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Ortho > Forearm and Hand > Flashcards

Forearm and Hand Flashcards

1
Q

what humerus injury in more often seen in the elderly due to falls or trauma

A

proximal humerus

most are 1 part fractures - no displacement or angulation

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2
Q

how would you treat a proximal humerus fracture

A

sling or immobilizer

surgical if severe comminution or displacement

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3
Q

who is a distal fracture of humerus most common in

A

3-11 y/o (supracondylar)

and 50 y/o (commuinuted)

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4
Q

when would you most likely see a posterior fat pad and when an anterior fat pad

A

Posterior = children with distal humerus fracture (supracondylar)

Anterior = 50 y/o (commuinuted) – sail sign

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5
Q

tx for distal humerus fracture

A

splint; surgery is displacement

NSAIDs, pain management

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6
Q

what may be damaged with a proximal humerus fracture

A

brachial plexus

axillary nerve

axillary artery

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7
Q

where does a humerus shaft fracture usually occur and what can be injured

A

mid 1/3

radial, ulnar, and median nerve injury

Based on age and displacement determines conservative vs surgical tx.

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8
Q

with someone with olecranon bursitis what test would you do?

A

gram stain, c&S, crystal analysis

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9
Q

treatment for olecranon bursitis

A

RICE

NSAIDs

Steroid injection

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10
Q

in medial epicondylitis (golfers elbow) what is inflamed and what movements will be painful

A

flexor-pronator

pain worse with twisting or palmar flexion

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11
Q

in lateral epicondylitis (tennis elbow) what is inflamed and what movements are painful

A

inflammation of extensor-supinator

Pain worse with wrist dorsiflexion or twisting

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12
Q

Tx for lateral/medial epicondylitis

A

splint wrist/compressive banding of elbow

NSAIDs/PT/steroid injections

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13
Q

what is a nursemaids elbow?

MOI?

A

Radial head subluxation

MOI: pulling motion on hand

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14
Q

what is the presentation of a nurse maids elbow

A

2-5 y/o

elbow slightly flexed

will not move arm

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15
Q

treatment for nursemaids elbow

A

reduction

  • hold elbow with one hand, supinate and flex
  • or pronate and extend
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16
Q

what can cause carpal tunnel syndrome and what makes it worsen

A
  1. over us
  2. chronic disease - DM, hypothyroid, SLE, RA, PG

worsened by sustained wrist flexion

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17
Q

PE for carpel tunnel:

pt shakes hand vigorously to relieve pain

A

Flick sign

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18
Q

PE for carpel tunnel:

sustained wrist flexion

A

phalen

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19
Q

PE for carpel tunnel:

tapping on median nerve produces symptoms

A

Tinels

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20
Q

symptoms of carpal tunnel

A

burning
tingling
weakness
pain

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21
Q

Treatment for carpal tunnel

A
  • avoid repetitious activities of hand/wrist
  • wrist splint
  • NSAIDs
  • Steroid injection
  • surgical release if no response to conservative management
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22
Q

localized pain overlying the radial styloid - may radiate to hand/thumb

worsened pain with extension/abduction (of thumb)

A

DeQuervains Tenosynovitis

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23
Q

PE: Finkelstein test for Dequervains Tenosynovitis

A

pt places thumb into palm of hand, places fingers over thumb. Ulnar deviation of hand will cause a positive test

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24
Q

Tx of DeQuervains Tenosynovitis

A

Rest, ice, NSAIDs

PT

steroid injections

surgery if conservative management fails

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25
Q

Swelling of the hand/wrist that will vary in size

made up of synovial fluid collection

A

ganglion cyst

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26
Q

tx for ganglion cyst

A

aspiratate (recurrence likely

surgical excision

27
Q

name for physeal fractures in KIDS

A

salter harris

28
Q

type 1 classification of salter harris

A

straight across physeal plate

29
Q

type 2 salter-harris

A

across and above physeal plate

30
Q

type 3 salter-harris

A

across and below physeal plate

31
Q

type 4 salter-harris

A

through physeal plate (above and below)

