IP joints)

38
Q

Ulnar Claw Treatment

A 
Modify activity
Avoid elbow flexion beyond 30 degrees
Night splint
NSAID
Surgery
39
Q

Mallet Finger

A

Finger droops at the tip due to injury to terminal extensor mechanism

40
Q

Mallet Finger History

A

Inability to extend DIP joint, sports related injury, minor trauma

41
Q

Mallet Finger PE

A

Tenderness at site of injury
Passive extension intact
Hyperextension may present in PIP joint (compensatory swan neck deformity)

42
Q

Mallet Finger treatment

A

Splint DIP in slight hyperextension
Only DIP joint, leave PIP free
Surgery

43
Q

Origin of wrist extensors

A

From lateral epicondyle of humerus and all innervated by radial nerve

44
Q

Long finger flexors origin

A

medial epicondyle and innervated by median and ulnar nerves

45
Q

Intrinsic ligaments

A

Connect bone-bone

46
Q

Extrinsic ligaments

A

Thickening in capsules of wrist

47
Q

Hook of hamate

A

Found 1 cm distal and 1 cm radial from the pisiform

Should feel like a pea if you roll finger over that area

48
Q

Interosseous muscles

A

Primary flexors of MP joint

49
Q

Lumbricals

A

Help take tension off flexor tendons

Easier to extend the fingers

Musculoskeletal (7 decks)

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