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OCS > Elbow, wrist, and hand > Flashcards

Elbow, wrist, and hand Flashcards

1
Q

carpal bones

A

Proximal: lunate, scaphoid, triquetrum
Distal: trapezium, hamate, capitate, trapezoid, pisiform

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2
Q

Ulnar collateral ligament

A
  • ulnar N: involvement is most commonly associated with UCL injury
  • provides about 55% of stability in elbow extension and up to 75% in 90 degrees of flexion
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3
Q

TFCC triangularfibrocartilagenous complex

A
  • disc provides smooth and conforming gliding surface
  • disc allows flecion, extension, rotation, and translation motions
  • disc cushions force
  • connects otherwise incongruous surfaces
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4
Q

Flexor tendon zones: zone 5: wrist region things to be aware of

A
  • muscle contractures occur quickly

- neurovascular injuries

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5
Q

Flexor tendon zones: zone 4: CT region things to be aware of

A
  • other tendon injuries
  • neurovascular injuries
  • tendon adhesions
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6
Q

Flexor tendon zones: zone 3: palm region things to be aware of

A
  • good prognosis

- intrinsic contractures

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7
Q

Flexor tendon zones: zone 2: MC heads, middle phalanx

A
  • “no man’s land”, poor prognosis
  • sheaths/pulleys may have adhesions
  • poor blood supply
  • both FDP and FDS severed
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8
Q

Flexor tendon zones: zone 1: distal digits things to be aware of

A
  • good prognosis

- avulsion injuries

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9
Q

Lateral epicondylgia

A
  • pain over lateral epicondyle with gripping activities and wrist extension, most common in ages 40-55 y/o.
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10
Q

Diagnosis for lateral epicondylgia

A
  • localized pain over lateral epicondyle.
  • Pain on palpation immediately distal to lateral epicondyle (1-5 cm).
  • Pain reproduction with resisted wrist extension or resisted extension of middle digit.
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11
Q

Interventions for epicondylgia

A
  • regional manual therapy
  • exercise
  • strength training
  • nerve glides
  • cervical and thoracic mobs/manips
  • patient education
  • ergonomics
  • neuromuscular re-ed
  • pain free grip strength is preferred outcome measure vs overall grip strength.
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12
Q

Ulnar collateral ligament strain of elbow

A
  • clinical findings: pain with palpation of UCL, (+) valgus stress test, (+) moving valgus stress test
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13
Q

Posterolateral rotary instability

A
  • a lack of stability of the radial collateral complex including the lateral or radial collateral ligament
  • MOI: FOOSH injury, elbow dislocation
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14
Q

Clinical findings for posterolateral instability

A
  • pain with palpation of LCL
  • (+) posterolateral rotary instability (PRLI) test
  • (+) internal rotation push up test
  • (+) lift off test from chair
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15
Q

Elbow dislocation stage 1

A
  • disruption of LCL, elbow begins to sublux in posterolateral direction
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16
Q

Elbow dislocation stage 2

A
  • disruption of anterior capsule; coronoid process “perched” on trochlea
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17
Q

Elbow dislocation stage 3

A
  • disruption of posterior and finally, UCL; elbow dislocates fully
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18
Q

Terrible triad with elbow dislocation

A
  • Elbow dislocation, fractures of the coronoid process and radial heads
  • complications include persistent instability, mal-union, osseous proximal radio-ulnar synostosis, non-union
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19
Q

Triangular fibrocartilage complex (TFCC) injury

A
  • disruption of the ulnar sided capsulo-ligamentous structure of the wrist by way of trauma or degeneration
  • MOI: FOOSH with pronated, hyperextended wrist or distraction injury that pulls ulnar side of wrist
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20
Q

Triangular fibrocartilage complex (TFCC)

A
  • allows the corpus to rotate with the ulna around the radius during forearm rotation and is the primary stabilizer to the ulnar wrist
  • vascular supply: inner portion avascular periphery vascular
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21
Q

TFCC injury presentation

A
  • ulnar sided wrist pain
  • pain with loaded, end-range wrist extension, wrist ulnar deviation, forearm supination/pronation
  • arthroscopy is the gold standard for diagnosis
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22
Q

Non-operative treatment for TFCC is lacking…

A
  • strap/wrist/widget, splint
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23
Q

