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Ortho/Rheumatology > Hand Injuries > Flashcards

Hand Injuries Flashcards

1
Q

How many bones are in the hand?

A

27 bones - 14 phalanges, 5 metacarpals, 8 carpal bones.

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2
Q

Metacarpal and phalangeal heads are __ with the bases __, midsection called the __?

A

Heads are distal with the bases proximal, midsection is called the shaft.

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3
Q

Name the 8 carpal bones?

A

Scaphoid-Lunate-Triquetrum-Pisiform.

Trapzium-Trapezoid-Capitate-Hamate.

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4
Q

Run through the palmar surface of the hand?

A

Refer to slide 6 of hand injuries.

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5
Q

What is the FDS and what does it do?

A

Flexor Digitorum Superficialis- superficial finger flexor.

Flexes the PIP and weakly flexes the MCP.

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6
Q

Where does the FDS bifurcate and insert?

A

Bifurcates at base of proximal phalanges and inserts at palmar aspect of the base of the middle phalanges.

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7
Q

How do you test the FDS or the FDP?

A

Place the pt’s hand dorsally on a flat surface, hold the proximal (FDS) or distal (FDP) phalanx and ask the pt to flex the finger.

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8
Q

What is the FDP and what does it do?

A

Flexor Digitorum Profundus.

Flexes the DIP and some PIP Flexion.

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9
Q

Where does the FDP bifurcate and insert?

A

Bifurcates the same as the FDS (near base of proximal phalanges) and inserts at base of the Distal Phalanges.

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10
Q

Why does inflammation or swelling present more on the dorsal side of the hand?

A

Lymphatic and venous drainage is mostly dorsal.

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11
Q

Extrinsic muscles of the hand…

A

proximal attachments in the forearm and distal attachments in the wrist or hand.

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12
Q

Intrinsic muscles of the hand…

A

proximal and distal attachments are within the hand.

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13
Q

Any Open, Intra-articular, Displaced or Rotational Fx requires what?

A

Ortho (or Plastics) consult - may be OR bound.

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14
Q

How much of the intra-articular surface must be involved to have an ortho consult?

A

1/3rd.

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15
Q

What is helpful when reducing a hand displacement for fracture?

A

Hematoma Block

  • 3-5 cc of 1% Lidocaine injected into Fx sit w/a 25 needle.
  • WAIT 15 mins to reduce.
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16
Q

Why no EPI for hand digital blocks?

A

EPI is a powerful vasoconstrictor; there are lots of small vessels that when vasoconstricted can cause significant necrosis.

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17
Q

Untreated Scaphoid fracture will lead to?

A

AVN -avascular necrosis.

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18
Q

What makes up the anatomical snuff box?

A

Extensor Pollicis Longus and Brevis, Abductor Pollicis Longus, Scaphoid makes up most of the floor along with the trapezium - the radial artery runs through it.

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19
Q

What is a Swan Neck Deformity?

A

Hyperextended PIP and Flexed DIP usually seen with chronic, non-traumatic arthritis.

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20
Q

Thumb laceration over the thenar eminence may involve what nerve? What may happen if untreated?

A

may involve the median nerve; untreated may lead to “Ape Hand,” which is thenar atrophy and loss of opposition.

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21
Q

Hypertrophic scars and contractures result from?

A

A perpendicular laceration of any of the major palmar creases that were not carefully realigned when suturing?

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22
Q

What is a paronychia? Eponychia?

A

A superficial infection or abscess over the lateral nail fold - Eponychia if infection over proximal nail soft tissue.

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23
Q

MC organism involved in a paronychia or eponychia?

A

Staphylococcus Aureus.

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24
Q

Treatment of acute and chronic paronychia/eponychia?

A

Acute - warm soaks, elevation, oral PCN-resistant PCS (dicloxicilin).
Chronic - I and D; usually very painful and swollen.

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25
Q

What is a Local block, Field Block and a Nerve Block?

A

Local Block - digital block into the wound edge, infiltrate on way out.
Field Block - digital block around something; ex: periauricular.
Nerve Block - complete anesthesia of an entire nerve; requires more lido - avoid injection into nerve itself, always aspirate.

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26
Q

What is a felon of the finger?

