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OCS > Elbow, Wrist, and Hand > Flashcards

Elbow, Wrist, and Hand Flashcards

1
Q

What injuries may occur from a Fall on Outretched Hand?

A
  • Distal Radial Fracture
  • Scaphoid Fracture
  • Radial Head Fracture
  • AC Separation
  • Glenoid Labral Tear
  • Perilunate Dislocation
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2
Q

What is Little League Elbow?

A
  • Can refer to several overuse injuries
  • Often is Osteochondritis Dissecans of the radial head and/or capitellum or Osteochondrosis of the capitellum (panners syndrome)
  • May be from compressive forces through the lateral elbow during throwing
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3
Q

How is Little League Elbow treated?

A
  • Relative Rest

- No throwing for up to 1 year

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4
Q

What Functional tests help confirm little league elbow?

A
  • Bending and Flexing of the Elbow with maintenance of Valgus Stress should elicit pain
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5
Q

Which Structure is most commonly affected in Lateral Epicondylitis?

A
  • Extensor Carpi Radialis Brevis

- Occasionally the Extensor Digitorum

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6
Q

What is the Mills Maneuver?

A
  • Used in treating Lateral Epicondylitis

- Forceful and quick Extension of the forearm with wrist flexed and pronated

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7
Q

What is Radial Tunnel Syndrome?

A
  • Entrapment of Radial nerve in the radial tunnel
  • tunnel is approx 2 inches long from the capitellum of the humerus to the supinator
  • Pain can mimic Lateral Epicondylitis, but often tennis elbow strap will make pain worse due to compressive forces
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8
Q

What is NurseMaids Elbow and how is it treated?

A
  • Subluxation of the radial head, usually in children after traction injury
  • Reduced with Supination
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9
Q

How would you differentiate Ulnar Collateral Injuries and Medial Epicondylitis?

A
  • If Valgus stress applied with elbow slightly flexed, wrist flexed and forearm pronated, should be painless if Medial Epicondylitis
  • If UCL, would still reproduce Sx
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10
Q

At what sites can the Median Nerve be compressed in the elbow and forearm?

A
  • Ligament of Struthers

- Pronator Teres

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11
Q

In terms of the Elbow, what does the acronym CRITOE stand for?

A
  • The Order of appearance of the ossification centers of the elbow
  • C - Capitellum - 1 year
  • R - Radial Head- 3 years
  • I- Internal (Medial) Epicondyle - 5 years
  • T- Trochlea - 7 years
  • O - Olecranon - 9 years
  • E- External (Lateral) Epicondyle- 11 years
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12
Q

What is a GreenStick Fracture?

A
  • Occurs only in children

- Part of the bone is broken but not all the way through

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13
Q

What is a Metaphyseal Fracture?

A
  • Fracture of the Metaphysis (upper or lower part of the bone shaft)
  • Does Not include the growth plate
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14
Q

What is a Colles Fracture?

A
  • Fractur of the distal radius and a dorsally angulated distal fragment
  • usually from FOOSH
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15
Q

What is a Galeazzi Fracture?

A
  • Combines a fracture of the radius, with displaced pieces of bone, and a dislocation of the ulna at the wrist
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16
Q

What is a Monteggia Fracture?

A
  • Involves both forearm bones
  • At the Proximal Forearm, the Ulna is Fractured and the Radius is Dislocated
  • Sometimes presents as a night stick fracture but can be caused by FOOSH as well
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17
Q

What are common sites of compression of the Ulnar Nerve at the elbow?

A
  • Ligament of Struthers
  • Arcade of Struthers
  • Cubital Tunnel (most common)
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18
Q

What is an elbow flexion test?

A
  • Passive Flexion of the elbow for approx 60 seconds
  • Reproduces Sx of Cubital Tunnel Syndrome
  • Ligamentous roof of cubital tunnel becomes taut in flexion and compresses ulnar nerve
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19
Q

What is Radial Tunnel Syndrome?