32
Q

type V salter-harris

A

erasure/crush of growth plate

33
Q

how would you splint a elbow/forearm fracture

A

long arm posterior

double sugar tong

34
Q

how would you splint a forearm/wrist fracture

A

volar/cockup

sugar tong

35
Q

how would you splint a hand/finger fracture

A

ulnar gutter

radial gutter

thumb spica

finger splints

36
Q

extension fracture of distal radius (may include ulna)

dinner fork deformity

A

Colles

37
Q

what nerves need to be checks with a colles fracture

A

median and ulnar nerve

38
Q

tx for colles fracture

A

reduction - finger traps

splint when done

39
Q

flexion fracture of distal radius (maybe ulna)

volar angulation

A

Smiths fracture (reverse of colles)

40
Q

Tx of Smiths fracture

A

all ortho

reduction - sedate and hemotoma block

splint - sugar tong; splint joint above and below

41
Q

intraacticular fracture of the distal radius with subluxation and disposed fragments of radius

A

Bartons

42
Q

radial styloid fx

A

Hutchinsons

43
Q

proximal ulna fx with dislocation of radial head

A

Monteggia

44
Q

fx at radioulnar joint space

A

Galezzi

45
Q

if someone has a scaphoid fx where would there be tenderness

what are they at risk for

A

snuff box

avascular necrosis

46
Q

Tx of scaphoid fracture

A

call ortho

prolonged immobilization; spica splint

47
Q

what is gamekeeps thumb/skiers thumb

what would you expect at PE

A

disruption of the ulnar collateral ligament

laxity of the MCP joint, weak thumb opposition

48
Q

why would you do an x ray of gamekeepers thumb/skiers thumb?

A

rule out avulsion fx

49
Q

tx for gamekeepers thumb/skiers thumb?

A

thumb spica splint; maybe surgery

50
Q

if someone punching something with a closed fist (boxers fx) what would you expect to be fx

how would it present

A

5th metacarpal

loss of 5th knuckle when making a fist

51
Q

what is disrupted with a PIP joint dislocation

A

2/3 of structures disrupted

- collateral ligaments x2; volar plate

52
Q

what is the most common PIP joint dislocation

A

middle phalanx displaced dorsal to proximal

53
Q

tx of PIP joint dislocation

A
  • digital block: 1/2 marcaine and 1/2 lidocaine in syringe
  • traction (pull)
  • may need to hyperextend to reduce (if can’t reduce may have volar plate entrapment)
  • splint - short posterior/or finger splint
54
Q

what would you expect to cause a PIP sprain?

what may also tear?

what test would you order and why?

A
  1. jammed finger
  2. collateral ligament
  3. X-ray to r/o avulsion fx; assess ligament stability while in full extension
55
Q

tx of PIP sprain

A

dynamic splint (buddy tape)

56
Q

injury to extensor tendon-cannot extend finger

A

Mallet finger

  • partial v complete tear
  • sometimes avulsion fracture
57
Q

tx of mallet finger

A

Xrays

immobilize with DIP at 0 extension

6-8 weeks

ortho f/u, consider surgery

PT

58
Q

difficulty extending the digit (usually 3rd and 4th)

  • thickening of flexor mechanism
A

trigger finger

59
Q

what causes trigger finger and who is it more commonly seen in

A

repetitive gripping actions

more common in women and diabetics

*X rays are not helpful

60
Q

what causes a subungual hematoma/tuft fx

A

trauma to finger/nail bed (e.g. shutting in car door)

Xrays to help determine between tuft fx or hematoma

61
Q

Tx for subungual hematoma and tuft fx

A

Digital block - pain control

  • if over 1/3 discoloration remove nail (prob nailbed fx or laceration)
  • anchor nail back on as splint to the wound
  • need to keep nail matrix open
  • splint, abx

Hematoma only: remove pressure of blod via cautery or needle

62
Q

finger tip avulsion tx

A

bone showing - call ortho

if not: digital block for pain control, stop bleeding

63
Q

tx for cat bite

A

OR for clean out

Augmentin (P. multocida)
Tetnus
check rabies

64
Q

tx for dog bite

A

Tetanus
Augmentin

DO NOT CLOSE SMALL WOUNDS - IF CLOSURE NEEDED CLOSE LOOSELY (don’t want to suture infection into hand)

Ortho (9 decks)

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