Hand And Wrist Flashcards
What are the important components of a FALLS history?
Before
During
After
What is important to ask a patient before their fall?
Cause of fall
Dizziness
SOB
Chest pain
Giving way
Consciousness
What pathologies may you consider if a patient states they were dizzy before their fall??
Postural Hypotension
Arrhythmias
Ear pathology
What is important to ask a patient during their fall?
Remain conscious?
Hit head
Involuntarily bite lip or pass urine
How did they land
What is important to ask a patient after their fall?
How long on floor
Get up independently?
Why is it important to know whether the patient involuntarily bit their lip or passed urine?
Indicates potential seizure
Why is it important to know how long a patient was on the floor for after their fall?
Longer = higher chances of rhabdomyolysis which increases the risk of developing an AKI
What is the first step in assessing a patient who has fallen on their wrist?
Neurovascular assessment
What do you assess in the vascular assessment of the hand/wrist?
Pulses
Temperature
Cap refill
Colour
What are the 2 basic components that you would be assessing in the neurological exam of the wrist?
Sensation
Power/motor
How do you assess the median nerve sensation to the hand?
Tip of index on palmar aspect
How do you assess the ulnar nerve sensation to the hand?
Tip of pinky finger on palmar aspect
How do you assess the radial nerve sensation to the hand?
1st webbed space on dorsum of the hand
How do you assess the median nerve motor/power component to the hand?
Abduct the thumb against force
How do you assess the ulnar nerve motor/power component to the hand?
Abduct fingers against force
How do you assess the radial nerve motor/power component to the hand?
Extension of the fingers against force
What are the 4 main types of wrist fractures?
Colles
Scaphoid
Bartons
Smiths
How to fractures typically present?
Pain
Deformity
Swelling
Reduced ROM
Bruising
What is the most common cause of a Colles fracture?
FOOSH
How does a Colles fracture look on X-ray?
Dinner fork deformity
Dorsal angulation of the distal fragment with dorsal displacement of the distal fragment
On extra articular fracture of the distal radius
What is the type of analgesia given to a patient with a wrist fracture to allow you to reduce the fracture?
Biers block
What is a biers block?
Blood pressure cuff put on arm and set to 100mmHg above normal systolic (no brachial pulse should be felt)
Then local injected into vein in the wrist
What is a smiths fracture?
Volar angulation of distal fragment and volar displacement of distal fragment
Extra articular fracture of distal radius
What is a Barton’s fracture?
Intra articular distal radius fracture with radioulnar dislocation/subluxation
What are the 3 managements of wrist fractures?
Back slab immobilisation
Closed reduction + back slab
ORIF
When would you do a back slab immobilisation for a wrist fracture?
When the fracture is non displaced
When would you do a closed reduction and back slab for a wrist fracture?
Fracture is displaced
What is a back slab?
Cast with an open side to allow for swelling
What are the 2 views required to assess a wrist fracture?
X-ray AP
X-ray lateral
What are the 2 measurements needed to assess whether a patient needs an ORIF?
Volar tilt
Radial inclination
What view is used to assess voLar tilt?
Lateral view
VoLar tilt = LateraL view
What view is needed to assess radial inclination?
AP view
What is ulnar variance?
When the ulnar can move proximal or dismally after a wrist fracture
How does negative ulnar variance present following a wrist fracture?
Ulnar moved more proximal
Ulnar impingement syndrome
How does positive ulnar variance present following a wrist fracture?
Ulnar moved more distal
Ulnar impaction syndrome
What are some complications of wrist fractures?
Mal union
Non union (no bony callus forms)
Osteoarthritis
Median nerve compression
What are the 2 types of forearm fractures?
Monteggia fracture
Galeazzi fracture
What is a monteggia fracture?
Proximal 1/3 of ulna fracture with radial healed dislocation
What is a galeazzi fracture?
Distal 1/3 of the radius fracture with dislocation of distal radioulnar joint
How do scaphoid fractures present?
Pain in anatomical snuff box
Positive scaphoid compression test
What is a positive scaphoid compression test?
Press down on the tip of the thumb compresses the scaphoid illiciting pain if fractures
What artery supplies the scaphoid?
Dorsal carpal branch of radial artery
What is the management for a suspected scaphoid fracture?
X-ray and immobilise even if no fracture visible
Re x-ray in 2 weeks
What is the management for a suspected scaphoid fracture?
X-ray and immobilise even if no fracture visible
Re x-ray in 2 weeks
What is the next step after re- xraying the wrist for a potential schaphoid fracture and still no fracture line is visible after 2 weeks?
CT or MRI
Why is the scaphoid at a high risk of Avascular necrosis or non union?
Retrograde blood supply
Is a fracture of the scaphoid more proximal or distal worse and why?
Proximal
Retrograde blood supply
Why do you get paraesthesia in the radial 3.5 digits in carpal tunnel and not the palm?
Palmar cutaneous branch supplies the palm and it doesn’t travel through the carpal tunnel
Digital cutaneous branch does pass through he carpal tunnel
Why can you get Thenar muscle wastage in carpal tunnel syndrome?
The anterior interosseous nerve that is a branch of the median nerve travels through the carpal tunnel
What muscle is atrophied if a patient has carpal tunnel syndrome and abduct the thumb?
Abductor pollicis brevis
What are the typically management steps for carpal tunnel syndrome?
Splint wrist in extension while sleep
Activity modification
Corticosteroid injection
Surgical decompression
What is the alternate name for trigger finger?
Stenosing tenosynovitis
How does trigger finger present?
Patients fingers locking or clicking and getting stuck in Flexion and struggle to extend
What is the pathophysiology of trigger finger?
Inflammation of the flexor tendons or their sheaths that they run through lead to thickening and fibrous bands forming leading to nodule formation
These nodules get caught in the sheath leading to the clicking and locking
What are the management steps for trigger finger?
Activity modification
NSAIDS
Splint in extension
Corticosteroid injection
Surgical intervention
What are the 2 surgical options for trigger finger?
Percutaneous surgical release
Open decompression
What is cubital tunnel syndrome?
Compression ulnar neuropathy at elbow
What is ulnar tunnel syndrome?
Compressive ulnar neuropathy at wrist
What is the most common neuropathy associated with a supracondylar fracture of the elbow?
Anterior interosseous nerve neuropathy
How would an injury to the anterior interosseous nerve in a supracondylar elbow fracture present?
Weakness or inability to make the ok sign with thumb and index finger
What structure is affected with Dupuytrens contracture?
Fascia of palm
What is the pathophysiology of Dupuytrens contracture?
Myofibroblasts contract causing plamar thickening
Nodules form
Fibroblasts follow line of tension causes cords
Fibroblasts become abdundant and contract cord
What are the symptoms of Dupuytrens contracture?
Nodules
Pits
Finger Flexion
Skin thickening
What are some managements for Dupuytrens contracture?
Collagenous injections
Radiotherapy
Fasciectomy
Percutaneous needle fasciotomy or aponeurotomy