A
  • Compression Neuropathy to the PIN Nerve at the Supinator or Arcade of Frohse
  • Similar Presentation to Lateral Epicondylitis but approx 2-4 cm more distal
  • Differs from PIN, Radial Tunnel Syndrome includes pain only
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20
Q

What are the common special tests used to diagnose Radial Tunnel Syndrome?

A
  • Long Finger Extension Test

- Resisted Supination

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21
Q

What is Posterior Interosseous Nerve Compression Syndrome?

A
  • Compressive Neuropathy of the PIN at the Supinator or Arcade of Frohse
  • Differs from Radial Tunnel Syndrome, Motor Weakness only, no sensory deficits but can have pain
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22
Q

What are common findings of PIN Syndrome on physical exam?

A
  • Wrist Extensor Weakness
  • Weakness of Finger MCP Extension
  • Radial Drift
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23
Q

What is Dequervains Syndrome?

A
  • Stenosing Tenosynovitis of the 1st Dorsal compartment of the wrist
  • Includes Abductor Pollicis Longus and Extensor Pollicis Brevis
  • (+) Finkelsteins Test
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24
Q

What is Anterior Interosseous Nerve Syndrome?

A
  • Compressive Neuropathy of AIN at the Pronator Teres Most often
  • Motor Loss Only, No Pain or sensory deficits
  • Unable to make OK sign
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25
Q

What is Parsonage Turner Syndrome?

A
  • Bilateral Anterior Interosseous Signs
  • Caused by Viral Brachial Neuritis
  • Be suspicious if motor loss is preceded by intense shoulder pain and viral prodrome
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26
Q

What is Pronator Syndrome?

A
  • Compressive Neuropathy of Median Nerve at elbow
  • Most commonly at Ligament of Struthers or Pronator Teres
  • Differentiated from Carpal Tunnel d/t pain in volar forearm and Sensory Disturbances of palmar cutaneous branch of median nerve (palm of hand)
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27
Q

What is Cubital Tunnel Syndrome?

A
  • Compressive Neuropathy of the Ulnar Nerve most often at cubital tunnel and arcade of struthers
  • Sensory and Motor loss in ular nerve pattern distal to elbow
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28
Q

What are common Signs and Special Tests for Cubital Tunnel Syndrome?

A
  • (+) Froments Sign
  • Weakened Grasp and Grip
  • (+) Tinels at cubital tunnel
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29
Q

What is Saturday Night Palsy?

A
  • Compressive Neuropathy of the Radial Nerve at the proximal Humerus
  • Often presents with Triceps and Wrist Extensor Weakness
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30
Q

What is a Bouttoniere Deformity?

A
  • Flexion of PIP
  • Extension of DIP
  • Caused by Central Slip Injury
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31
Q

What is a Swan Neck Deformity?

A
  • Hyperextension of PIP
  • Flexion of DIP
  • Caused by Volar Plate Laxity/Injury
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32
Q

What is Mallet Finger?

A
  • A finger deformity caused by disruption of the terminal extensor tendon distal to DIP joint
  • Lack of active DIP extension
  • Painful and swollen DIP joint following impaction injury to finger
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33
Q

What is Jersey Finger?

A
  • Avulsion injury of FDP from insertion at base of distal phalanx
  • •FDP muscle belly in maximal contraction during forceful DIP extension
  • No active flexion of DIP, Slight extension compared to other fingers
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34
Q

In general, what position should the MCP Joint be splinted in?

A
  • Flexion, not extension

- Collateral ligaments more taut in flexion and therefore easier to get ROM back after splinting

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35
Q

What is Trigger Finger?

A
  • Locking or attempt to lock of a finger in the position of flexion
  • Caused by thickening of A1 pulley and flexor tendon inflammation
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36
Q

What is Dupuytrens contracture?

