Elbow, Wrist, and Hand Flashcards
What is a Bennett’s fracture?
Fracture of the BASE of the first metacarpal
What is a boxer’s fracture?
Fracture of the 5th metacarpal
What to do when unsure if a child has a scaphoid fracture. Why?
Immobilize the hand and get a work-up to prove it is not a fracture prior to having them return to normal function.
Higher risk of avascular necrosis in young people/children
CPR for scaphoid fractures (4)
- Male
- Sport activity related
- Anatomic snuff box pain on ulnar deviation w/in 72 hours of injury
- Scaphoid tubercle tenderness at 2 weeks
Cluster of tests for scaphoid fractures (3)
Sensitivity/specificity if all three are present
- Snuff box tenderness
- Scaphoid tubercle tenderness
- Longitudinal compression
100% Sn and 74% Sp
Dinner fork deformity seen in what fracture(s)?
Smith’s and Colles’ fractures
Difference between Colles’ fracture and Smith’s fracture
Smith’s: distal radius angles towards volar side
Colles’: angles to dorsal side
Colles’ fractures common in what demographic with what MOI?
Very common in elderly following a fall.
What is a nightstick fracture?
fracture of midportion of ulna
What is a Monteggia fracture?
fracture of the proximal ulnar with dislocation of the RADIAL HEAD from the wrist
What is a Galeazzi fracture?
fracture of the distal radius with dislocation of the ULNAR HEAD from the wrist
Most common elbow fracture? MOI?
Radial head fracture.
FOOSH - close packed position with longitudinal compression
Mnemonic for elbow ossification sequence in children/adolescents
CRITOE Capitulum (6 months - 2 years) Radius (3 years) Internal (medial) Epicondyle (5 years) Trochlea (7-10 years) Olecranon (6-12 years) External (lateral) Epicondyle (10-14 years)
Pt unable to extend elbow after injury. Course of action?
Referral for radiographs (50% chance of fracture)
Scapholunate dissociation key clinical findings (2)
- Positive Watson’s shift test
2. Tenderness to palpation (localized under ECRL)
Sign of scapholunate dissociation on imaging?
Notable gap between scaphoid and lunate
What is the TFCC?
Triangular Fibrocartilage Complex
MOI for TFCC tear? (2 separate common ways)
- FOOSH with pronated, hyperextended wrist
2. Distraction injury that pulls ulnar side of wrist
TFCC vascularity
Periphery vascular, inner portion avascular (similar to meniscus of the knee)
Endoneurium
encompasses the axon or nerve fiber; blood-nerve barrier
Perineurium
surrounds each fascicle; bidirectional diffusion barrier controlling flow of substances
Epineurium
outermost CT of the nerve; highly vascular and provides no diffusion barrier fxn
Sunderland grade
5 level grade of nerve damage
Recovery prognosis for damage to the epineurium; Sunderland grade
No recovery possible (grade 5)
Sunderland Grade 1 injury; what tissue? recovery prognosis?
Myelin
Full recovery
Causes of mononeuropathy(ies)
Traumatic
Non-Traumatic
Peripheral n. entrapment syndromes
Peripheral n. lesion
Causes of polyneuropathy
Metabolic Nutritional Hereditary Immunologically mediated Infectious dz Neoplastic
Mononeuropathy deficits
- Motor - weakness; dependent on motor units involved
2. Sensory - nerve field distal to injury site
Polyneuropathy deficits
- Bilateral and fairly symmetric
- Affects large fibers distally first
- Sensory loss before motor loss
Clinical features in peripheral nerve injuries
- Tremors
- Tendon hyporeflexia
- Autonomic dysfunction
Difference between skier’s and gamekeeper’s thumb? What structures?
Same thing (synonymous) Structures: ulnar collateral ligaments along the MCP joint.
CPR for Cervical Myelopathy (5)
- Gait deviation
- Positive Hoffmann’s sign
- Positive Babinski
- Positive reverse/inverted supinator sign
- > 45 y/o
Meds assoc. with CTS
Metformin
Thyroxine
Insulin
Suphonylureas
Proximal ow carpal with a tendon insertion
Pisiform (flexor carpi ulnaris)(near hook of the hamate)
resting pressure in carpal tunnel
2-10 mmHg
How to test normal light touch sensation when suspecting CTS. What gauges?
Semmes-Weinstein monofilament testing
2.83-3.22 for normal light touch (level A research)
CPR for CTS
Shaking hands
Wrist-ration index greater than .67
Boston Carpal Tunnel Questionnaire Symptom Severity scale (CTQ-SSS) >1.9 (0-13 scale)
Reduced median sensory field of digit 1
>45 y/o
**>3 of these = acceptable diagnostic accuracy
Special tests and diagrams for CTS dx
Phalen’s
Tinel
Carpal compression test
Katz hand diagram
Research level strength on use of neurodynamic tests for CTS dx
Level D (conflicting) evidence
Self-report questionnaires for CTS when CTS dx is confirmed
Boston Carpal Tunnel Questionnaire FS (CTQ-FS)
DASH
True or False: Clinicians should use lateral pinch strength as an outcome measure for surgically or nonsurgical managed CTS
False - level A (strong) evidence indicates lateral pinch strength should not be used as an outcome measure
True or False: Clinicians should not use grip strength as a short-term measure (<3 months) change in individuals following CTR surgery
True - level B (moderate) evidence confirms this
True or False: Grip strength and 3 point or tip pinch may be used for s/s assessment in pts with CTS to compare to normal values
True - supported by level C (weak) evidence
What modalities should not be used to treat CTS per the CPG
Thermal US
Low-level laser therapy or other types of nonlaser light therapy
Iontophoresis
True or False: Magnets are recommended for CTS management
False - Per level B (moderate) evidence, magnets should not be used nor recommended for CTS management
True or False: clinicians’ should not recommend use of neutral-positioned wrist orthosis at night for short-term symptom relief
False - per level B (moderate) evidence, neutral-positioned night splints should be recommended for those pts who wish to avoid surgical interventions
True or False: CTS risks increase with higher BMI
True - per level I research from a 7 year long study, having a BMI >30 kg/m2 doubled the risk of CTS development
Effects of psychological demand on CTS development per Level I research
High job strain (low decision latitude) and high psychological demand increased likely of CTS compared to those with low demand and high control at work
Strongest intrinsic factors for CTS development
Female gender
Increasing age
BMI
Lesser extent: OA, DM, cardio dz, prev. MSK issues, hypothyroidism, FMH of CTS, and others
AROM range: forearm supination and pronation
80-90 deg each
AROM range: wrist flexion and extension
flexion: 90
extension: 70
AROM range: wrist RD and UD
RD: 15-20
UD: 20-30
AROM range: PIP flexion and extension
flexion: 100-110
extension: 0
AROM range: DIP flexion
flexion: 70-80
AROM range: thumb MCP joint flexion and extension
flexion: 50-55
extension: 0
AROM range: IP joint flexion and extension
flexion: 80-85
extension: 0
