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Hand Clinic (musculoskeletal) > Hand > Flashcards

Hand Flashcards

1
Q

What are NTBM with hand/finger pain? (2)

A
  1. Potential infection (e.g. bite)
  2. Avulsion of long flexor tendons
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2
Q

Common causes of hand and finger pain (3 cat)

A
  1. Bone
    • #
      • MC
      • Phalynx
  2. Ligamentous
    • Dislocation of PIP
    • Mallet finger
    • Ulnar collateral lig (first MCP)
    • PIP sprain
  3. Other
    • Laceration
    • Infection
    • Subungual hematoma
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3
Q

Less common causes of hand and finger pain (3 cat)

A
  1. Bone
    • Bennett’s fracture
    • Stress #
  2. Ligamentous
    • Dislocation
      • MCP
      • DIP
    • Radial collateral lig (1st MCP)
    • DIP joint sprain
  3. Other
    • Glomus tumour
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4
Q

What is a subungual hematoma? (describe, treatment)

A

Collection of blood underneath toenail or fingernail (painful, non-serious).

Rx options =

  • Release pressure conservatively
  • Drill hole
  • Remove nail
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5
Q

What is a glomus tumor?

A

Description

  • Rare, benign neoplasm arising from the glomus body.
  • Usually found under the nail, on fingertip or in the foot (often painful)

Rx

  • Sx excision
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6
Q

Why is early Ax and Mx necessary in finger injuries?

A

Long-term deformity/functional impairment avoided.

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7
Q

What is very important in a history for hand injuries? (2)

A
  • Mechanism (think…)
  • Associated features
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8
Q

What are common mechanisms of injury and what do they indicate? (4)

A
  • Severe, direct blow (#)
  • Blow to point of finger (dislocation, sprain, long flex/ext tendon avulsion)
  • Punching injury (# - base of 1st MC/neck of other MC)
  • Grabbing oponent’s clothing (flexor digitorum profundus tendon avulsion)
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9
Q

What are common associated features of injury to ask in a history?

A
  • Degree of pain
  • Appearance (bruise, swell)
  • Sounds (crack)
  • Loss of fn
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10
Q

Normal ROM for digits 2-5

A

Flexion (deg)

  • DIP = 80
  • PIP = 100
  • MCP = 90
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11
Q

What is the volar plate?

A

Thick fibrocartilagenous tissue that reinforces the pharyngeal joints

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12
Q

Base of 1st MC # (mech and types)

A

Mech = punch

Types

  • Extra-articular transverse (1cm distal)
  • Bennett’s # dislocation of 1st CMC
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13
Q

How does an extra-articular transverse # of 1st MC look and how is it treated?

A

Thumb flexed across palm

Rx = immobilise in short arm spica

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14
Q

Bennett’s # (mech/path)

A

Mech/pathology

  • Axial compression
  • 1st MC driven proximally, shearing at base
    • Small medial frag of MC still attached to volar lig
    • Main shaft of MC pulled proximally
      • (Unopposed pull of abductor pollicis longus)
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15
Q

Bennett’s # (Rx)

A
  • Refer to hand surgeon
    • Closed reduction
    • Percutaneous Kirschner wire fixation
  • Cast immob 4-6/52

Physio (after cast removed):

  • Mobilise surrounding jts
  • Protective device if early RTS
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16
Q

MC #s (not 1st) (Mech, other, Rx)

A

Mech = usually punch (often 4th/5th - boxer’s #)

Usually has flexion deformity (“dropped knuckle”)

Rx

  • Splint/cast in 90deg MCP flexion (no shortening of collateral ligs)
    • Ensure no #-displacement
  • Remove after 2-3/52 and immediate RTS with protection
17
Q

PROXIMAL Pharyngeal #s (complications, Rx)

A

Can lead to functional impairment (ext/flex tendons into contact with callus/exposed bone)

Rx

  • Immobilised (wrist slight extn, MCP = 70deg)
    • Weekly imaging to check position
    • 3-4/52 and continue buddy taping
  • Motion at 3-4/52
18
Q

MIDDLE Pharyngeal #s (general 3)

A

General

  • Cortical bone involved
  • Usually transverse or oblique
  • Heal slowly
19
Q

MIDDLE Pharyngeal #s (Rx)

A

Rx

  • STABLE
    • Splint (70 deg MCP flex, 0 deg PIP flex)
      • 3/52
      • ROM after splint
  • UNSTABLE/INTRA-ARTICULAR with >25% PIP jt surface
    • ORIF (small-caliber Kirschner wires)
    • ROM ASAP after fixation considered stable
20
Q

DISTAL Pharyngeal #s (mech, displaced?, Rx, healing time)

A

Mech = crushing (e.g. finger jammed between ball and bat)

Usually non-displaced.

Rx

  • Splint and compression dressing
  • Pain often due to subungual hematoma
    • No perforation of the nail though
      • (means closed-# is now a compound-#)

Most heal in 4-6/52

21
Q

Mallet finger (description, mech)

A

Description

  • Flexion deformity
  • Avulsion of extensor mechanism at DIP jt

Mech

  • Extended fingertip struck into flex
  • Extensor mech actively contracts
    • Disruption/stretching
22
Q

Mallet finger (Rx)

A

Rx

  • Any volar sublux = ORIF
  • Uncomplicated =
    • DIP jt splint (slight hyperextn)
      • 6-8/52 - always on, reg monitoring
      • Additional 6-8/52 with sport and at night
    • NOTE:
      • Splint type can be volar or dorsal (dorsal = fingertip sensation)
      • Keep finger dry and examine for skin slough/maceration

Hand Clinic (musculoskeletal) (3 decks)

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