A
  • Familial disease characterized by the development of new fibrous tissue in the palmar and digital fascia of the hand
  • Usually treated surgically and then with Active Splinting
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37
Q

What is Keinbocks Disease?

A
  • Avascular Necrosis of the Lunate
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38
Q

What nerve innervates sensation to palmar triangle of the hand?

A
  • Palmar Cutaneous Branch of the Median
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39
Q

When should Extensor and Flexor Tendon injuries be repaired?

A
  • Extensor- injuries with >50% of the tendon lacerated

Flexor- >60%

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40
Q

What is the benefit of pressure therapy in managment of a burned hand?

A
  • Pressure Therapy helps prevent hypertrophic scarring after a burn
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41
Q

What is a Boxers Fracture?

A
  • Fracture of the metacarpal neck of the ring and little finger
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42
Q

What is Gamekeepers Thumb?

A
  • Injury to the Ulnar Collateral Ligament of the thumb

- If completely torn, the Adductor Aponeurosis can become wedged in the lax joint space, this is called a steners lesion

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43
Q

How are Gamekeepers Thumbs Treated?

A
  • Partial Rupture - Thumb Spica Splint x 4 weeks

- Complete tear- Usually Surgery

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44
Q

What is an Essex Lopresti Fracture?

A
  • Fracture of the Radial Head and Dislocation of the DRUJ Joint as well as disruption of the interosseous membrane
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45
Q

What is a Froments Sign?

A
  • Pinch paper between thumb and index pads and examiner attempts to pull it away. Ulnar deficient hands with flex DIP to hold the thumb opposed to paper
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46
Q

What are common sites of entrapment of the Median, Ulnar, and Radial Nerves at the Elbow?

A
  • Median- Pronator Teres
  • Ulnar- Cubital Tunnel
  • Radial- Arcade of Frohse/Supinator
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47
Q

Which Porton of the Ulnar Collateral Ligament (MCL) is strongest?

A
  • Anterior Portion
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48
Q

What structure is the Greatest Restrain to Valgus stress at the elbow?

A
  • UCL (MCL)
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49
Q

What movement flattens the roof of the cubital tunnel and can ellicit symptoms of Cubital Tunnel Syndrome?

A
  • Elbow Flexion
50
Q

Discuss the Management of a Simple Elbow Dislocation

A
  • Closed Reduction
  • Ligament injury present, but surgical outcomes poorer
  • Immediate ROM if stable, if unstable cast or sling <14 days to prevent motion loss
51
Q

Discuss Management of a Complex Elbow Dislocation

A
  • Most common is terrible triad

- Surgical Fixation is a must, if not stable enough with ORIF, External Fixator or Posterior Splint is used

52
Q

What is a “Terrible Triad” of the elbow?

A
  • Elbow Dislocation
  • Radial Head Fracture
  • Coronoid Fracture
  • Surgery is a must
53
Q

What are some signs/ symptoms that an elbow fracture may be present?

A
  • History of Trauma
  • Presence of Fat Pad Sign (Effustion over the posterior aspect of the elbow)
  • Inability to fully extend the elbow
54
Q

What are the 3 most common MOI’s for Radial Head Fractures?

A
  • Axial load on a pronated forearm
  • Direct blow to the elbow
  • Hyperflexion Injury
55
Q

Describe the Mason Johnston Classification for Radial Head Fractures

A
  • Type 1: Undisplaced
  • Type 2: Large Displaced Fragment
  • Type 3: Comminuted
  • Type 4: Associated with elbow dislocation
56
Q

Complications of a distal humeral fracture can result in damage to what nerve?

A
  • Ulnar Nerve
57
Q

What type of Neuritis is common in individuals with severe flexion contracture?

A
  • Ulnar
58
Q

What are some hallmark symptoms of Complex Regional Pain Syndrome?

A
  • Intractable Pain in Non Peripheral nerve distribution
  • Allodynia, Hyperalgesia
  • Must be evidence of edema with sensory and motor changes
59
Q

What are some signs and symptoms of a patient with Radial Collateral Ligament Injury or PLRI?

