Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK > Hand and Wrist Conditions > Flashcards

Hand and Wrist Conditions Flashcards

1
Q

What bone fractures account for 70-80% of Carpal bone fractures?

What is the most common mechanism of injury?

A

Scaphoid fractures

Adolescents + young adults fall onto an outstretched hand (resulting in hyperextension and impaction against rim of radius)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

List 3 ways a Scaphoid fracture presents

A
  • Pain in anatomical snuffbox, exacerbated by wrist movement
  • Passive range of motion is reduced (but not dramatically)
  • Swelling around radial and posterior aspects of wrist (common)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which parts of the scaphoid are affected in a fracture

Why is delayed diagnosis common

A
  • Waist (70-80%)
  • Proximal pole (10%)
  • Distal pole/ scaphoid tubercle (10%)

X-rays taken immediately after the fracture may not show the fracture line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What do you do if an X-ray doesn’t show a Scaphoid fracture line?

A
  • Follow up X-ray after 10 to 14 days (fracture line might be more visible after some bone resorption)
  • CT/ MRI if symptomatic and X-ray still doesn’t show fracture after 10 to 14 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Since the blood supply to scaphoid is retrograde, what can a fracture cause?

A

Avascular necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a Colles’ fracture?

In 50% of cases, what accompanies this?

A

An extra-articular fracture of the distal radial mepaphysis, with dorsal angulation and impaction

(most common type of radial fracture)

Associated ulnar styloid fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What patient group are Colles’ fractures most commonly seen in? Why?

A

Post-menopausal women, as they are common in osteoporosis patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the usual mechanism of injury for a Colles’ fracture

Why is the fracture dorsally angulated and impacted

A

Fall onto outstretched hand with pronated forearm, and dorsiflexed wrist

Energy is transmitted from carpus to distal radius in a dorsal direction and along the long axis of the radius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does Colles’ fracture present in 3 ways

How can most of them be treated

A

Wrist is;

  • Painful
  • Deformed
  • Swollen

Reduction and immobilisation in a cast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

State 4 complications of a Colles’ fracture

A
  • Malunion (results in a dinner-fork deformity)
  • Median nerve palsy, post-traumatic carpal tunnel syndrome
  • Secondary osteoarthritis
  • EPL tendon tear (Tendon goes over sharp bone fragment)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a Smith/ Smith’s fracture?

Why can these be thought of as a reverse Colles’ fracture

A

Fractures of the distal radius with volar/ palmar angulation of the distal fracture fragment

80% are extra-articular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

In what 2 patient groups do Smith fractures usually occur?

What are 2 usual mechanisms of injury?

A 
Young males (most common) 
Elderly females

Fall onto dorsum of a flexed wrist
Direct blow to back of wrist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the result of Malunion of a smith fracture, with residual volar displacement of distal radius?

A

Garden spade deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does Garden Spade deformity affect the carpal tunnel

A

Narrows and distorts the carpal tunnel, can result in carpal tunnel syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Rheumatoid arthritis is described as a symmetrical polyarthritis. What does this mean?

A

Affects multiple joints usually in a symmetrical distribution (right and left wrists at same time)

(Makes it hard to diagnose as there’s no normal hand to compare with)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How can patients with RA of MCPJs and IPJs present in 5 ways?

A
  • Pain and swelling of MCPJs and PIPJs of fingers
  • Erythema overlying the joints (inflammation)
  • Stiffness, that is worst in morning or after inactivity
  • Carpal tunnel syndrome
  • Fatigue and flu like symptoms (systemic nature of rheumatoid disease)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Name 2 hand deformities associated with Rheumatoid Arthritis

A

Swan neck deformity

Boutonnière deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does Swan Neck deformity present in 2 ways

How does Boutonnière deformity present in 2 ways

A

Swan neck deformity;

  • Hyperextension of PIPJs
  • Flexion of MCPJs and DIPJs

Boutonnière deformity

  • Hyperextension of MCPJs and DIPJs
  • Flexion of PIPJ
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

In Swan neck deformity, why is the PIPJ hyperextended

Why is the DIPJ flexed

A

PIPJ: Tissues on palmar aspect of PIPJ become lax (due to adjacent synovitis)

DIPJ: Elongation/ rupture of insertion of ED into base of distal phalanx (results in a mallet deformity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

In Boutonnière deformity, which muscle is affected and how?

