Forearm, wrist and hand Flashcards
What is the function of the proximal radioulnar joint
Pronation and supination
What does the stability of the distal radioulnar joint depend on
the integrity of the triangular fibro-cratilage attached to the ulnar styloid process
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)
What action does the wrist allow
palmar and dorsiflexion
ulnar and radial deviation
What action do the MCPHs of the fingers allow
abduction and adduction in addition to flexion and extension
What type of joints are the interphalangeal joints
simple hinge joints
What are some deformities that could be seen on inspection
dinner fork - Colles fracture
mallet or boutonniere deformity
Ulnar deviation of the fingers - RA
What are the landmark of the wrist
styloid processes of the radius and ulna
How can you examine dorsiflexion of the wrist
Prayer sign
How is palmar flexion test
placing the back of the hands together and dropping the elbows
What is internal rotation of the metacarpals described as
opposition
What muscles produce pronation of the wrist
pronator quadratus and pronator teres (median nerve)
What muscles produce supination of the wrist
Biceps
supinator muscles
How can the wrist flexors be tested
ask the patient to flex the wrist and palpate the radial and ulnar flexor tendons
How do all of the joints of the fingers become flexed
Flexor digitorum profundus
What muscle flexes the proximal interphalangeal joints
flexor digitorum superficialis
How is flexor digitorum superficalis tested
by holding the other fingers extended and asking the patient to flex the appropriate finger
How is flexor digitorum proudness tested
asking the patient to flex the terminal interphalangeal joint whilst the proximal interphalangeal joint is held extended
How are the MCJs normally flexed
by the lumbrical and interosseous muscles
What happens if the lumbrical and interosseous muscles are paralysed
the fingers take up a claw position
How are the interpose best tested
ask the patient to spread the fingers or to hold them tightly together
What muscle extends the MCPJs
extensor digitorum longus
What flexes the thumb
flexor pollicis longus
What abducts the thumb
abductors pollicis brevis and longus
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
