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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
Elbow extension test for acute fracture
- patients who cannot fully extend their elbow after injury shoulder be referred to radiography as they have about a 50% chance of fracture
26
Elbow ossification sequence (CRITOE)
- 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
27
Night stick fracture
- fracture of the mid portion of the ulna usually occurs with falls with force through midshaft of ulna
28
Monteggia fracture
- fracture of the proximal ulna with dislocation of the ulnar head from the wrist
29
Greenstick fracture
- incomplete fracture due to flexibility of young bone
30
Galeazzi fracture
- fracture of the distal radius with dislocation of the ulnar head from the wrist
31
Colles fracture
- fracture of the distal radius with dorsal displacement
32
Scaphoid fracture
- most common carpal fracture, risk of avascular necrosis.
33
Clinical signs of scaphoid fracture
- snuff box tenderness - scaphoid tubercle tenderness - longitudinal compression
34
Clinical practice rules for scaphoid fracture
- male - injury during sporting activity - anatomic snuff box pain on ulnar deviation within 72 hours of injury - scaphoid tubercle tenderness at 2 weeks
35
Boxer's fracture
- fracture of the 5th metacarpal
36
Bennett's fracture
- fracture of the base of the 1st metacarpal
37
DeQuervain's tenosynovitis
- 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
Diagnosis of DeQuervain's
- radial wrist pain - radial deviation of wrist with gripping motion of thumb aggravates symptoms - symptom-based diagnosis - (+) finkelstein test
39
Thumb ulnar collateral ligament tear
- 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
Goals of tendon healing
- promote healing - control inflammation - promote tendon gliding - decrease adhesions - promote strong union of sutured tendons - return hand to normal pain free function
41
Kleinert protocol
- wrist in 10-30 degrees of flexion - MCP joints in 70 degrees of flexion - Dorsal hood for full IP extension
42
Duran protocol
- wrist in 10-30 degrees of flexion - MCP joints in 30-70 degrees of flexion - IP joints are neutral
43
Specific outcomes we should see post tendon repair
- AROM - Total active motion (TAM) - Grip strength - Pinch strength - Profundus tendon function - Neurologic function
44
Total active motion
- 260 degrees is expected | - flexion of MCP, PIP, and DIP, minus any extension deficits from that
45
Prognosis given TAM motion percentage
- excellent 100% - good >75% - fair >50% - poor <50%
46
Extensor tendon zones: zones I and II injuries
- mallet finger | - disruption of terminal tendon
47
Extensor tendon zones: zones III and IV injuries
- disruption of central slip
48
Extensor tendon zones: zones V
- may involve the sagittal band
49
Extensor tendon zones: zones VI
- may involve junctura tendons
50
Extensor tendon zones: zones VII and VIII injuries
- may involve extensor retinaculum
51
Early stage treatment for mallet finger
- splint at all times - no active motion of the DIP joints - AROM of uninvolved joints
52
Intermediate stage treatment for mallet finger
- wean to night splinting | - begin gentle active DIP flexion
53
Late stage treatment for mallet finger
- discontinue splint, unless extensor lag | - gentle progressive strengthening at 8 weeks
54
Early stage treatment for disruption of central slip
- splint at all times | - active flexion/extension of DIP joint
55
Intermediate stage treatment for disruption of central slip
- wean to night splinting | - begin active/passive PIP motion
56
Late stage treatment for disruption of central slip
- discontinue splint, unless extensor lag | - gentle progressive strengthening
57
Stenosing tenosynovitis (trigger finger) stage 1
Normal
58
Stenosing tenosynovitis (trigger finger) stage 2
a painful palpable nodule
59
Stenosing tenosynovitis (trigger finger) stage 3
triggering
60
Stenosing tenosynovitis (trigger finger) stage 4
the PIP joint locks joint into flexion and is unlocked with active PIP joint extension
61
Stenosing tenosynovitis (trigger finger) stage 5
the PIP joint locks and is unlocked with passive PIP extension
62
Stenosing tenosynovitis (trigger finger) stage 6
the PIP joint remains locked in flexion
63
Endoneurium
- encompasses the axon or nerve fiber, protects against transmission of substances across membrane
64
Perinerium
- surrounds each fasicle
65
Epinerium
- outermost connective tissue, highly vascular, provides protection
66
Peripheral nerve entrapment/compression
- 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
Peripheral nerve lesion
- can occur from various forms or trauma, eg fracture, dislocation, wound - may result in demyelination, axonal degeneration, or both
68
Polyneuropathy
- metabolic, nutritional, hereditary, immunologically mediated, infectious diseases, or neoplastic
69
Mononeuropathies
- motor and sensory deficits limited in distribution
70
Polyneuropathies
- bilateral and fairly symmetrical, affects large fibers distally first and sensory loss precedes motor loss
71
Autonomic dysfunction
- can be seen with either poly- or mono- neuropathies - sympathetic>parasympathetic - anhidrosis - orthostatic hypotension - trophic changes - loss of erector pilae function
72
Mononeuropathies
- weakness: dependent on motor units involved | - sensory: nerve field distal to injury site
73
Polyneuropathies
- weakness: symmetrical and distal | - sensory: feet, then hands, bilateral
74
Median N entrapment
- pronator teres syndrome - anterior interosseous syndrome - carpal tunnel syndrome - ligaments of struthers (can have pronator teres weakness)
75
Pronator teres syndrome
- median N is compressed, or trapped between 2 heads of the pronator
76
Pronator teres syndrome tests include
- pronator compression test - compression at pronator test - compression at lacertus fibrosis - compression at FDS - (+) hand of benediction
77
Clinical features of pronator teres syndrome
- 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
Carpal tunnel syndrome
- 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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