A
  • Inflammation in PIPJ leads to lengthening/ rupture of central slip of ED at its insertion into dorsal surface of middle phalanx
  • Lateral bands of ED slip down the sides of the finger, so are now on the palmar surface at level of PIPJ
  • Act as flexors of PIPJ rather than extensors + Hyperextend the DIPJ
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is Psoriasis

A

A skin condition that causes red, flaky patches of skin covered with silvery scales

(Patches are generally on elbows, knees, scalp, lower back bu can be anywhere)

22
Q

What is Psoriatic Arthritis/ Arthropathy

Describe its pattern of development

A

Arthritis that develops in patients with psoriasis (most commonly in hands and feet)

Develop as an asymmetrical oligoarthritis (one joint at a time, in an asymmetrical manner)

23
Q

How does Psoriatic Arthritis/ Arthropathy present in 2 ways

A
  • Dactylitis (digit swelling)
  • Affected joints stiffen

(Can progress to widespread joint destruction- arthritis mutlians)

24
Q

Compare the joints affected by RA and Psoriatic Arthritis

A

RA: MCPJs, PIPJs

PA: DIPJs

25
Q

How are 80% of Psoriatic Arthritis patients nails’ affected?

A

Have nail lesions such as Pitting or Oncholysis (Separation of nail from nail bed)

(Oncholysis can also be caused by hyperthyroidism and fungal nail infections)

(Pitting is very typical of psoriasis)

26
Q

Which hand joint is most commonly affected by Osteoarthritis?

Which patient group is it more common in?

A

Carpometacarpal joint 1 (CMCJ)

(Between trapezium and metacarpal 1)

Women

27
Q

How does OA of CMCJ 1 present in 3 ways?

What happens in the later stages?

A
  • Pain at base of thumb, relieved by rest/ aggravated by movement
  • Increased stiffness following periods of rest (mornings)
  • May be swelling around base of thumb
  • In later stages, metacarpal subluxes in an ulnar direction-> Loss of normal contour and ‘squaring of the hand’
28
Q

What are Heberden’s nodes?
What are they a classic sign of

When do they typically develop?
In what patient group are they more common?
Describe the cause

A

Bony swellings of the DIPJs
Classic sign of OA

  • Typically develop in middle age
  • More common in women
  • Tend to run in families (suggesting a genetic predisposition)
29
Q

What are 2 possible ways that Heberden’s nodes begin?

Heberden’s nodes are bony swellings of the DIPJs. What are they called if the swellings are on the PIPJs?

A
  • Chronic swelling of affected joints
  • Sudden onset of pain, swelling and loss of manual dexterity

Bouchard’s nodes

30
Q

What is Carpal Tunnel Syndrome?

What are 5 risk factors?

A

Compression of the median nerve as it passes through carpal tunnel into hand (most common site of nerve entrapment in body)

  • Obesity
  • Repetitive work
  • Pregnancy
  • Hypothyroidism
  • Rheumatoid arthritis
31
Q

List 3 sensory symptoms/ signs of carpal tunnel syndrome

A
  • Parasthesia in cutaneous distribution of median nerve (except palm)
  • Worse at night (wrist drifts into flexion when aslee, further narrowing the tunnel and waking patient up)
  • As condition worsens, daily activities aggravate parasthesia
32
Q

Why is sensation in palm normal in carpal tunnel syndrome

A

Palm supplied by palmar cutaneous branch of median nerve, which branches off proximally to carpal tunnel and passes superficial to palm

33
Q

In carpal tunnel syndrome, the motor branch of the median nerve to the thenar muscles is affected.

This causes weakness/ atrophy of the thenar muscles (OP,FPB Superficial head, APB)

Explain the effects on;

  1. Thumb flexion
  2. Thumb adduction
A

Flexion;
- Possible as FPL and FPB deep head are functioning

Adduction;
- Possible as adductor pollicis is functioning

34
Q

How many carpal tunnel syndrome patients can experience pain?

Where is the pain? (4 places)

A

Up to 1/3rd

  • Proximal forearm
  • Elbow
  • Shoulder
  • Neck
35
Q

What is Ulnar tunnel/ Guyon’s canal syndrome or Handlebar palsy?

How does it present in 2 ways?

