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Clin Med IV Exam 1 > Hand and Wrist Injuries > Flashcards

Hand and Wrist Injuries Flashcards

1
Q

What is Boxer’s Fracture ?

A

Fx of the 5th metacarpal neck

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2
Q

MOI Boxer’s Fx

A

Object struct w/ a closed fist

VOLAR angulation up to 40deg

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3
Q

Is rotational deformity acceptable in a boxer fracture?

A

NO; need surgery

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4
Q

What kind of splint/cast do you want to put a pt w/ a boxer fx in?

A

ULNAR GUTTER SPLINT 1st then transition to ULNAR GUTTER CAST (3-4wks)

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5
Q

What is a Bennet Fracture-Dislocation?

A

2 part fracture of BASE OF 1ST METACARPAL d/t force ABDUCTION of 1st metacarpal

intra-articular
thumb fracture

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6
Q

Comminuted intra-articular fx of 1st metacarpal is what?

A

ROLANDO FRACTURE

worst prognosis

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7
Q

What kind of splint/cast do you want to put a pt w/ bennet fx in?

A

THUMB SPICA SPLINT/CAST

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8
Q

Indication to do CRPP (closed reduction percutaneous pinning) fixation ?

A
  • <3mm displacement
  • break of fx <50% of palmar slope of MC
  • when concave dome of MC maintained
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9
Q

What is the most frequently fractured carpal bone?

A

SCAPHOID

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10
Q

What area on the hand can you palpate for tenderness when looking for a scaphoid fracture?

A

Snuff box

over scaphoid tuberosity

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11
Q

What ROM is limited in scaphoid fx?

A

Wrist flexion & extension

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12
Q

What MOI can cause a scaphoid injury?

A

FOOSH

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13
Q

What artery provides blood supply to scaphoid?

A

Dorsal carpal branch of radial artery

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14
Q

Which type of scaphoid fx will take longer to heal?
A. distal third fx
B. middle third fx
C. proximal third fx

A

Distal third fx (6-8wks)
Middle third fx (8-12wk)
Proximal third fx (12-23 wks)***

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15
Q

When would you get an MRI for a hand/wrist injury?

A

Occult fx or if surgery is indicated

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16
Q

How would you tx a non-displaced scaphoid fx?

A

THUMB SPICA SPLINT (6wks) followed by cast until radiographs shows signs of union

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17
Q

How often do you want to do a cast change and why?

A

q10-14 days for 1st 6wks

*want cast to remain firm around wrist

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18
Q

Basal Joint Arthritis presentation

A
  • insidious radial thumb pain that worsens w/ use
  • decrease strength & dexterity
  • increase pain w/ opposition (writing, opening jars, carrying heavy objects)
  • Crepitus
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19
Q

Where in the hand is basal joint arthritis seen?

A

1st carpal metacarpal joint

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20
Q

In what pt population is basal joint arthritis most commonly seen?

A

Post-menopausal women

50-70yo

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21
Q

What kind of test can you do to elicit pain for basal joint arthritis?

A

GRIND TEST of trapeziometacarpal joint

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22
Q

Tx for Basal Joint Arthritis?

A
  • Tylenol
  • NSAID (short term)
  • splinting
  • ice
  • intraarticular cortisone injection (not that great)
  • total joint replacement
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23
Q

Boutonniere Deformity

A

Flexion of PIP joint
Hyperextension DIP joint

*Manifestation of RA in hands

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24
Q

Swan Neck Deformity

A

Hyperextension PIP joint

Flexion DIP joint

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25
Q

Causes of swan neck deformity

A

Trauma
RA
Scleroderma
Psoriatic arthritis

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26
Q

What test can you do to dx Carpal tunnel syndrome?

A

Tinnel test

Phalen test

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27
Q

What nerve is being compressed in carpal tunnel syndrome?

A

MEDIAN NERVE

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28
Q

What is compressing the median n in carpal tunnel syndrome?

A

Transverse carpal ligament

d/t decrease canal size or increase vol of soft tissue structures in canal

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29
Q

What can you do to tx carpal tunnel syndrome?

A
  • Wrist splint
  • PT
  • Ergonomics
  • Steroid injection
  • Surgery
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30
Q

Positive Finkelstein test is diagnostic for what?

