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Hand and wrist Flashcards

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0
Q

When do you reduce a metacarpal fracture?

A

1) Any angulation of second and third digits
2) Greater than 20° of angulation at the fourth digit
3) Greater than 30° of angulation at the fifth digit

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1
Q

What is the test of choice and best treatment modality for hook of hamate fractures?

A

CT scan

Excision of the hamate.

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2
Q

What is a Bennett fracture and how do you treat it?

A

It’s an interarticular non-comminuted fracture at the base of the first metacarpal and it is treated with ORIF.

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3
Q

What is a Rolando fracture and how is it treated?

A

It’s an intra-articular comminuted fracture at the base of the first metacarpal and it is treated with internal or external fixation. It has a worse prognosis compared to a Bennett fracture.

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4
Q

What defines an unstable scaphoid fracture?

A

More than 1 mm of displacement, Malangulation or associated carpal instability.

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5
Q

When does a distal radius fracture require surgery?

A
  1. Displaced and comminuted
  2. Intra-articular
  3. Loss of radial inclination, a dorsal tilt greater than 20° or an articular step off greater than 2 mm
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6
Q

Which pole of scaphoid fractures have a worse prognosis for healing and why?

A

Proximal pole. Secondary to retrograde flow of blood to the proximal pole via the dorsal vessels of the radial artery.

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7
Q

Which direction will a middle phalanx fracture go if it’s proximal or distal?

A

If it’s a proximal fracture of the middle phalanx, it will angulate dorsally and if it’s a distal fracture it will angulate volarly.

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8
Q

What is the recommended treatment for perilunate dislocations or lunate dislocations?

A

Surgical treatment with closed or open reduction

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9
Q

A jammed finger or proximal interphalangeal joint dislocation is more commonly dislocated dorsally or volarly?

A

Dorsally. Usually one of the collateral ligaments in conjunction with the volar plate are injured. Treat with buddy taping if stable

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10
Q

How do you define an unstable proximal interphalangeal joint dislocation and how do you treat it?

A

If there is an intra-articular fracture of the base of the middle phalanx affecting 40% or more of the joint surface. It can be treated with a dorsal extension block splint with incremental extension of the splint and digit performed on a weekly basis for four weeks.

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11
Q

What is Watson’s sign and what does it suggest?

A

You apply a dorsal load to the distal pole of the scaphoid as the wrist is moved from Ulnar to radial deviation. Reproduction of pain and hearing a pop is a positive test and suggests scapholunate ligament insufficiency.

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12
Q

What type of radiographs do you obtain and what will it show for a scapholunate instability?

A

AP and pronated clenched fist views. It will be positive if there is a gap of 2 to 3 mm and shortened appearance of the scaphoid with the ring sign.

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13
Q

How do you image for scapholunate instability and what is the treatment?

A

MR arthrogram, or arthroscopy. Acutely (3 to 4 weeks): open surgical treatment. Chronic (greater than three months) surgical repair when anatomic reduction is possible otherwise partial wrist arthrodesis.

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14
Q

What is a Stener lesion?

A

It’s when the ulnar collateral ligament of the first MCP ruptures. The UCL detaches from the base of the proximal phalanx and is transposed dorsal to the abductor aponeurosis, thus facing proximately. It is present in 50 to 70% of suspected cases and is best treated with surgery.

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15
Q

What is the nonoperative treatment for a first MCP or ulnar collateral ligament injury (gamekeepers thumb)?

A

Short arm thumb spica cast for four weeks and then removable spica splint for 2 to 4 months.

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16
Q

What two tendons are affected in DeQuervains tenosynovitis?

A

Abductor pollicis longus and the extensor pollicis brevis (APL and EPB).

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17
Q

What is a jersey finger and how is it treated?

A

Flexor digitorum profundus avulsion at the distal phalanx. The ring finger is most commonly involved. Inability to flex the DIP actively. Surgery is the treatment of choice in acute cases and should be considered within 7 to 10 days.

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18
Q

What is intersection syndrome?

A

Pain at the crossing points of the APL and EPB with the radial wrist extensors 4 to 6 cm proximal to listers tubercle. Treatment is conservative.

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19
Q

What is a mallet finger and how is it treated?

