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Y3(S) - T & O > Hand And Wrist > Flashcards

Hand And Wrist Flashcards

1
Q

What are the important components of a FALLS history?

A

Before
During
After

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2
Q

What is important to ask a patient before their fall?

A

Cause of fall
Dizziness
SOB
Chest pain
Giving way
Consciousness

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3
Q

What pathologies may you consider if a patient states they were dizzy before their fall??

A

Postural Hypotension
Arrhythmias
Ear pathology

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4
Q

What is important to ask a patient during their fall?

A

Remain conscious?
Hit head
Involuntarily bite lip or pass urine
How did they land

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5
Q

What is important to ask a patient after their fall?

A

How long on floor
Get up independently?

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6
Q

Why is it important to know whether the patient involuntarily bit their lip or passed urine?

A

Indicates potential seizure

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7
Q

Why is it important to know how long a patient was on the floor for after their fall?

A

Longer = higher chances of rhabdomyolysis which increases the risk of developing an AKI

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8
Q

What is the first step in assessing a patient who has fallen on their wrist?

A

Neurovascular assessment

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9
Q

What do you assess in the vascular assessment of the hand/wrist?

A

Pulses
Temperature
Cap refill
Colour

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10
Q

What are the 2 basic components that you would be assessing in the neurological exam of the wrist?

A

Sensation
Power/motor

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11
Q

How do you assess the median nerve sensation to the hand?

A

Tip of index on palmar aspect

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12
Q

How do you assess the ulnar nerve sensation to the hand?

A

Tip of pinky finger on palmar aspect

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13
Q

How do you assess the radial nerve sensation to the hand?

A

1st webbed space on dorsum of the hand

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14
Q

How do you assess the median nerve motor/power component to the hand?

A

Abduct the thumb against force

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15
Q

How do you assess the ulnar nerve motor/power component to the hand?

A

Abduct fingers against force

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16
Q

How do you assess the radial nerve motor/power component to the hand?

A

Extension of the fingers against force

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17
Q

What are the 4 main types of wrist fractures?

A

Colles
Scaphoid
Bartons
Smiths

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18
Q

How to fractures typically present?

A

Pain
Deformity
Swelling
Reduced ROM
Bruising

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19
Q

What is the most common cause of a Colles fracture?

A

FOOSH

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20
Q

How does a Colles fracture look on X-ray?

A

Dinner fork deformity

Dorsal angulation of the distal fragment with dorsal displacement of the distal fragment

On extra articular fracture of the distal radius

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21
Q

What is the type of analgesia given to a patient with a wrist fracture to allow you to reduce the fracture?

A

Biers block

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22
Q

What is a biers block?

A

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

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23
Q

What is a smiths fracture?

A

Volar angulation of distal fragment and volar displacement of distal fragment

Extra articular fracture of distal radius

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24
Q

What is a Barton’s fracture?

A

Intra articular distal radius fracture with radioulnar dislocation/subluxation

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25
Q

What are the 3 managements of wrist fractures?

A

Back slab immobilisation
Closed reduction + back slab
ORIF

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26
Q

When would you do a back slab immobilisation for a wrist fracture?

A

When the fracture is non displaced

27
Q

When would you do a closed reduction and back slab for a wrist fracture?

A

Fracture is displaced

28
Q

What is a back slab?

A

Cast with an open side to allow for swelling

29
Q

What are the 2 views required to assess a wrist fracture?

A

X-ray AP
X-ray lateral

30
Q

What are the 2 measurements needed to assess whether a patient needs an ORIF?

A

Volar tilt
Radial inclination

31
Q

What view is used to assess voLar tilt?

A

Lateral view

VoLar tilt = LateraL view

32
Q

What view is needed to assess radial inclination?

A

AP view

33
Q

What is ulnar variance?

A

When the ulnar can move proximal or dismally after a wrist fracture

34
Q

How does negative ulnar variance present following a wrist fracture?
Ulnar moved more proximal

A

Ulnar impingement syndrome

35
Q

How does positive ulnar variance present following a wrist fracture?
Ulnar moved more distal

A

Ulnar impaction syndrome

36
Q

What are some complications of wrist fractures?