Scapulolunate dissociation

A
  • instability of the scapulolunate joint as a result of ligament elongation or ligament failure
  • MOI: FOOSH injury (dorsiflexed wrist)
  • related to keinbocks disease (avascular necrosis of lunate)
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24
Q

Clinical findings for scapulolunate dissociation

A
  • TTP localized under ECRL tendon

- watson shift test

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25
Q

Elbow extension test for acute fracture

A
  • patients who cannot fully extend their elbow after injury shoulder be referred to radiography as they have about a 50% chance of fracture
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26
Q

Elbow ossification sequence (CRITOE)

A
  • Capitulum (6mo-2yrs)
  • Radial head (4-7 yrs)
  • Internal (medial) epicondyle
  • Trochlea (7-10 yrs)
  • Olecranon (6-12 yrs)
  • External (lateral) epicondyle (10-14 yrs)
  • Ossification usually complete by mid-teens
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27
Q

Night stick fracture

A
  • fracture of the mid portion of the ulna usually occurs with falls with force through midshaft of ulna
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28
Q

Monteggia fracture

A
  • fracture of the proximal ulna with dislocation of the ulnar head from the wrist
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29
Q

Greenstick fracture

A
  • incomplete fracture due to flexibility of young bone
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30
Q

Galeazzi fracture

A
  • fracture of the distal radius with dislocation of the ulnar head from the wrist
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31
Q

Colles fracture

A
  • fracture of the distal radius with dorsal displacement
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32
Q

Scaphoid fracture

A
  • most common carpal fracture, risk of avascular necrosis.
33
Q

Clinical signs of scaphoid fracture

A
  • snuff box tenderness
  • scaphoid tubercle tenderness
  • longitudinal compression
34
Q

Clinical practice rules for scaphoid fracture

A
  • male
  • injury during sporting activity
  • anatomic snuff box pain on ulnar deviation within 72 hours of injury
  • scaphoid tubercle tenderness at 2 weeks
35
Q

Boxer’s fracture

A
  • fracture of the 5th metacarpal
36
Q

Bennett’s fracture

A
  • fracture of the base of the 1st metacarpal
37
Q

DeQuervain’s tenosynovitis

A
  • stenosis of EPB and ABL within the first dorsal compartment
  • more common in women than men
  • MOI: static positions, repetitive movements, pregnancy, and more
  • evidence of symptom relief with manual techniques
38
Q

Diagnosis of DeQuervain’s

A
  • radial wrist pain
  • radial deviation of wrist with gripping motion of thumb aggravates symptoms
  • symptom-based diagnosis
  • (+) finkelstein test
39
Q

Thumb ulnar collateral ligament tear

A
  • skier’s thumb
  • FOOSH injury with thumb ABDucted resulting in valgus force overload to UCL
  • UCL injuries to the thumb are reported to constitute 86% of all injuries to the base of the thumb
  • grade I and II injuries are treated non-operatively, grade III injuries are treated operatively
40
Q

Goals of tendon healing

A
  • promote healing - control inflammation
  • promote tendon gliding - decrease adhesions
  • promote strong union of sutured tendons
  • return hand to normal pain free function
41
Q

Kleinert protocol

A
  • wrist in 10-30 degrees of flexion
  • MCP joints in 70 degrees of flexion
  • Dorsal hood for full IP extension
42
Q

Duran protocol

A
  • wrist in 10-30 degrees of flexion
  • MCP joints in 30-70 degrees of flexion
  • IP joints are neutral
43
Q

Specific outcomes we should see post tendon repair

A
  • AROM
  • Total active motion (TAM)
  • Grip strength
  • Pinch strength
  • Profundus tendon function
  • Neurologic function
44
Q

Total active motion

A
  • 260 degrees is expected

- flexion of MCP, PIP, and DIP, minus any extension deficits from that

45
Q

Prognosis given TAM motion percentage

A
  • excellent 100%
  • good >75%
  • fair >50%
  • poor <50%
46
Q

Extensor tendon zones: zones I and II injuries

A
  • mallet finger

- disruption of terminal tendon

47
Q

Extensor tendon zones: zones III and IV injuries

A
  • disruption of central slip
48
Q

Extensor tendon zones: zones V

A
  • may involve the sagittal band
49
Q

Extensor tendon zones: zones VI

A
  • may involve junctura tendons
50
Q

Extensor tendon zones: zones VII and VIII injuries

A
  • may involve extensor retinaculum
51
Q

Early stage treatment for mallet finger

A
  • splint at all times
  • no active motion of the DIP joints
  • AROM of uninvolved joints
52
Q