A
  • Vague Elbow Discomfort
  • Lateral Elbow Pain
  • Clicking, Snapping, Clunking that is worse with Supination
  • Feeling that “something is not right” during comined elbow extension and forerarm supination
  • Giving out sensation with loading of a flexed elbow and supinated forearm
60
Q

What are some special tests indicative of Posterolateral Rotary Instability/RLC?

A
  • PLRI Test
  • Push Up Sign
  • Chair (Push) sign
  • Press Up Maneuver
61
Q

What is the most common special test used to determine RLC Laxity?

A
  • Varus Stress Test
62
Q

How is the UCL typically damaged?

A
  • Acutely from FOOSH

- Insidiously from overuse or chronic attenuation, Overhead Throwing Athletes

63
Q

What are the 6 phases of throwing?

A
  • Wind Up
  • Stride
  • Arm Cocking
  • Arm Acceleration
  • Arm Deceleration
  • Follow Through
64
Q

What are some signs and symptoms of Ulnar Collateral (MCL) Ligament Injury?

A
  • Medial Elbow Pain
  • May report hearing a “pop”
  • Tenderness at Ulnar insertion of the UCL (2 cm distal medial epicondyle)
65
Q

What are some special tests indicative of UCL/ MCL injury?

A
  • Moving Valgus Stress test
  • Milking Test
  • Valgus Stress Test
66
Q

What are some signs and symptoms of Valgus Extension Overload Syndrome?

A
  • Tenderness at Posteromedial Olecranon
  • Flexion Contracture
  • Painful Active Motion with Crepitus
  • PROM painful into Pronation, Valgus and Extension
  • Treat with NSAIDs, Rest, Correction of Throwing Mechanics
67
Q

Describe Operative management of UCL/ MCL

A
  • Reconstruction of the UCL
  • Tommy John Procedure and Newer “Docking Technique” Procedure
  • First 2 weeks, very gradual ROM
  • 4-6 weeks Strength
  • 4 months interval throwing
  • 12 months competition
68
Q

What are some special tests indicative of Medial Epicondylitis?

A
  • Palpation of Medial Epicondyle
  • Grip Strength
  • Passive Positioning Test
69
Q

What are some special tests indicative of Lateral Epicondylitis?

A
  • Cozen Test
  • Mill Test
  • Isometric contraction of wrist extension
  • Third Finger Resistance Test
70
Q

What is initial treatment progression of Lateral Epicondylitis?

A
  • Rest
  • Avoidance of Aggravating Factors
  • Self Stretching
  • Eccentric Strength
71
Q

What is surgical criteria for patient with lateral epicondylitis?

A
  • Failure of success after multiple cortizone injections
  • Failure of Rehab > one year
  • Constant Pain
  • Associated with Intra Articular Pathology
72
Q

What are some milestones after surgical intervention for Distal Biceps Tendon Rupture?

A
  • Posterior Splint x 2 weeks
  • Full ROM by week 4
  • Strength starts weeks 6-8
  • Unrestricted Activity by 8-16 weeks
73
Q

Describe a Neuropraxia

A
  • Least Serious Nerve Dysfunction
  • No Tinels Sign
  • Presenting Signs and Symptoms resolve in days to weeks
74
Q

Describe Axonotomesis

A
  • Mid Serious Nerve Dysfunction
  • (+) Tinels and EMG
  • Recovery Complete, 1mm a day, 1 inch a month
75
Q

Describe Neurotmesis

A
  • Most Serious Nerve Dysfunction
  • (+) Tinels and EMG
  • Recovery Incomplete and Surgical intervention is required
76
Q

What are some common special tests indicative of Cubital Tunnel Syndrome (Ulnar Nerve Pathology)?

