Elbow Wrist and Hand Injuries Flashcards
Monteggia Fracture
- dislocation of the proximal radioulnar joint in association with a ulna fracture
- ulna fracture is usually clinically & radiographically apparent
- radial head dislocation can be subtle & overlooked
- make sure you XRay until forearm
Boxer fracture
Fracture to the 4th or 5th metacarpal
Bennett fracture
base of 1st metacarpal, extending into the CMC joint, intraarticular fracture, most common fracture of the thumb
Rolando’s fracture
3 part or comminuted fracture through the base of the 1st metacarpal bone
Skier’s or Gamekeeper’s thumb
UCL injury of thumb
- Testing: stress XRays
- Treatment: short arm cast with thumb spica
Colles fracture
- Complete fracture of the radius bone
- results in upward displacement of the radius
Boutonneire’s Deformity
- rupture of central slip over PIP joint
- Elson test
- Treatment:
- splint PIP joint in full extension for 6 weeks
- encourage active DIP extension & flexion in splint
- complete part time splinting for an additional 4-6 weeks
Mallet Finger
Disruption of terminal extensor tendon
Treatment:
-Extension splinting of DIP joint for 6-8 weeks
- Maintain free motion of the PIP joint
Stener Lesion
Occurs when a torn distal edge of UCL displaces superficial and proximal to the adductor aponeurosis
Kienbock’s Disease
- AVN of lunate
- most common in males 20-40 years old
- Imaging: MRI
What tendon’s are involved in DeQuervain’s Tenosynovitis?
- Extensor Pollicis brevis
- Adductor Pollicis Longus
Scapholunate Dissociation
- most common & most serious ligamentous injury to wrist
- hyperextension wrist injury
- XRays:
- Clenched fist view: gap greater than 3 mm is considered to be pathologic
Sx: Radial sided wrist pain, giving way, clicking
Jersey Finger
- Flexor Digitorum Profundus Tendon Injury
- Cause: Forced extension of DIP
- Signs: No active flexion with isolation
Scaphoid Fracture
- most commonly fractured carpal bone
- Imaging: CT Scan
What can a delay in dx of a scaphoid fracture lead to?
- non union
- delayed union
- decreased grip strength
- OA of the radiocarpal joint
What supplies blood to the scaphoid?
- Radial artery (70-80%)
- proximal portion has no direct blood supply
How do you assess the radial nerve?
- Wrist extension
- Sensation in the doral aspect of the first webspace
How do you assess the median nerve?
- ability to make an OK sign
- sensation over the palmer tip of the index finger
How do you assess the ulnar nerve?
- strength testing of intrinsic muscles of the hand
- sensation of the palmar tip of the little finger
What are the main tendons along the medial aspect of the elbow?
- pronator teres
- flexor carpi radialis
What muscle is most commonly involved in lateral epicondylitis?
What nerve is commonly involved?
- extensor carpi radialis brevis
- radial nerve:
- divides into superficial radial nerve & PIN
What is the most common focal peripheral neuropathy?
CTS
- median nerve
What is the typical healing rate of metacarpal fractures?
- 3-6 weeks
Swan neck deformity
DIP flexion
PIP hyper-extension
What is intersection syndrome?
Inflammation at the site where the first dorsal compartment (APL & EPB) crosses with the wrist extensors (ECRB, ECRL)
- caused by repetitive wrist extension
Bunnell-Littler Test
Measure PIP ROM with MCP joint flexed and extended. If the PIP has more ROM with the MCP flexed, the test is positive and indicative of intrinsic muscle tightness
Murphey’s Sign
Make a fist. If the head of the 3rd MC is level with second and fourth MC, the sign is positive for presence of lunate dislocation
In general, what is the best (or ‘safe’) position for splinting of the hand after injury for prevention of ligamentous and muscular shortening?
Wrist extended
MCP partially flexed
IP joint extended
thumb palmarly abducted.
What nerve is the pinch grip test assessing?
AIN
- branch of median nerve
What portion of the UCL is the primary restraint to stresses during a baseball pitching?
Anterior bundle
Second most common cause of overuse wrist pain?
ECU tendintis
Best test to identify a UCL sprain?
Moving valgus stress test (SN = 100%, SP = 75%)
s/p distal humerus fracture, when is a dynamic splint used & light strengthening started?
Soft callus @ 3-4 weeks
