Hand Flashcards
most common injury for the skeletal parts of the hand
fracture
treatment for displaced fractures
open reduction and internal fixation
test for finger alignment
- normal: all fingers except thumb point towards scaphoid
- not observed = fingers cross on top of each other
what is boxer’s fracture
- force is borne by smallest portion of 5th metacarpal (fracture of neck)
what is gamekeeper’s or skier’s thumb
- avulsion fracture of attachment of ulnar collateral ligament of the thumb
- caused by hyperextension and valgus force on the interphalangeal joint of thumb
the strongest ligament at the proximal interphalangeal joint
volar plate
injury to volar plate
rupture of volar plate -> dorsal subluxation of proximal interphalangeal joint
- reduction of subluxation requires application of traction and volar pressure on middle phalanx
- splint for 2-3 wks
counterpart of volar plate on dorsal side
extensor hood
what is boutonniere deformity
the rupture of the extensor hood on the proximal interphalangeal joint
what is mallet finger injury
rupture at distal interphalangeal joint
management of extensor hood injuries
- traction and dorsal pressure across joint
- immobilization (splint)
flexor zones
1: over distal interphalangeal joint
2: over proximal interphalangeal join and metacarpophalangeal joint
3: over palm
4: over wrist
5: over forearm
what are pulleys
4 annular pulleys
3 cruciate pulleys
- keep tendon close to bone
- allow more efficient transmission of flexion
most important flexor pulleys
a2 and a4
what is a bowstring
- rupture of a2 or a4 = less efficient finger flexion
- bowstring effect: tendons move away from bone
test for intact flexor tendons
- passively extend wrist = fingers will flex
- passively flex wrist = fingers will extend
- (+) finding = tenodesis effect
radial nerve provides sensation to __
- dorsum of thumb, index, and radial side of long finger up to proximal interphalangeal joint
test for radial nerve
- pinch dorsal side of first web space
what is median nerve
- sensation to volar side of hand
- from thumb to radial side of ring finger
what is ulnar nerve
- sensation to the small finger and ulnar side of the ring finger on both volar and dorsal sides
carpal tunnel syndrome is caused by __
compression of median nerve
symptoms of carpal tunnel
numbness and pain on thumb, index finger, long finger, and radial side of ring finger
ten structures that pass through carpal tunnel
- 4 flexor digitorum superficialis tendons
- 4 flexor digitorum profundus tendons
- flexor pollicis longus
- median nerve
test for median nerve
phalen’s test and tinel’s test
differentials for carpal tunnel
c6-c7 radiculopathy and polyneuropathy in dm
diagnosis for carpal tunnel
- emg-ncv
- msk uts
- check thenar muscles for atrophy (chronic compression)
treatment for carpal tunnel
- conservative treatment: splint
- pharma: corticosteroid injections
- tendon gliding exercises
- median nerve mobilization exercises
- surgery
de quervain’s tenosynovitis affects __
extensor pollicis brevis and abductor pollicis longus = pain in area of first dorsal compartment of wrist
what is finkelstein’s test
- provocative test to reproduce symptoms of de quervain’s tenosynovitis
treatment for de quervain
- anti-inflammatory drugs
- thumb spica splint
- corticosteroid injection
- surgery (incise retinaculum)
what is trigger finger
- overuse of flexor tendon = microtrauma
- produce nodules
- affect a1 pulley
treatment for trigger finger
- corticosteroids
- rehab exercises
- surgery (incise a1 pulley)