A

An infection that occurs within the closed-space compartments of the fingertip pulp - the swelling leads to intense throbbing pain.

27
Q

What is Flexor Tenosynovitis?

A

Infection within the closed space of the synovial sheaths that surround the flexor tendons.

The synovial sheaths lubricate and decrease friction during motion.

28
Q

Name the 4 Kanavel’s Signs? What does it indicate?

A

It indicates Flexor Tenosynovitis.

  • TTP along the course of the flexor tendon and sheath.
  • “Sausage Digit” - symmetric swelling of the finger.
  • Pain on passive extension.
  • Digit held in flexed posture.
29
Q

Treatment of Flexor Tenosynovitis?

A

Admit for IV antibiotics; possible OR for I and D if it progresses.

30
Q

What is DeQuervain’s Tenosynovitis? How do you treat?

A

Swelling of the thumb tendons - Abductor Pollicis Longus and Brevis, due to repetitive overuse of thumb.

Treat = rest, ice, NSAIDs, thumb spica splint.

31
Q

What is the Finkelstein’s Test used for?

A

If positive, depicts DeQuervain’s Tenosynovitis.

-Thumb is tucked into lightly closed fist, examiner passively ulnar deviates the wrist; if pain produced, +for DeQuervain’s Tenosynovitis.

32
Q

What is considered “no man’s land” when it comes to tendon lacerations of the palmar surface of the hand?

A

“No man’s land” = distal palmar crease to PIP crease; many important structures here - if a tendon lac, the vessels and nerves likely damaged.

33
Q

Which is more easily repairable, flexor tendon or extensor tendon, and why?

A

Extensor tendon because there is no tendon sheath.

34
Q

What are ‘notorious’ for becoming infected?

A

Human bites! such as Clenched fist injuries or “fight bite.”

35
Q

Why is the procedure ‘Injecting A Joint’ done?

A

If we suspect communication b/t the outside world and a joint space; typically, involves a laceration over or near a joint space.

-Inject 1% plain lido into joint space.

36
Q

Results of “Injecting A Joint?”

A
  • When you inject the joint space, IF you see fluid pouring out of the wound during injection, then suspect the joint space is open and involved – the pt will NEED OR irrigation.
  • If NO fluid is seen from the wound during injection, the the laceration can be closed after careful exploration and irrigation; will need close f/u.
37
Q

What is Mallet Finger? Presentation?

A

Sudden forceful flexion of the DIP; sometimes associated w/an avulsion Fx by the extensor tendon.

Presentation = DIP in flexion.

(ex. when a baseball strikes the tip of the finger and forces it to bend further than it is intended to go).

38
Q

Treatment of Mallet Finger? Important general rule of thumb?

A

Treatment = splint DIP in HYPERextension (PIP in flexion, MCP in full flexion as want extensors max stretched) for 6-8 weeks.

Rule of Thumb = if assoc. Fx is >than 1/3 the articular space, then OR.

39
Q

What is Boutonniere’s Deformity?

A

Disruption of central extensor tendon just proximal to insertion at base of the middle phalanx.

40
Q

What is the MOI and presentation of Boutonniere’s Deformity?

A

MOI is typically a “jersey injury,” where the finger gets caught on someones jersey and the feel a pop sensation. It can also be caused by chronic, nontraumatic arthritis due to erosion of the joint.

Presentation = flexed PIP w/Hyperextension of DIP.

41
Q

Treatment of Boutenniere’s Deformity?

A

Splint PIP in extension and DIP and MCP free for 6-8 weeks.

Surgical repair does not shorten healing time.

42
Q

What is “Trigger Finger” also known as?

A

Stenosing Tenosynovitis

43
Q

What is Trigger finger, the cause and the typical presentation?

A
  • Painful finger or thumb - one digit or more; can be bilateral.
  • Caused by inflammation of the flexor tendon narrowing the tendon sheath; may be due to a nodule and is typically associated w/repetitive activity (gripping motion).
44
Q

What is the presentation of Trigger Finger, epidemiology and treatment?

A
  • Presentation = stiffness, catching or locking, snapping or popping sensation; may have a palpable bump.
  • Age 40-60, F>M.
  • Treatment = splinting, steroid injection, NSAIDs, surgery.
45
Q

What happens during a High Pressure Injection injury?

