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Musculoskeletal Pathophysiology > Hand (RITA) > Flashcards

Hand (RITA) Flashcards

1
Q

What is the MOI for skiers thumb/gamekeepers thumb?

A

forced or repetitive radial deviation of dumb

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2
Q

What are complications associated with thumb MCP joint injuries?

A

chronic laxity leading to DJD
decreased pinch and grip strength
pain

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3
Q

What clinical finding is found with thumb MCP joint injuries when ulnar stress is applied to joint?

A

INSTABILITY

15* valgus deformity compared to uninvolved side

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4
Q

What are treatments for thumb MCP joint injuries?

A

splint
cast
surgical repair of ligament

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5
Q

What do you need to rule out for thumb MCP joint injuries?

A

avulsion fx of MC bone - check X-rays before stress testing

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6
Q

What are indications for surgical repair of MCP joint injuries?

A

complete UCL rupture
UCL injury with fx that is rotated, displaced, or interarticular
Stener lesion

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7
Q

What is stener lesion?

A

aponeurosis of adductor pollicis becomes interposed bw ruptured UCL of thumb and its site of insertion at base of prox phalanx

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8
Q

What is the outcome of stener lesion?

A

UCL cannot heel spontaneously because the ligament looses contact with its insertion site

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9
Q

What is primary surgical intervention for MCP joint injuries prior to 6 weeks post injury?

A

direct reinsertion of ligament onto bone

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10
Q

For chronic instability or delayed repair, what is surgical intervention of MCP joint injuries?

A

tendon transfers or MCP joint fusion

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11
Q

With UCL tear, what is prognosis 3 weeks after surgery?

A

96% full fxn

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12
Q

If repair of UCL tear occurs > 6 weeks after injury what is prognosis?

A

poor

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13
Q

The carpal tunnel is formed by?

A

carpal bones and 9 flexor tendons

covered by carpal ligament

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14
Q

CTS is usually related to what conformation of the tunnel?

A

volumetric increases of contents of tunnel OR decreases of tunnel dimensions

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15
Q

What are common causes of CTS?

A

structural/traumatic changes
underlying systemic/physiological disorders
repeated microtrauma due to repetitive use
pressures within tunnel with positions

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16
Q

What is the pressure in the carpal tunnel with neutral wrist?

A

20 mmhg

17
Q

What is the pressure in the carpal tunnel with 20* flex at wrist?

A

35 mmhg

18
Q

What is the pressure in the carpal tunnel with 44* flex at wrist?

A

45 mmhg

19
Q

What is the pressure in the carpal tunnel with 20* ext at wrist?

A

30 mmhg

20
Q

What is male:female ratio of CTS incidence?

A

1:3

21
Q

What are risk factors for CTS?

A 
repetitive use
force
posture/unaccustomed work activities
vibration/temperature
personal risk factors
22
Q

What is double crush syndrome?

A

peripheral nere phenomenon associated with two neurological involvements

23
Q

What is the most common double crush syndrome pathology combo?

A

CTS/TOS/Cubital tunnel syndrome

clinical evidence in 64%

24
Q

What is the incidence of CTS + TOS?

A

30%

25
Q

What is the incidence of CTS + cervical radiculopathy?

A

18%

26
Q

How is double crush syndrome diagnosed?

A

electrophysiology
pahlens test
tinel test
semmes weinstein

27
Q

What are indications for surgical treatment of CTS?

A

> 6 month duration of symptoms
not responding to conservative treatment
severe symptoms interfere with sleep and fan
clinical/electrophysio evidence of median nerve dysfxn

28
Q

To treat CTS, the _____ ligament may be released.

A

transverse retinacular ligament

arthroscopic or open

29
Q

A complication of CTS surgery is decreased grip/pinch strength an dexterity for up to ____ months.

A

25

30
Q

CTS surgery complications include:

A 
decreased wrist/grip/pinch strength
stiffness
nerve adherence
hypersensitivity
pillar pain
31
Q

What is pillar pain?

A

pain on either side of the incision

32
Q

What factors interfere with surgical treatment success of CTS?

A 
> 65yo
severe pre-op symptoms
poor ncv results
hemodialysis
ETOH abuse/smoking
heavy labor
poor mental health
33
Q

What is DeQuervain’s tenosynovitis?

A

inflammation of tendon sheath of APL and EPB due to excessive friction bw two tendons

34
Q

What factors are associated with DeQuervain’s tenosynovitis

A 
DM
hypothyroidism
pregnancy
RA
Gender
35
Q

What are some differential Dxs for DeQuervain’s tenosynovitis?

A

thumb CMC arthritis
scaphoid fx
entrapment of superficial branch of radial n
radiocarpal dysfxn

36
Q

What are symptoms/clinical findings of DeQuervain’s tenosynovitis?

A

decreased strength
pain/swelling/heat at thumb base
℅ pain with resisted MCP thumb extension

37
Q

What sign might be positive with DeQuervain’s tenosynovitis?

A

Finkelstein

Musculoskeletal Pathophysiology (14 decks)

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