A

Usually caused by a ball hitting the tip of the finger. Disruption of the terminal extensor tendon at its insertion on the distal phalanx. The patient can’t extend the DIP actively. Treatment is splint DIP in extension for six weeks then for four weeks at night.

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20
Q

What is a boutonniere deformity and what causes it?

A

Rupture of the central slip of the extensor mechanism at its insertion on the base of the middle phalanx. The PIP is flexed and the DIP is extended. Treatment is splint PIP in extension for six weeks.

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21
Q

Why should you always x-ray nailbed injuries?

A

To check for fractures of the phalanx.

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22
Q

What is a clay shovelers fracture?

A

It is an evulsion fracture of the spinous process in the lower cervical spine or upper thoracic spine. It is a stable fracture.

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23
Q

What is seidel’s test?

A

It’s an eye test used to rule out a corneal perforation.

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24
Q

What is the preferred treatment for obturator nerve entrapment?

A

Surgery

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25
Q

What type of symptoms will you see in anterior cord syndrome and how is it caused?

A

Lower extremity symptoms will dominate more than upper extremity symptoms. It is caused by hyperflexion of the cervical spine.

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26
Q

What is central cord syndrome and how is it caused?

A

Upper extremity symptoms will dominate over lower extremity symptoms and it is caused by hyperextension.

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27
Q

What is the most common mechanism of injury for the carotid artery?

A

Hyperextension

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28
Q

What are the borders of the femoral triangle?

A

Inguinal ligament, medial border of the adductor longus and medial border of the sartorius.

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29
Q

What is the main arterial blood supply to the ACL in the knee?

A

Middle genicular artery

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30
Q

What muscles make up the erector spinae?

A

Iliocostalis, longissimus and spinalis muscles.

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31
Q

What type of antibiotic can cause prolonged QT syndrome in children and tendon rupture in the elderly?

A

Fluoroquinolones

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32
Q

Which antidiabetic agent can cause lactic acidosis during exercise?

A

Metformin (Glucophage)

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33
Q

Which antihypertensive is a good choice for athletes?

A

Calcium channel blocker-Amlodipine

Has little effect on heart rate.

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34
Q

How long should you wait for activity after injecting a corticosteroid into a joint?

A

48 hours. You should also not fully submerge for 48 hours after injection.

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35
Q

Can you use creatine in the NCAA?

A

Yes, but not according to WADA

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36
Q

What are the criteria for compartment pressure testing for the leg for compartment syndrome, preexercise, one minute postexercise and five minutes post-exercise?

A

Greater than 15 mmHg pre-exercise, greater than 30 mmHg one minute post-exercise and greater than 20 mmHg five minutes post-exercise.

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37
Q

Why shouldn’t you excessively stretch previously immobile limbs after a contusion or use heat right away after a contusion?

A

It increases the risk of myositis ossificans

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38
Q

What is the gold standard to detect myositis ossificans and why do you not want to do an MRI or biopsy?

A

Bone scan is the gold standard.

An MRI or biopsy will look like a sarcoma.

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39
Q

How long should you wait to resect myositis ossificans if it is symptomatic?

A

6 to 12 months.

40
Q

What is the best imaging modality to diagnose tendinopathy?

A

Ultrasound

41
Q

How do you treat incomplete tendon ruptures?

A

You have to use a cast or splint. Daily range of motion exercises within protected range is also needed.

42
Q

What is a desmoid tumor?

A

It’s a benign but locally aggressive tumor in the muscle. It’s due to overgrowth of fibroblasts in the muscle.

Treat with surgical excision and consider chemotherapy.

43
Q

What does parathyroid hormone do?

A

Increases serum calcium and decreases phosphate

44
Q

What does vitamin D –1, 25 do?

A

Increases serum calcium and phosphate

45
Q

How long does it take for adequate strength in a bone fracture?

A

3 to 6 months

46
Q

What is the indication for an oats procedure?

A

Age less than 45 years, chondral/osteochondral defects less than 2 cm

47
Q

What is the indication for an allograft surgery for an osteochondral lesion?

A

Age less than 30 years and a defect greater than 2 cm

48
Q

What’s a positive Wilson sign and what is it used to diagnose?