A

The injection of toxic substances into the hand at high velocity; typically from grease guns, paint guns, etc.

The entrance of the wound may be small (appear insignificant) but the damage is far from site of entry, often w/in the fascial planes and sheaths.

46
Q

Why are high pressure injection injuries worrisome?

A

Initially, it may not appear severe but over several days, it will worsen and symptoms may increase to include: swelling, pain, vascular compromise and paresthesias.

47
Q

What is the treatment and complications of high pressure injuries?

A

Treatment = immediate surgical consult for exploration and irrigation, splint, elevation, tetanus prophylaxis and broad spectrum Abx.

Complications = amputation.

48
Q

Pros and Cons of reimplantation?

A

salvaging a functionless, painful digit for cosmetic benefit, often may be the wrong decision for an otherwise healthy and active person.

49
Q

What are the causes of a Degloving Injury?

A

Associated with machinery; jewelry may get caught on moving parts and strips bone of soft tissue.

50
Q

Complication of a Degloving Injury?

A

Reimplantation is unlikely if proximal to FDS distal attachment, as digit would never bend at PIP.

51
Q

What is the most important thing about foreign body injuries?

A

organic material NEEDS to be removed (fish fin, wood, spines, etc), will cause infection. Metals are typically harmless and can remain if not affecting the individual.

52
Q

What is the aftercare for a F.B injury such as a fish hook?

A

Explore the F.B. (bait).

Irrigate, leave wound open, Abx ointment, simple dressing, tetanus consideration, F/U.

53
Q

What is important about examination of the hand?

A

There are both SENSORY and MOTOR components.

**Always do a Sensory exam BEFORE anesthetics are given! Distal and Proximal to the injury.

54
Q

What is Stereognosis?

A

The ability to identify familiar objects placed in the pt’s hand w/o the aid of visualization; needs to be within a reasonable time period.

It tests fine sensation and ability to discriminate (key, coin, paperclip, etc).

55
Q

How far apart should one feel a two-point discrimination?

A

5 mm or greater; problematic if can’t distinguish.

56
Q

What is the Tinel’s test and what is it used for?

A

Tapping/percussion over the median nerve at the wrist.

Indicates Carpal Tunnel Syndrome if the tapping produces symptoms of severe pain or paresthesia.

57
Q

Tinel’s at Guyons?

A

The same as Tinel’s over volar wrist, but over the Guyons Tunnel, which is where the ulnar nerve runs; it is located on volar wrist/hand just radial to the pisiform bone.

58
Q

Median Nerve Compression Test?

A

Examiner places external compression manually over the pt’s median nerve for 60 secs - if Sx reproduced, consider positive.

59
Q

Moberg’s Test?

A

In 10 sec, 10 objects are picked-up by one hand and placed in a receptacle.

It tests dexterity and observation; may yield info about fine sensory and motor control of both median (opposition) and ulnar (intrinsics) nerves.

60
Q

Fromet’s Test?

A

ADDuction by placing a piece of paper b/t the thumb and finger - ask the pt to hold it w/o using the thumb flexors.

It detects motor loss of ulnar nerve.

61
Q

What is Ulnar Neuropathy?

A

The loss of finger abduction and adduction (intrinsics); specifically, the inability to form an “O” b/t thumb and index finger.

62
Q

What is the physical exam presentation of ulnar neuropathy and what other injury is it associated with?

A

May see hollowing/atrophy of the hypothenar eminence or first dorsal interossei (webspace).

Can be associated with injuries of the ‘funny bone;’ the ulnar nerve is found b/t the medial epicondyle and olecranon and enters the hand w/the ulnar artery.

63
Q

What is Median Neuropathy?

A

It causes an inability to flex the thumb, index and middle fingers, weakened pronation, weakened wrist flexion or ulnar-deviated flexion by overcompensation (of ulnar nerve), and loss of thumb opposition; may see thenar atrophy.

The pt will show an inability to “scratch the table top” w/index finger when the palm is palm-down on a table.

64
Q

What is Radial Neuropathy?

A

Usually seen with Humoral Fx causing a characteristic “wrist drop,” if radial nerve innervates wrist extensors. May also see decreased extension at MCP joints, as innervates digit extensors.

Ortho/Rheumatology (15 decks)

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