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Lecture Notes- Orthopaedics and Fractures > Forearm, wrist and hand > Flashcards

Forearm, wrist and hand Flashcards

1
Q

What is the function of the proximal radioulnar joint

A

Pronation and supination

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2
Q

What does the stability of the distal radioulnar joint depend on

A

the integrity of the triangular fibro-cratilage attached to the ulnar styloid process

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3
Q

What is the wrist joint

A

articulation between the distal surface of the radius, the triangular fibrocartilage and the proximal row of carpal bones (scaphoid, lunate and triquetrum)

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4
Q

What action does the wrist allow

A

palmar and dorsiflexion

ulnar and radial deviation

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5
Q

What action do the MCPHs of the fingers allow

A

abduction and adduction in addition to flexion and extension

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6
Q

What type of joints are the interphalangeal joints

A

simple hinge joints

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7
Q

What are some deformities that could be seen on inspection

A

dinner fork - Colles fracture
mallet or boutonniere deformity
Ulnar deviation of the fingers - RA

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8
Q

What are the landmark of the wrist

A

styloid processes of the radius and ulna

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9
Q

How can you examine dorsiflexion of the wrist

A

Prayer sign

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10
Q

How is palmar flexion test

A

placing the back of the hands together and dropping the elbows

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11
Q

What is internal rotation of the metacarpals described as

A

opposition

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12
Q

What muscles produce pronation of the wrist

A

pronator quadratus and pronator teres (median nerve)

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13
Q

What muscles produce supination of the wrist

A

Biceps

supinator muscles

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14
Q

How can the wrist flexors be tested

A

ask the patient to flex the wrist and palpate the radial and ulnar flexor tendons

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15
Q

How do all of the joints of the fingers become flexed

A

Flexor digitorum profundus

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16
Q

What muscle flexes the proximal interphalangeal joints

A

flexor digitorum superficialis

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17
Q

How is flexor digitorum superficalis tested

A

by holding the other fingers extended and asking the patient to flex the appropriate finger

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18
Q

How is flexor digitorum proudness tested

A

asking the patient to flex the terminal interphalangeal joint whilst the proximal interphalangeal joint is held extended

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19
Q

How are the MCJs normally flexed

A

by the lumbrical and interosseous muscles

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20
Q

What happens if the lumbrical and interosseous muscles are paralysed

A

the fingers take up a claw position

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21
Q

How are the interpose best tested

A

ask the patient to spread the fingers or to hold them tightly together

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22
Q

What muscle extends the MCPJs

A

extensor digitorum longus

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23
Q

What flexes the thumb

A

flexor pollicis longus

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24
Q

What abducts the thumb

A

abductors pollicis brevis and longus

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25
Q

How is the thumb adducted

A

Thenar group and the adductor pollicis

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26
Q

What produces wrist extension

A

extensor carpi ulnaris and extensor carpi radialis longus and brevis

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27
Q

How can sensation of the hand be tested

A

using a pin

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28
Q

What is Madelung’s deformity

A

a complex deformity of the distal end of the radius due to a growth defect of the radius. The lower end of the ulnar becomes prominent

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29
Q

What does Multiple enchondromatosis cause

A

multiple swellings in the digits often with considerable interference with function

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30
Q

What does achondroplasia produce

A

a hand with short fingers and often a single transverse palmar crease

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31
Q

What causes trigger thumb

A

constriction of the fleecer tendon sheath opposite the metacarpal head resulting in a flexed interphalangeal joint

32
Q

What is the treatment for trigger thumb

A

longitudinal division of the tendon sheath

33
Q

What is a Colles fracture

A

a fracture within 1 inch of the distal end of the radius

34
Q

Describe the appearance of a typical Colles fracture on Xray

A

dorsal tilt
dorsal displacement
impaction of the distal fragment producing shortening of the radius
Styloid process of the ulna is often avulsed
Dinner form dermority of the forearm and wrist

35
Q

How is a Colles fracture usually produced

A

fall on the outstretch hand

36
Q

What are some complications of Colles fractures

A

Median nerve compression

Malunion

37
Q

What is the treatment of a Colles fracture

A

minimally displaced - reduction is not necessary

38
Q

What is the usual method of reducing a Colles fracture

A

manipulation under anaethetic

39
Q

What is a Smith’s fracture

A

a fracture of the lower end of the radius with palmar angulation

40
Q

How is a Smith’s fracture treated

A

open reception and internal fixation with a plate

41
Q

Where is tenderness present with a scaphoid fracture

A

anatomical snuff box

42
Q

What are the Xray views required for a potential scaphoid break

A

AP
Lateral
Oblique

43
Q

What is the main complication of a scaphoid fracture

A

the proximal half of the bone may be deprived of blood and necrosis of the proximal fragment may occur