A

Compression of ulnar nerve in Guyon’s canal (as it passes lateral to the pisiform bone over the palmar surface of the flexor retinaculum)

  • Parasthesia in ring and little fingers
  • Progressing to weakness of intrinsic muscles supplied by ulnar nerve
36
Q

What is Dupuytren’s contracture

A

A common condition in which there is localised thickening and contracture of the palmar aponeurosis, leading to a flexion deformity of adjacent fingers

37
Q

Describe the 4 stages in the process of how Dupuytren’s contracture comes about

A
  1. A painful/ painless thickening/ NODULE forms in palm
  2. Myofibroblasts of ‘nodule’ contract-> Formation of tight bands called CORDS in Palmar Fascia
  3. Overlying skin is tightly adherent to palmar aponeurosis, so becomes involved as well as proximal fascia+skin of fingers
  4. Fingers stuck in a flexed position, can’t passively straighten (Fixed flexion)
38
Q

In Dupuytren’s contracture, what are the most common digits to be affected?

A

Ring and little finger (But thumb and first webspace may also be involved)

39
Q

Name 3 patient groups in Dupuytren’s contracture is most common

What are 2 causes?

A
  • People between 40 and 60
  • Males
  • People of Northern European origin
  • Inherited (Autosomal Dominant) (70% of cases)
  • Sporadic (Infrequently and irregularly)
40
Q

List up to 10 risk factors for Dupuytren’s contracture

Only need to know 5

A
  • Type 1 Diabetes
  • Smoking
  • Frozen shoulder/ adhesive capsulitis
  • HIV
  • Trauma to hand/ fingers
  • Vibration related hand injury
  • Liver disease and/ or excessive alcohol consumption
  • Heart disease
  • Hypeercholesterolaemia
  • Hypo/ Hyperthyroidism
41
Q

In an injury to the radial nerve in the radial groove of the humerus, will the patient be able to actively extend their elbow?

Explain why

A

Yes (Will be normal or mildly compromised)

Nerve supply to long+lateral triceps heads is given off before the radial nerve enters the groove

Supply to the medial head is given off IN the groove, but this is usually proximal to the fracture

42
Q

In an injury to the radial nerve in the radial groove of the humerus, what position will the patient’s wrist and fingers be in when pronated?

Explain why

A

Wrist and fingers will be flexed due to gravity

Paralysis of Brachioradialis + all extensor muscles of wrist and fingers

(results in inability to actively extend fingers and wrist drop- inability to actively extend wrist

43
Q

What is a High Median Nerve Injury

What is the clinical appearance of the hand;

  1. When making a fist
  2. At rest, in a long standing lesion
A

Injury to median nerve in the arm

  1. Hand of Benediction (Index, middle fingers don’t flex when making a fist)
  2. Ape Hand Deformity (Thumb flexed at MCPJ, wasting of thenar eminence)
44
Q

What is a Low Median Nerve Injury

How does the hand present?

A

Injury to median nerve at the wrist

Ape Hand Deformity

45
Q

What can long-standing damage to the ulnar nerve at the wrist result in?

(Low ulnar nerve lesion)

A

Ulnar claw/ claw hand, affecting little and ring fingers

Fingers are hyperextended at MCPJ, flexed at PIPJs and DIPJs

46
Q

In Ulnar claw, why are the MCPJs of fingers 4,5 hyperextended

A

Normally, Lumbricals 3,4 (ulnar nerve )flex MCPJs

These are paralysed

Thus, unopposed extension from Extensor Digitorum

47
Q

In Ulnar claw, why are the PIPJs DIPJs of fingers 4,5 flexed?

A

Normally, Lumbricals 3,4 extend the IPJs

These are paralysed

Thus, unopposed flexion from FDS and FDP

(ED cannot extend the joints, as they are occupied in hyperextending the MCPJs)

48
Q

What is High Ulnar nerve lesion?

A

Injury to ulnar nerve at the elbow

49
Q

Compare the Ulnar Claw formed in a High VS Low Ulnar Nerve lesion

A

Low:

  • Hyperextension at MCPJ
  • Flexion at PIPJs and DIPJs

High: (Less pronounced ulnar claw)

  • Hyperextension at MCPJ
  • Flexion at PIPJ only
50
Q

Explain the difference in Ulnar Claw in a High VS Low ulnar nerve lesion

A

In a High ulnar nerve lesion, FDP is paralysed as well as the muscles involved in a Low ulnar nerve lesion

Thus, no flexion at DIPJ

51
Q

Describe the Ulnar paradox

A

You would expect a High Ulnar Nerve Lesionto produce a more pronounced deformity than a LUNL (as it is more proximal), but in fact the opposite occurs

MSK (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions