Forearm, wrist and hand Flashcards by Sasha Murdoch

What is the function of the proximal radioulnar joint

Pronation and supination

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What does the stability of the distal radioulnar joint depend on

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

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What is the wrist joint

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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What action does the wrist allow

palmar and dorsiflexion

ulnar and radial deviation

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What action do the MCPHs of the fingers allow

abduction and adduction in addition to flexion and extension

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What type of joints are the interphalangeal joints

simple hinge joints

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What are some deformities that could be seen on inspection

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

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What are the landmark of the wrist

styloid processes of the radius and ulna

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How can you examine dorsiflexion of the wrist

Prayer sign

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How is palmar flexion test

placing the back of the hands together and dropping the elbows

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What is internal rotation of the metacarpals described as

opposition

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What muscles produce pronation of the wrist

pronator quadratus and pronator teres (median nerve)

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What muscles produce supination of the wrist

Biceps

supinator muscles

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How can the wrist flexors be tested

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

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How do all of the joints of the fingers become flexed

Flexor digitorum profundus

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What muscle flexes the proximal interphalangeal joints

flexor digitorum superficialis

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How is flexor digitorum superficalis tested

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

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How is flexor digitorum proudness tested

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

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How are the MCJs normally flexed

by the lumbrical and interosseous muscles

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What happens if the lumbrical and interosseous muscles are paralysed

the fingers take up a claw position

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How are the interpose best tested

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

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What muscle extends the MCPJs

extensor digitorum longus

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What flexes the thumb

flexor pollicis longus

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What abducts the thumb

abductors pollicis brevis and longus

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How is the thumb adducted

Thenar group and the adductor pollicis

What produces wrist extension

extensor carpi ulnaris and extensor carpi radialis longus and brevis

How can sensation of the hand be tested

using a pin

What is Madelung's deformity

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

What does Multiple enchondromatosis cause

multiple swellings in the digits often with considerable interference with function

What does achondroplasia produce

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

What causes trigger thumb

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

What is the treatment for trigger thumb

longitudinal division of the tendon sheath

What is a Colles fracture

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

Describe the appearance of a typical Colles fracture on Xray

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

How is a Colles fracture usually produced

fall on the outstretch hand

What are some complications of Colles fractures

Median nerve compression | Malunion

What is the treatment of a Colles fracture

minimally displaced - reduction is not necessary

What is the usual method of reducing a Colles fracture

manipulation under anaethetic

What is a Smith's fracture

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

How is a Smith's fracture treated

open reception and internal fixation with a plate

Where is tenderness present with a scaphoid fracture

anatomical snuff box

What are the Xray views required for a potential scaphoid break

AP Lateral Oblique

What is the main complication of a scaphoid fracture

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

How is non-union of a scaphoid fracture treated

bone graft and a screw across the fracture line

What is a complication of a dislocation of the carpus

median nerve compression

What is a Bennett's fracture

Fracture dislocation of the carp-metacarpal joint of the thumb

What is a Boxer's fracture

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

What is the treatment for a fractured metacarpal

Usually just simple strapping for 3 weeks

What are fracture of the phalanges often associated with

tendon and nerve damage

What is the treatment for fractures of the phalanges

strapping the finger to the adjacent one

What are fractures of the terminal phalanges caused by

crush injuries

What is Mallet finger

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

What is the treatment for Mallet finger

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

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

rupture of the ulnar collateral ligament of the thumb

What causes rupture of the ulnar collateral ligament of the thumb

Forced abduction

What does a rupture of the ulnar collateral ligament interfere with

the pinch grip of the thumb against the index finger

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

scaphoid-type plaster cast for minor degrees of instability | Surgical repair and plaster immobilisation if the instability is obvious

What is acute paronychia

infection under the nailfold

What is apical abscess

a small collection of pus under the end of a nail

What is an intradermal abscess

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

What is required if pus has already formed

surgical drainage

What is suppurative tenosynovitis

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

What is the clinical presentation of suppurative tenosynovitis

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

What is the treatment for suppurative tenosynovitis

Elevation and drainage

What causes De Quervain's tenovaginitis

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

What are the clinical features of De Quervain's tenovaginitis

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

What is the treatment for De Quervain's tenovaginitis

hydrocortisone injection

What is often the curative treatment for trigger finger

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

What might be early manifestations of RA

De Quervain's tenovaginitis and trigger finger

What is Dupuytren's contracture

A condition affecting the collagenous tissue of the palmar fascia

What are the clinical features of Dupuytren's contracture

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

What is the treatment for Dupuytren's contracture

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

Where does OA affect in the wrist and hand

between the trapezium and base of the first metacarpal | terminal interphalangeal joints (Heberden's nodes)

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

Excision of the trapezium

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

Swan neck and boutonniere deformity

What is the treatment of RA in the wrist and hand

rest and splintage in acute phases surgery occasionally Arthrodesis