A

deQuervain’s Tenosynovitis

stenosing tenosynovitis of 1st dorsal compartment of wrist

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31
Q

Si/Sx deQuervain’s Tenosynovitis

A

pain, swelling, point tenderness along dorsal radial aspect of wrist

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32
Q

Tx of deQuervain’s Tenosynovitis

A
  • rest/activity modification
  • thumb spica cast/splint immobolization
  • NSAIDs
  • PT
  • steroid injection
  • surgical decompression of 1st dorsal compartment
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33
Q 
When would you NOT use a thumb spica cast/splint?
A. Bennet fracture
B. Scaphoid fx
C. deQuervain's Tenosynovitis
D. Boxer fx
E. Gamekeeper's thumb
A

D. boxer fx (fx of 5th MC neck)

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34
Q

What is being injured in Gamekeeper’s thumb?

A

Ulnar collateral ligament of thumb at MCP joint

causes decrease thumb grip

35
Q

What imaging do you need for gamekeeper’s thumb?

A

Stress view and MRI

Plain films might not show deviation

36
Q

Tx Gamekeeper’s thumb?

A

Partial tear:
-thumb spica cast/splint 4-6wks

Complete tear:

  • open repair of avulsed ligament
  • necessary stener lesion
37
Q

Kanavel cardinal signs are for what? and what are they?

A

HAND INFECTIONS

  1. Tenderness along flexor tendon
  2. edema
  3. Pain w/ passive extension**
  4. flexed resting posture
38
Q

What can cause a hand infection?

A

Cat bite
human bite
puncture wound (IV drug use)

39
Q

Common bacteria hand infection

A

Staph*
Strep
Pasteurella (cat bite)
Oral anaerobes

40
Q

Why would get an x-ray for a hand infection?

A

Looking for FOREIGN BODIES & OSTEOMYELITIS

41
Q

TX hand infection?

A 
Cephalexin (Keflex)
Clindamycin
Cefazolin
Unasyn
Vancomycin

Surgical wash out

42
Q

Tx for finger dislocation?

A
  • Volar alumafoam splint
  • buddy tape
  • tylenol, nsaid, ice
  • follow up w/ hand surgeon
43
Q

Presentation of mallet finger?

A

Inability to extend DIP joint

slight flexion at rest “mallet”

44
Q

MOI of mallet finger?

A

extended DIP undergoes sudden FLEXION

extended finger struct at tip by an object

45
Q

What splint do you put a mallet finger in?

A

STAX SPLINT 6-8wks in slight hyperextension (10deg)

MUST NOT REMOVE FOR 6-8WKS

46
Q

Presentation of jersey finger?

A

Inability to FLEX finger at DIP joint

slight extension at joint

47
Q

What tendon is being injured in a jersey finger?

A

Flexor Digitorum Profundus (FDP) tendon (from insertion at base of distal phalanx

48
Q

MOI jersey finger

A

Sudden HYPEREXTENSION of actively flexed finger
(grabbing opponent’s jersey during rugby)

Ring finger is commonly involved

49
Q

What imaging would you get for jersey finger?

A

MRI–shows disruption of FDP at volar base of distal phalanx +/- avulsion fx

X-ray often normal

50
Q

Presentation of trigger finger

A
  • difficult to straighten or bend affected finger
  • finger transiently gets “locked” in flexed position & then w/ painful snapping sensation goes into extension
  • pt has to MANUALLY extend their finger
51
Q

MOI of trigger finger

A
  • stenosing flexor tensoynovitis
  • d/t repetitive microinjury from frequent flexion-extension movement of fingers –> result in thickening of flexor tendon sheath & tendon
52
Q

In what pt population may you see a trigger finger?

A

Women 50-60yo
Diabetic
Rheumatoid arthritis

53
Q

Tx of trigger finger

A

NSAID
Splinting
Glucocorticoid injection
Surgery–release A1 pulley

54
Q

Pt presents w/ the inability to grip everyday objects. The pt noticed this after falling from skiing. X-ray doesn’t show any abnormalities. What additional view may you get to help you with your diagnosis?

A

Stress view –> for gamekeeper’s (skier) thumb

MRI for surgical planning

55
Q

Pt presents w/ 4th DIP joint in slight extension. Pt cannot actively flex the finger. Pt noticed this after playing rugby and grabbing the opponent’s shirt. What injury may this be?

A

Jersey Finger–avulsion injury of flexor digitorum profundus tendon

56
Q

45yo pt w/ a hx of heroin use presents w/ erythematous and swollen hand. Hand is slightly flexed and passive extension elicits pain. Based on the dx, what tx would you use?