A

It’s for osteochondritis desiccans and it is when pain is provoked by extending the knee from 90° to 0° of flexion with the tibia internally rotated

49
Q

What is a Jeffersons fracture and how do you treat it?

A

It’s a burst fracture of C1 from an axial load and is treated with surgery.

50
Q

What is Klippel-Feil syndrome?

A

Patients usually have a short webbed neck with decreased range of motion and short hairline.

Type III includes multiple fused cervical segments that are contiguous and therefore they cannot play if it involves above C3.

There are associated renal abnormalities seen with these patients.

51
Q

In cervical spinal cord injuries, when should methylprednisolone be started?

A

Within three hours

52
Q

What is Bertolotti’s syndrome?

A

When there is sacralization of the L5 vertebrae and this creates degenerative disc disease at L4-5 which is symptomatic.

53
Q

What defines an unstable compression fracture?

A

Greater than 40% loss of anterior body height or greater than 25° of kyphotic deformity

54
Q

Where can facet joint pain be referred to?

A

Flank, buttock, groin or thigh.

55
Q

How often should you re-image someone with adolescent idiopathic scoliosis?

A

Every 4 to 6 months until skeletally mature.

56
Q

When do you brace for scoliosis?

A

20 to 40°

57
Q

When should surgery be considered in scoliosis?

A

Greater than 40° in skeletally immature persons and greater than 50° in skeletally mature persons.

Or greater than 35° curve in neuromuscular disease.

58
Q

When do you use a Milwaukee brace?

A

For high thoracic curves at T8 or higher. Otherwise you can use a low profile TLSO.

59
Q

Where are most clavicular fractures?

A

Mid clavicle

60
Q

What is the most common treatment for a distal clavicle fracture?

A

Surgery using a coracoclavicular screw which should be removed at a later date.

61
Q

How many types of AC joint separations are there and which ones need surgery?

A

There are six and four through six require surgery, type III AC joint separations are controversial.

62
Q

What is the number one risk for recurrent dislocations of the shoulder?

A

Age

63
Q

What is the best view to identify a Hill Sachs lesion and what is a Hill Sachs lesion?

A

Stryker view. It’s a cortical depression of the posterior lateral humeral head after an anterior dislocation as the humeral head makes contact with the anterior glenoid fossa.

64
Q

What is a bony Bankart lesion and what is the best view to see it?

A

It’s a fracture of the anterior inferior glenoid and the best view is a West Point axillary view.

65
Q

What structures comprise the rotator interval?

A

Long head of the biceps, coracohumeral ligament and superior glenohumeral ligament

66
Q

How long is the recovery for pectoralis major ruptures after surgery?

A

4-6 months

67
Q

What range of motion is lost with adhesive capsulitis?

A

External rotation

68
Q

What is a Bennett’s lesion in the shoulder?

A

Calcification of the posterior band of the inferior glenohumeral ligament.

69
Q

What x-ray is needed in order to assess a sternoclavicular joint dislocation?

A

Serindipity view which is 45° of cephalic tilt centered on the sternoclavicular joint

70
Q

What is the imaging study of choice for a sternoclavicular joint dislocation?

A

CT scan and possibly a CT angiography to evaluate great vessels.

71
Q

What is the treatment for both anterior and posterior sternoclavicular joint dislocations?

A

Closed reduction if seen within seven days with a figure of 8 brace. Otherwise surgery and immobilize for 6 to 10 weeks.

72
Q

What nerve is affected with supracondylar fractures?

A

AIN

73
Q

What is a Volkman’s contracture in regards to supracondylar fractures?

A

Compartment syndrome, muscle necrosis and degeneration caused by brachial artery injury.

74
Q

How do you immobilize a type I olecranon fracture?

A

Immobilize in a long arm cast with 20° of flexion to minimize the pull of the triceps.

75
Q

What is the criteria for surgery for a coronoid fracture at the elbow?

A

If greater than 50% of the coronoid is involved, surgical intervention is required.

76
Q

What is the treatment for a nonoperative elbow dislocation?

A

Splint with the elbow in 90° of flexion for less than one week, then early protected range of motion with a hinge brace. The patient may return to play in 4 to 6 weeks.

Most are posterior dislocations.

77
Q

What muscle is usually involved with lateral epicondylitis?

A

Extensor carpi radialis brevis

78
Q

What structures are in the Carpal Tunnel?