44
Q

How is non-union of a scaphoid fracture treated

A

bone graft and a screw across the fracture line

45
Q

What is a complication of a dislocation of the carpus

A

median nerve compression

46
Q

What is a Bennett’s fracture

A

Fracture dislocation of the carp-metacarpal joint of the thumb

47
Q

What is a Boxer’s fracture

A

a fracture of the neck of the fifth metacarpal following a blow with the fist

48
Q

What is the treatment for a fractured metacarpal

A

Usually just simple strapping for 3 weeks

49
Q

What are fracture of the phalanges often associated with

A

tendon and nerve damage

50
Q

What is the treatment for fractures of the phalanges

A

strapping the finger to the adjacent one

51
Q

What are fractures of the terminal phalanges caused by

A

crush injuries

52
Q

What is Mallet finger

A

an avulsion injury of the extensor tendon from the base of the terminal phalanx

53
Q

What is the treatment for Mallet finger

A

malleable splint to hyper-extend the terminal interphalangeal joint and allow flexion of the proximal interphalangeal joint

54
Q

What is also known as gamekeeper’s or skier’s thumb

A

rupture of the ulnar collateral ligament of the thumb

55
Q

What causes rupture of the ulnar collateral ligament of the thumb

A

Forced abduction

56
Q

What does a rupture of the ulnar collateral ligament interfere with

A

the pinch grip of the thumb against the index finger

57
Q

What is the treatment for a ruptured ulnar collateral ligament of the thumb

A

scaphoid-type plaster cast for minor degrees of instability

Surgical repair and plaster immobilisation if the instability is obvious

58
Q

What is acute paronychia

A

infection under the nailfold

59
Q

What is apical abscess

A

a small collection of pus under the end of a nail

60
Q

What is an intradermal abscess

A

a collection of pus on the palmar surface of the ginger or hand lying between the depend superficial layers of the dermis

61
Q

What is required if pus has already formed

A

surgical drainage

62
Q

What is suppurative tenosynovitis

A

A serious condition usually originating from a penetrating injury which may be minor
The tendon sheath fills with fluid and later pus

63
Q

What is the clinical presentation of suppurative tenosynovitis

A

digit is swollen and very painful and tender along the whole length of the sheath
All movements are painful

64
Q

What is the treatment for suppurative tenosynovitis

A

Elevation and drainage

65
Q

What causes De Quervain’s tenovaginitis

A

Thickening of the tendon sheaths of the abductor policies longs and extensor policies braves where they cross the radial styloid

66
Q

What are the clinical features of De Quervain’s tenovaginitis

A

Pain at the site
worse by gripping and extending the thumb
Localised tenderness and often a swelling over the radial styloid

67
Q

What is the treatment for De Quervain’s tenovaginitis

A

hydrocortisone injection

68
Q

What is often the curative treatment for trigger finger

A

longitudinal division of the tendon pulley ensuring that the tendon runs freely

69
Q

What might be early manifestations of RA

A

De Quervain’s tenovaginitis and trigger finger

70
Q

What is Dupuytren’s contracture

A

A condition affecting the collagenous tissue of the palmar fascia

71
Q

What are the clinical features of Dupuytren’s contracture

A

Very slowly progressing flexion contracture of the fingers and thumb
Palmar fascia feels thickened and nodular and tends to pucker the overlying skin

72
Q

What is the treatment for Dupuytren’s contracture

A

Surgery for established contracture with symptoms and this involves careful dissection of the whole of the affected area of fascia

73
Q

Where does OA affect in the wrist and hand

A

between the trapezium and base of the first metacarpal

terminal interphalangeal joints (Heberden’s nodes)

74
Q

What is a last stage treatment for OA between the trapezium and base of the first metacarpal

A

Excision of the trapezium

75
Q

What are two classical deformities of RA in the hand and wrist

A

Swan neck and boutonniere deformity

76
Q

What is the treatment of RA in the wrist and hand

A

rest and splintage in acute phases
surgery occasionally
Arthrodesis

Lecture Notes- Orthopaedics and Fractures (23 decks)

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