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MSK Disorders > Hand And Wrist > Flashcards

Hand And Wrist Flashcards

1
Q

How do scaphoid fractures occur?

A

Fall onto outstretched hand

Hyperextension and impact of scaphoid into rim of radius

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2
Q

What are the symptoms of a scaphoid fracture?

A

Pain in anatomical snuffbox
Exacerbated by moving wrist
Passive range motion reduced

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3
Q

Why may a scaphoid fracture have delayed diagnosis?

A

Not clear initially

Becomes visually when bone reabsorption starts to occur

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4
Q

What are common complications of scaphoid fractures?

A 
Avascular necrosis (if fracture at waist of bone due to retrograde blood supply)
Malunion  
Non-union
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5
Q

What is a Colles’ fracture?

A

Extra-articular fracture of distal radial metaphysics with dorsal angulation and impaction

Looks like upturned fork

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6
Q

What is the mechanism of Colles’ fractures?

A

Fall onto outstretched hand with pronated forearm
Wrist is dorsiflexed

Energy transmitted from carpus to distal radius in dorsal direction

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7
Q

What are complications of Colles’ fractures?

A

Malunion (dinner fork deformity)
Median nerve palsy
Secondary OA
Tear in extensor pollcis longus tendon

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8
Q

What is a Smith fracture?

A

Fracture of distal radius with palmar angulation of distal fragment

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9
Q

What is the mechanism of a Smith fracture?

A

Fall onto dorsal of flexed wrist

Direct blow to back of wrist

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10
Q

What is a complication of a Smith fracture?

A

Malunion = garden spade deformity

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11
Q

What joints in the hand are normally affected by rheumatoid arthritis?

A

MCPJ

PIPJ

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12
Q

How does RhA present in the hands?

A 
Pain and swelling of effected joint 
Redness 
Stiffness 
Carpal tunnel syndrome (due to swelling)
Flu symptoms 
Rheumatoid nodules on the fingers
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13
Q

What is a swan neck deformity?

A

When the PIPJ joint is hyperextended and DIPJ are flexed

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14
Q

Why does swan neck occur?

A

Tissues in palmar aspect of PIPJ become lax due to adjacent synovitis
Extension> flexion at this joint

At DIPJ elongation or rupture to inversion of extensor digitorum

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15
Q

What is Boutonnière deformity?

A

MCPJ and DIPJ hyperextended

PIPJ flexed

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16
Q

Why does Boutonnière deformity occur?

A

Inflammation of PIPJ lengthening of extensor digitorum at insertion
Lateral bands of extensor digitorum slip down sides of finger so now on palmar surface and instead as acting as extensors, act as flexors

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17
Q

What is Psoriatic arthropathy?

A

Arthritis develops in joints with overlying Psorosis

Affects DIPJs

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18
Q

How does Psoratic arthritis present?

A

Asymmetrically
Fusiform digits
Nail lesions (pitting)

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19
Q

Which joint is most commonly affected by OA?

A

1st CMC

20
Q

How does OA in CMC joint present?

A

Pain at base of thumb
Stiffness
Swelling
1st metacarpal subluxes in ulnar direction = squaring of hand

21
Q

What causes Heberden’s nodes?

A

OA

Cystic swelling containing gelatinous hyaluronic acid on dorsal aspect of DIPJ
Once inflammation subsides left with Osteophytes

Reduces manual dexterity

22
Q

What is carpal tunnel syndrome?

A

Compression of median nerve as travels through carpal tunnel

23
Q

What are risk factors of Carole tunnel syndrome?

A

Obesity
Pregnancy
Repetitive wrist work
RhA

24
Q

Where is paraesthesia felt in carpal tunnel syndrome?

A

Distribution of median nerve

Thumb, index, middle and radial half of ring

25
Q

Why is sensation to the palm spared in carpal tunnel syndrome?

A

The cutaneous branch of the medial nerve is given off before the carpel tunnel

26
Q

Why can long standing carpel tunnel syndrome result in?

A

Weakness and atrophy of thenar muscles

Still able to flex thumb

27
Q

Where can the ulnar nerve be compressed?

A

Guyon’s canal

28
Q

Where is paraesthesia felt in ulnar nerve compression in wrist?

A

Ring and little fingers

Weakening of intrinsic muscles of hand supplied by ulnar nerve

29
Q

What is Dupuyten’s contracture?

A

Localised thickening and contracture of palmar aponeurosis leading to flexion deformity of fingers

30
Q

How does Dupuytren’s contracture develop?

A

Thickening in palm
Myofibroblasts in nodule contract forming tight bands called cords in palmar fascia
Fingers become stuck in flexed position due to close association with aponeurosis

31
Q

What are risk factors for Dupuytren’s contracture?

A

Type 1 diabetes
Smoking
Heart disease
Trauma to hand and fingers

32
Q

When do injuries to the radial nerve in the radial grove occur?

A

Mid- shaft humoral fractures

33
Q

In radial groove nerve injuries what will the sensory impairment be?

A

Posterior cutaneous brach is before the radial groove so unaffected
Lower lateral and posterior cutaneous of forearm high in groove so normally fine

Paraestesia in superficial brach

34
Q

What muscles are paralysed in radial groove nerve injuries?

A

Brachioradialis

All extensor muscles of wrist and fingers

35
Q

What muscles are paralysed by a supracaondular fracture that damages the median nerve?

A

Flexor muscles from medial epicondyle

Pronators and flexors of wrist and hand

36
Q

How will the arm appear in a supracondular fracture that damage the median nerve?

A

Supurnated
Weak flexion of wrist (adduction due to pull of flexor carpi ulnaris)
Flexion of thumb weak

37
Q

What is the hand of Benediction?

A

When a patient attempts to are a fist with a high median nerve injury
Only able to flex medial 2 digits

38
Q

What causes low level median nerve injuries?

A

Penetrating wrist injury

Compression of carple tunnel

39
Q

What is the presentation of a low medial nerve injury?

A 
Muscles paralysed= LOAF
Lubricals to index and middle finger 
Opppones pollicis 
Abductor polllicis brevis 
Flexor pollicis brevis

Ape hand deformity

40
Q

What is ape hand deformity?

A

Results from lower median nerve injury

Thenor eminence is flattered
Thumb adducted and laterally rotated

41
Q

What functions will be lost in wrist level ulnar nerve injury?

A 
Muscles of hypothenor eminence 
Adductor pollcis 
Deep head of flexor pollicis brevis 
Interossi
Lumbricals the ring and little finger 
Palmaris brevis 
Palmar branches if medial 1 an a half digits
42
Q

What is claw hand and why does it occur?

A

Little and ring finger hyperextended at MCPJ and flexed at both IPJ at rest

This is as lumbricals supplying these are paralysed (these flex at MCPJ and extend at IPJ)

43
Q

What causes the ulnar never to be damaged in injuries at the elbow?

A

Medial epicondyle fractures

Compression of cubital tunnel

44
Q

What muscles are affected in a high ulnar nerve injury?

A

Same as in a low injury
Paralysis of flexor carpi ulnaris
Ulnar half of flexor digitorum profundus
Loss of sensation in palmar and dorsal cutaneous branches

45
Q

How does an ulnar claw appear with a high level ulnar nerve lesion?

A

Less pronounced than with lower injury

As no flexion at DIPJ of medial fingers as flexor digitorum profundus paralysed

Only hyperextension at MCPJs

MSK Disorders (9 decks)

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