Intermediate stage treatment for mallet finger

A
  • wean to night splinting

- begin gentle active DIP flexion

53
Q

Late stage treatment for mallet finger

A
  • discontinue splint, unless extensor lag

- gentle progressive strengthening at 8 weeks

54
Q

Early stage treatment for disruption of central slip

A
  • splint at all times

- active flexion/extension of DIP joint

55
Q

Intermediate stage treatment for disruption of central slip

A
  • wean to night splinting

- begin active/passive PIP motion

56
Q

Late stage treatment for disruption of central slip

A
  • discontinue splint, unless extensor lag

- gentle progressive strengthening

57
Q

Stenosing tenosynovitis (trigger finger) stage 1

A

Normal

58
Q

Stenosing tenosynovitis (trigger finger) stage 2

A

a painful palpable nodule

59
Q

Stenosing tenosynovitis (trigger finger) stage 3

A

triggering

60
Q

Stenosing tenosynovitis (trigger finger) stage 4

A

the PIP joint locks joint into flexion and is unlocked with active PIP joint extension

61
Q

Stenosing tenosynovitis (trigger finger) stage 5

A

the PIP joint locks and is unlocked with passive PIP extension

62
Q

Stenosing tenosynovitis (trigger finger) stage 6

A

the PIP joint remains locked in flexion

63
Q

Endoneurium

A
  • encompasses the axon or nerve fiber, protects against transmission of substances across membrane
64
Q

Perinerium

A
  • surrounds each fasicle
65
Q

Epinerium

A
  • outermost connective tissue, highly vascular, provides protection
66
Q

Peripheral nerve entrapment/compression

A
  • chronic compression of a peripheral nerve characterized by pain and/or loss of motor strength and/or sensation
  • nerve injury occurs as it travels through a tunnel
  • may result in ischemic changes, edema, injury to the myelin
67
Q

Peripheral nerve lesion

A
  • can occur from various forms or trauma, eg fracture, dislocation, wound
  • may result in demyelination, axonal degeneration, or both
68
Q

Polyneuropathy

A
  • metabolic, nutritional, hereditary, immunologically mediated, infectious diseases, or neoplastic
69
Q

Mononeuropathies

A
  • motor and sensory deficits limited in distribution
70
Q

Polyneuropathies

A
  • bilateral and fairly symmetrical, affects large fibers distally first and sensory loss precedes motor loss
71
Q

Autonomic dysfunction

A
  • can be seen with either poly- or mono- neuropathies
  • sympathetic>parasympathetic
  • anhidrosis
  • orthostatic hypotension
  • trophic changes
  • loss of erector pilae function
72
Q

Mononeuropathies

A
  • weakness: dependent on motor units involved

- sensory: nerve field distal to injury site

73
Q

Polyneuropathies

A
  • weakness: symmetrical and distal

- sensory: feet, then hands, bilateral

74
Q

Median N entrapment

A
  • pronator teres syndrome
  • anterior interosseous syndrome
  • carpal tunnel syndrome
  • ligaments of struthers (can have pronator teres weakness)
75
Q

Pronator teres syndrome

A
  • median N is compressed, or trapped between 2 heads of the pronator
76
Q

Pronator teres syndrome tests include

A
  • pronator compression test
  • compression at pronator test
  • compression at lacertus fibrosis
  • compression at FDS
  • (+) hand of benediction
77
Q

Clinical features of pronator teres syndrome

A
  • pain and TTP over pronator teres, increasing with activity
  • sensory changes thenar eminence
  • motor involvement in FPL, FDP, PQ, APB, OP, 1/2 of FPB
78
Q

Carpal tunnel syndrome

A
  • compression neuropathy of the median N at the level of the wrist. Can lead to variable symptoms including numbness, tingling, hand and arm pain, and muscle dysfunction

OCS (11 decks)

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