Hand and Wrist Flashcards
Common Hand d/o
Tendon / ligament problems Fx Infections Arthrist Nerve entrapment / other
Trigger finger - Patho
Swollen flexor tendon catches on A-1 pulley
Trigger finger - exam findings
Tenderness / pain over A-1 pulley (base of finger)
Catching of digit with flexion
Dx test unnecessary
Trigger finger - tx
Cortisone injection (approx. 60% cure rate) Sx release of A-1 pulley (approaches 100% cure)
Trigger finger - in general
All ages (even newborns) Common in DM Repetitive motion? Complaint is finger(s) locking/catching Ring, long, thumb - most common Cause - unknown
DeQuervain’s Tenosynovitis - in general
Common adult (usually repetitive) d/o
May be seen post-partum
May be confused with thumb or wrist arthritis
DeQuervain’s Tenosynovitis - Exam findings
Complaint is wrist/thumb pain when lifting
Tender over 1st dorsal compartment (dorsal-radial wrist)
Swelling
Positive Finklestien’s test
DeQuervain’s Tenosynovitis - dx testing
Unnecessary
DeQuervain’s Tenosynovitis - Patho
Inflamed / swollen first dorsal compartment tendons and sheath
DeQuervain’s Tenosynovitis - tx
Thumb spica splint NSAIDs Cortisone injections (70%) Sx for refractory cases (release sheath)
Swan neck deformity - in general
Flexed DIP, hyperextended PIP
Loss of terminal extensor tendon
Commonly seen in RA or trauma
Swan neck deformity - tx
Recommend referral to hand surgeon
Flexible - splint PIP
Rigid - may need sx
Swan neck deformity - dx tests
X-ray
Boutonniere deformity - in general
Hyperextended DIP, flexed PIP
Boutonniere deformity - patho
Caused by loss of central tendon
Volar sublux of lateral bands
Boutonniere deformity - tx
May be closed (splint tx) or open (sx repair)
Tendon laceration - in general
Flexor or extensor tendons
Be leery of any cut on the hand
PE is key to dx
Often with nerve / vessel injury
Flexor Tendon laceration
Profundus and/or Sublimus tendons - recognize the normal cascade
Zones are important
Requires timely repair (within 3 weeks)
6-8 weeks rehab (hand therapist)
Profundus Tendon test
Flexion of the DIP only
Sublimus tendon test
Flexion of the PIP and MCP of one finger
Mallet finger - in general
Direct blow to extended digit
Present with drooping of DIP joint
May have a displaced fx fragment (take an x-ray)
Mallet finger - tx
Most tx with extension splint for 8 weeks
If joint is sublux, tx with ORIF or pinning
Gamekeeper’s thumb - in general
Ulnar collateral ligament tear of thumb (skier’s thumb)
Cause is blow to / fall on thumb
Severe MP joint pain & swelling
Gamekeeper’s thumb - exam
Laxity with valgus stress
Gamekeeper’s thumb - tx
If laxity present - sx
If partial tear (stable) - splint for 6 weeks
Phalanx fx - distal
Usually tx non-operatively
Phalanx fx - middle, proximal
Often unstable
If displaced, intra-articular or malrotated fx - ORIF vs. pinning
If non-displaced - splint appropriately
“jammed” finger - in general
Pt presents with swollen PIP joint after a blow to end of finger
All age groups
Often sports related
“jammed” finger - exam
Tender
Swollen
Stiff PIP joint
“jammed” finger - imaging
Isolated x-ray of digit
AP
Lat
May see small avulsion fx (volar plate injury)
“jammed” finger - tx
Early ROM
PIP fx / sublux
Presents similar to “jammed finger”
Lateral x-ray is key to dx
Requires CRIF or ORIF
Must restore joint congruity
Metacarpal / boxer’s fx
Usually caused by a direct blow Present with local pain / swelling Check carefully for rotational deformity (requires ORIF) "Knuckle" often depressed Most tx non-operatively Can accept 45° of angulation
Metacarpal shaft fx
Tx with splint if non-displaced or minimally displaced
Requires ORIF if significantly displaced or malrotated
Bennett’s fx
Intra-articulat fx at base of thumb metacarpal
Unstable injury (CMC joint sublux)
Requires ORIF or pinning
Distal radius fx - in general
Commonly referred to as Colle’s fx
Most common adult upper extremity fx
Usual cause is fall on an outstretched wrist (FOOSH)
Distal radius fx - tx
Depends on degree of displacement, age and activity level of pt
Colles’ fx - exam
Clinical deformity
Tender over distal radius