A
  • Tinel at Cubital Tunnel
  • Elbow Flexion Test
  • Pressure Provocative Test
  • Froment Sign
77
Q

What are differences in Pronator Teres and Anterior Interosseous Syndromes?

A
  • Pronator Teres Syndrome, Sensory Changes in fingers 2-4

- No sensory changes in AIN

78
Q

What are differences in Radial Tunnel Syndrome and Posterior Interosseous Nerve Syndrome?

A
  • Raidal Tunnel Syndrome, Pain Only, Lateral Forearm and resisted supination painful but not weak
  • PIN Syndrome Weakness of Finger Extensors and Wrist Extension with radial deviation
79
Q

What population is Osteochondritis Dissecans most prevalent in the Elbow?

A
  • Ages 12-17
  • Adolescent Male Baseball Pitchers and young female gymnasts
  • Insidious Onset
  • Vague Elbow Pain
  • Extension ROM loss
  • Clicking, popping, locking may occur
80
Q

What is Panners Disease?

A
  • 7-10 year olds
  • Affects Ossification centers, mostly in Capitulum
  • Self Limiting and will heal with rest and avoidance of valgus stress
  • May require symptomatic splinting and up to 3 years to heal fully
81
Q

What are the 5 P’s of Compartment Syndrome?

A
  • Pain
  • Pallor
  • Pain with passive stretch
  • Parasthesias
  • Pulselessness
82
Q

What is MOI and s/s of Dequervains Syndrome?

A
  • Repetitive wrist and thumb motion (opening jars, scissors)
  • Finkelsteins Test Positive
  • RICE, NSAIDS, Forearm Based Thumb Spica
83
Q

With a Flexor Tendon Injury in the hand, why would a surgeon choose debridement over repair?

A
  • < 50% lacerated: Debridement

- 60% or more: Repair

84
Q

What is Post Op treatment of Flexor Tendon Repair in Hand?

A
  • Dorsal Block Spint, Passive Flexion and Active Extension (0-3.5 weeks)
  • Wrist Cuff and rubber band tension so finger extension and wrist extension cannot be done simultaneously (3.5-8 weeks)
  • Resistive Exercise begun (8 weeks)
  • All programs limit active flexion for first 3-5 weeks
85
Q

How do you treat laceration of Extensor Tendon in Zone 1 and 2 of hand?

A
  • Immobilization in Slight Hyperextension

- wean from splint in 8 weeks

86
Q

How do you treat laceration of Extensor Tendon in Zone 3 and 4 of hand?

A
  • Surgical Repair
  • PIP Splint in Extension (DIP joint Free)
  • 6 weeks for complete, 3 weeks for partial
  • Move DIP and MP freely and PIP begins gentle ROM at 3 weeks
  • 6-8 weeks wean from splint and initiate resistance exercises
87
Q

What is Tenolysis as it relates to Extensor/ Flexor Tendon Repair in the Hand?

A
  • Mechanical removal of adhesions that have formed after extensor/ flexor tendon repair
  • AROM Immediately
  • 4-6 weeks, gentle grip
88
Q

What is a Smith Fracture (reverse Colles)?

A
  • Fracture of distal radius with Volar Displacement
89
Q

What is the typical timeframe for cast immobilization with Smith, Colles, Barton Fractures?

A
  • 6-8 weeks
90
Q

Describe Scaphoid Fracture

A
  • MOI of falling backward onto hand
  • If initial Rads negative, immobilize for two weeks and retake
  • Nondisplaced Distal Pole Fx, 8-10 weeks in Forearm Thumb Spica
  • Nondisplaced Waist Fx, Long Arm Thumb Spica 6 weeks, then 6 weeks is short arm
  • Displaced, surgery
91
Q

What is MOI for Hook of Hamate Fracture?

A
  • Force transmitted through base of palm while holding a tool gripped with force
  • Using the hand to pound an object
92
Q

What nerve can become irritated in the rare Pisiform Fracture?

