Hand (RITA) Flashcards
What is the MOI for skiers thumb/gamekeepers thumb?
forced or repetitive radial deviation of dumb
What are complications associated with thumb MCP joint injuries?
chronic laxity leading to DJD
decreased pinch and grip strength
pain
What clinical finding is found with thumb MCP joint injuries when ulnar stress is applied to joint?
INSTABILITY
15* valgus deformity compared to uninvolved side
What are treatments for thumb MCP joint injuries?
splint
cast
surgical repair of ligament
What do you need to rule out for thumb MCP joint injuries?
avulsion fx of MC bone - check X-rays before stress testing
What are indications for surgical repair of MCP joint injuries?
complete UCL rupture
UCL injury with fx that is rotated, displaced, or interarticular
Stener lesion
What is stener lesion?
aponeurosis of adductor pollicis becomes interposed bw ruptured UCL of thumb and its site of insertion at base of prox phalanx
What is the outcome of stener lesion?
UCL cannot heel spontaneously because the ligament looses contact with its insertion site
What is primary surgical intervention for MCP joint injuries prior to 6 weeks post injury?
direct reinsertion of ligament onto bone
For chronic instability or delayed repair, what is surgical intervention of MCP joint injuries?
tendon transfers or MCP joint fusion
With UCL tear, what is prognosis 3 weeks after surgery?
96% full fxn
If repair of UCL tear occurs > 6 weeks after injury what is prognosis?
poor
The carpal tunnel is formed by?
carpal bones and 9 flexor tendons
covered by carpal ligament
CTS is usually related to what conformation of the tunnel?
volumetric increases of contents of tunnel OR decreases of tunnel dimensions
What are common causes of CTS?
structural/traumatic changes
underlying systemic/physiological disorders
repeated microtrauma due to repetitive use
pressures within tunnel with positions
What is the pressure in the carpal tunnel with neutral wrist?
20 mmhg
What is the pressure in the carpal tunnel with 20* flex at wrist?
35 mmhg
What is the pressure in the carpal tunnel with 44* flex at wrist?
45 mmhg
What is the pressure in the carpal tunnel with 20* ext at wrist?
30 mmhg
What is male:female ratio of CTS incidence?
1:3
What are risk factors for CTS?
repetitive use force posture/unaccustomed work activities vibration/temperature personal risk factors
What is double crush syndrome?
peripheral nere phenomenon associated with two neurological involvements
What is the most common double crush syndrome pathology combo?
CTS/TOS/Cubital tunnel syndrome
clinical evidence in 64%
What is the incidence of CTS + TOS?
30%
What is the incidence of CTS + cervical radiculopathy?
18%
How is double crush syndrome diagnosed?
electrophysiology
pahlens test
tinel test
semmes weinstein
What are indications for surgical treatment of CTS?
> 6 month duration of symptoms
not responding to conservative treatment
severe symptoms interfere with sleep and fan
clinical/electrophysio evidence of median nerve dysfxn
To treat CTS, the _____ ligament may be released.
transverse retinacular ligament
arthroscopic or open
A complication of CTS surgery is decreased grip/pinch strength an dexterity for up to ____ months.
25
CTS surgery complications include:
decreased wrist/grip/pinch strength stiffness nerve adherence hypersensitivity pillar pain
What is pillar pain?
pain on either side of the incision
What factors interfere with surgical treatment success of CTS?
> 65yo severe pre-op symptoms poor ncv results hemodialysis ETOH abuse/smoking heavy labor poor mental health
What is DeQuervain’s tenosynovitis?
inflammation of tendon sheath of APL and EPB due to excessive friction bw two tendons
What factors are associated with DeQuervain’s tenosynovitis
DM hypothyroidism pregnancy RA Gender
What are some differential Dxs for DeQuervain’s tenosynovitis?
thumb CMC arthritis
scaphoid fx
entrapment of superficial branch of radial n
radiocarpal dysfxn
What are symptoms/clinical findings of DeQuervain’s tenosynovitis?
decreased strength
pain/swelling/heat at thumb base
℅ pain with resisted MCP thumb extension
What sign might be positive with DeQuervain’s tenosynovitis?
Finkelstein