A

Median nerve, flexor digitorum superficialis tendon, flexor digitorum profundus tendon and flexor pollicis longus tendon

79
Q

What makes up the quadrilateral space?

A

Teres minor superiorly, teres major inferiorly, long head of triceps medially, subscapularis anteriorly and the humeral shaft laterally

Posterior humeral circumflex artery and axillary nerve can get entrapped here.

80
Q

What will you see with posterior interosseous nerve syndrome and what is the treatment?

A

Painless weakness of wrist/finger extensors without sensory impairment.

Surgery often necessary.

81
Q

What is radial tunnel syndrome?

A

Controversial syndrome with pain of the extensor muscle mass several centimeters distal to the lateral epicondyle. Treatment is nonoperative.

82
Q

What nerve injury will you see froments sign?

A

Ulnar nerve. Cubital tunnel syndrome.

When trying to squeeze a piece of paper with the thumb and second digit, the interphalangeal joint of the thumb will flex indicating weakness of the adductor pollicis muscle with compensation by the flexor pollicis longus which is innervated by the anterior interosseous branch of the median nerve.

83
Q

What are the contents within the carpal tunnel?

A

The four tendons of flexor digitorum profundus, four tendons of flexor digitorum superficialis, flexor pollicis longus tendon and the median nerve

84
Q

What is the order of contents of the tarsal tunnel going anterior to posterior?

A

Tibialis posterior, flexor digitorum longus, posterior tibial artery/vein, tibial nerve, flexor hallucis longus

Symptoms are worse at night.

85
Q

What is the most common venous injury in sports?

A

Subclavian vein thrombosis (Paget-Von Schroetter syndrome)

Can lead to a pulmonary embolism. Presents with dull pain in upper limb, arm/hand with swelling. Diagnosis is made with Doppler ultrasonography. Treatment is emergent thrombolysis followed by decompression of the thoracic inlet and eight weeks of coagulation. Return to play= 3.5 months on average

86
Q

How do you perform Roos test for vascular thoracic outlet syndrome?

A

Abduction/external rotation of arms and opening and closing fists for three minutes will reproduce symptoms

87
Q

How do you perform Wright test for vascular thoracic outlet syndrome?

A

Loss of radial pulse or reproduction of symptoms with arm in 90° abduction/external rotation position

88
Q

How do you perform Adson maneuver for vascular thoracic outlet syndrome?

A

Loss of radial pulse during deep inspiration with the arms in anatomic position and the neck actively rotated towards the affected side

89
Q

How do you perform Halstead maneuver for vascular thoracic outlet syndrome?

A

Loss of radial pulse or reproduction of symptoms with scapular retraction and depression

90
Q

What is subclavian steal syndrome?

A

Proximal stenosis or occlusion of the subclavian artery leading to reversal of blood flow down the ipsilateral vertebral artery to supply the arm which compromises the vertebrobasilar circulation

91
Q

How does subclavian steal syndrome present?

A

Presyncope, syncope or CNF deficits. Can have arm weakness paresthesias and exertional claudication.

Angiography is gold standard to diagnose.

92
Q

What is iliofemoral endofibrosis?

A

Swollen thigh in cyclists which will give them a “dead leg” feeling. Effort induced claudication. Diagnosed by getting ABI postexercise and arteriography. Treatment is stenting or resection.

93
Q

What is the most sensitive test for popliteal artery entrapment?

A

Photoplethysmography

You’ll see decreased peripheral pulses with active ankle dorsiflexion and plantarflexion and extension.

94
Q

How long does someone need to be depressed to be diagnosed with major depressive disorder?

A

They need to be depressed daily for greater than two weeks.

95
Q

What is an educational sports psychology specialist?

A

Focuses on performance enhancement. Mental coach approach. Graduate degree in sport and exercise science, possibly psychology.

96
Q

What is a clinical sport psychologist?

A

Graduate degree in psychology. Licensed by state boards. Focuses on treating emotional disorders.

97
Q

What is the fluid recommendation for older athletes?

A

Drink 2 cups of fluids prior to exercise followed by 200 to 400 mL of water for every 20 to 30 minutes of activity

98
Q

Is there any difference between children and adults when it comes to exertional heat illness?

A

No

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