A. I & D
B. Cephalexin
C. Metronidazole
D. NSAIDs

A

B. Cephalexin for the hand infection!
Also surgical wash out

Caused by: cat bite, human bite, puncture wound

57
Q

55yo postmenopausal female presents w/ her 4th finger in a flexed position. She reports that she has manually extend her finger and when she does, it is VERY painful. What mechanism is causing this injury?

A

Stenosing flexor tenosynovitis –> thickening of flexor tendon sheath; repetitive microinjury from frequent flexion-extension

Trigger Finger

58
Q

Presentation of Duputren’s Contacture?

A
  • thickening or nodules in palm
  • painless initially
  • can progress to be painful w/ inflammation
  • usually ulnar side of both palms
  • 4th and 5th fingers affected earliest
  • loss of full extension of hand & fingers
59
Q

MOI of duputren’s contracture

A

Benign slowly progressive fibrosis of palmar fascia

commonly male >50yo
White northern european

60
Q

Tx of Duputren’s contractures?

A
  • cortisone injection into sheath
  • surgery w/ open fasciotomy
  • collagenase injection
  • ppx external beam radiation therapy
61
Q

T/F Mucous cyst seen in all ages

A

False!
Seen in pt 50-70yo
Ganglion cyst is seen in all ages

62
Q

Presentation of ganglion cyst

A
  • swelling +/- joint pain
  • cyst smooth, firm, rounded & rubbery (usu dorsal wrist)
  • sometimes tender
63
Q

Tx ganglion cyst

A

-splinting
-needle aspiration (apple jelly appearance)
-surgical removal for recurrent cysts
(40% recurrence rate)

64
Q

Mucous cyst presentation

A
  • visible swelling dorsal side of finger (DIP joint)
  • translucent nodule
  • groove in fingernail*
65
Q

Tx mucous cyst

A
  • intralesional corticosteroid injections

- surgical excision

66
Q

HSV-1 + Painful fingertip = ?

A

Herpetic whitlow

67
Q

Herpetic whitlow presentation

A

Painful, edematous fingertip w/ vesicular lesions

Most common digit: thumb, index finger

68
Q

Dx herpetic whitlow

A

Clinical
Tzank smear
Viral cx
Serum antibody titers

69
Q

Tx Herpetic Whitlow

A
  • Self-limited (approx 3wks)
  • Sx relief
  • Acyclovir
  • Famciclovir
  • Valacyclovir
70
Q

Felon presentation

A
  • throbbing pain
  • tension
  • edema
  • erythema
71
Q

MOI of felon

A
  • infection of fingertip pulp
  • thumb and index finger common affected
  • can lead to ischemic necrosis & osteomyelitis
72
Q

Dx felon

A

Clinical

Culture any fluid (staph, MRSA, eikennel corrodens, GI pathogens)

73
Q

Tx Felon

A

I&D
Abx directed at staph & MRSA
(cephalexin, doxycycline, dicloaxacillin, clinda, nafcillin, bactrim)

74
Q

What would you NOT want to inject in a fingertip/nail injury?

A

No ring block

No epi

75
Q

How would you tx a subungal hematoma of of the nailbed?

A

Trephination –> drill hole

76
Q

Stellate laceration to nail. How would you repair?

A
  • put any free tissue back into place
  • suture nail bed
  • small absorbable sutures
  • suture nail plate back
  • trephination
77
Q

Early presentation of compartment syndrome

A

Pain out of proportion to injury

Parethesia (pin and needle sensation

78
Q

Late presentation of compartment syndrome

A 
Pain
Pallor
Parethesia
Paralysis
Pulselessness --> LAST
79
Q

What pt population may you see compartment syndrome in?

A
  • Athletes
  • young men
  • following trauma
  • pt w/ casted extremity
  • pt w/ fx of radius & ulnar
80
Q

TX for compartment syndrome?

A

Fasciotomy (relieve pressure in compartment)

Will need to return to OR for closure at later date

81
Q

How often can you give an intra-articular corticosteroid injection to a single joint within a year?

A

3 injections per joint in 12month period

82
Q

Adverse reactions to intra-articular corticosteroid injection

A
  • Blanching of skin
  • localize fat atrophy
  • injection
  • transient rise in blood glucose
83
Q

Non traumatic cases that can cause compartment syndrome

A
  • Animal venom
  • Injection recreational drug
  • Prolong compression
  • Thrombosis vascular dz

Clin Med IV Exam 1 (9 decks)

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