A
  • Ulnar
93
Q

What visible defects might be noted with metacarpal fractures?

A
  • Loss of Knuckle Contour

- Palpable or visible Metacarpal deformity

94
Q

How would you treat proximal and middle phalangeal fractures?

A
  • Stable: Buddy tape

- Unstable: Short Forearm based Orthotic or surgical fixation

95
Q

How do TFCC Injuries Most often occur?

A
  • Axial Load to extended and pronated wrist or twisting the ulnarly loaded wrist
  • Golf Swing
96
Q

What is a Steners Lesion?

A
  • The Adductor Aponeurosis is interposed between the torn UCL of the thumb and the proximal phalanx
  • Occurs in Gamekeepers Thumb
97
Q

What disorders are associated with Pitting of the Nails?

A
  • Psoriasis

- Cyanosis

98
Q

You Observe Nodule protruding from wrist or dorsal hand. What is your Differential?

A
  • Ganglion Cyst
99
Q

You Observe Palmar Nodules with or without evidence of collagenous cords in palmar fascia upon finger extension. What is your Differential?

A
  • Dupuytren disease
100
Q

You Observe Nodule just proximal to A1 pulley. What is your Differential?

A
  • Trigger Finger
101
Q

You Observe Bouchards (PIP) or Heberdens (DIP) Nodes. What is your Differential?

A
  • Degenerative Joint Disease
102
Q

You Observe Ape or Claw Hand. What is your Differential?

A
  • Ape Hand: Median Nerve Lesion

- Claw Hand: Ulnar Nerve Lesion

103
Q

You Observe Thenar Atrophy. What is your Differential?

A
  • CTS or Median nerve lesion
104
Q

You Observe Hypothenar Atrophy. What is your Differential?

A
  • Ulnar Verve Lesion
105
Q

You Observe Wrist Drop. What is your Differential?

A
  • Radial Nerve Lesion
106
Q

You Observe Drooping of Distal Phalanx. What is your Differential?

A
  • Mallet Finger
107
Q

You Observe Loss of DIP Joint Flexion. What is your Differential?

A
  • Jersey Finger (FDP Tendon Injury)
108
Q

You Observe PIP Flexion and DIP Extension. What is your Differential?

A
  • Bouttonniere Deformity (Central Slip Injury)
109
Q

You Observe PIP Extension and DIP Flexion. What is your Differential?

A
  • Swan Neck Deformity (Volar Plate Injury)
110
Q

What would weakness in 3 point or tip pinch grip indicate vs Weakness in Key Pinch Grip?

A
  • 3 point and tip pinch: Median or AIN Lesion

- Key Grip: Ulnar Nerve Lesion

111
Q

What does this special test indicative of: Finkelsteins Test

A
  • De Quervain Syndrome
112
Q

What does this special test indicative of: First CMC Grind Test

A
  • OA of the First CMC Joint
113
Q

What does this special test indicative of: UCL stress test of the thumb

A
  • Gamekeepers Thumb
114
Q

What does this special test indicative of: Scaphoid Shift Test or Watsons Test

A
  • Scapholunate Dissociation
115
Q

What does this special test indicative of: Scapholunate Shear of Ballotement

A
  • Scapholunate Dissociation
116
Q

What does this special test indicative of: Piano Key sign of the wrist?

A
  • DRUJ Instability
117
Q

What does this special test indicative of: Ulna Fovea Sign

A
  • Disruption of DRUJ Ligaments
118
Q

What does this special test indicative of: Bunnell- Littler Test

A
  • Instrinsic Muscle Tightness or Contracture
119
Q

What does this special test indicative of: Allen Test

A
  • Vascular Disorder or Arterial Occlusion
120
Q

What does this special test indicative of: Froment Sign

A
  • Ulnar Nerve Lesion
121
Q

What does this special test indicative of: OK Sign (Teardrop Pinch)

A
  • AIN Lesion

OCS (13 decks)

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