A

Mal union
Non union (no bony callus forms)
Osteoarthritis
Median nerve compression

37
Q

What are the 2 types of forearm fractures?

A

Monteggia fracture
Galeazzi fracture

38
Q

What is a monteggia fracture?

A

Proximal 1/3 of ulna fracture with radial healed dislocation

39
Q

What is a galeazzi fracture?

A

Distal 1/3 of the radius fracture with dislocation of distal radioulnar joint

40
Q

How do scaphoid fractures present?

A

Pain in anatomical snuff box
Positive scaphoid compression test

41
Q

What is a positive scaphoid compression test?

A

Press down on the tip of the thumb compresses the scaphoid illiciting pain if fractures

42
Q

What artery supplies the scaphoid?

A

Dorsal carpal branch of radial artery

43
Q

What is the management for a suspected scaphoid fracture?

A

X-ray and immobilise even if no fracture visible

Re x-ray in 2 weeks

44
Q

What is the management for a suspected scaphoid fracture?

A

X-ray and immobilise even if no fracture visible

Re x-ray in 2 weeks

45
Q

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?

A

CT or MRI

46
Q

Why is the scaphoid at a high risk of Avascular necrosis or non union?

A

Retrograde blood supply

47
Q

Is a fracture of the scaphoid more proximal or distal worse and why?

A

Proximal
Retrograde blood supply

48
Q

Why do you get paraesthesia in the radial 3.5 digits in carpal tunnel and not the palm?

A

Palmar cutaneous branch supplies the palm and it doesn’t travel through the carpal tunnel

Digital cutaneous branch does pass through he carpal tunnel

49
Q

Why can you get Thenar muscle wastage in carpal tunnel syndrome?

A

The anterior interosseous nerve that is a branch of the median nerve travels through the carpal tunnel

50
Q

What muscle is atrophied if a patient has carpal tunnel syndrome and abduct the thumb?

A

Abductor pollicis brevis

51
Q

What are the typically management steps for carpal tunnel syndrome?

A

Splint wrist in extension while sleep
Activity modification
Corticosteroid injection
Surgical decompression

52
Q

What is the alternate name for trigger finger?

A

Stenosing tenosynovitis

53
Q

How does trigger finger present?

A

Patients fingers locking or clicking and getting stuck in Flexion and struggle to extend

54
Q

What is the pathophysiology of trigger finger?

A

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

55
Q

What are the management steps for trigger finger?

A

Activity modification
NSAIDS
Splint in extension
Corticosteroid injection

Surgical intervention

56
Q

What are the 2 surgical options for trigger finger?

A

Percutaneous surgical release
Open decompression

57
Q

What is cubital tunnel syndrome?

A

Compression ulnar neuropathy at elbow

58
Q

What is ulnar tunnel syndrome?

A

Compressive ulnar neuropathy at wrist

59
Q

What is the most common neuropathy associated with a supracondylar fracture of the elbow?

A

Anterior interosseous nerve neuropathy

60
Q

How would an injury to the anterior interosseous nerve in a supracondylar elbow fracture present?

A

Weakness or inability to make the ok sign with thumb and index finger

61
Q

What structure is affected with Dupuytrens contracture?

A

Fascia of palm

62
Q

What is the pathophysiology of Dupuytrens contracture?

A

Myofibroblasts contract causing plamar thickening
Nodules form
Fibroblasts follow line of tension causes cords
Fibroblasts become abdundant and contract cord

63
Q

What are the symptoms of Dupuytrens contracture?

A

Nodules
Pits
Finger Flexion
Skin thickening

64
Q

What are some managements for Dupuytrens contracture?

A

Collagenous injections
Radiotherapy
Fasciectomy
Percutaneous needle fasciotomy or aponeurotomy

Y3(S) - T & O (7 decks)

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