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Clin Med I > hand, wrist, and ortho infections > Flashcards

hand, wrist, and ortho infections Flashcards

1
Q

boxer’s fx

A
  • fx through base of 5th metacarpal neck
  • occurs when closed fist strikes hard surface
  • volar angulation up to 40 degrees acceptable
  • rotational deformity cannot be accepted
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2
Q

treatment of boxers fx

A
  • volar angulation > 45 degrees then reduce fx
  • unlar gutter cast for 3-4 weeks then splint
  • surgical repair
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3
Q

bennett fx

A
  • two part intra-articular fx and dislocation of the base of the 1st metacarpal
  • d/t forced abduction
  • common thumb fx
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4
Q

xray findings for bennett fx

A
  • 2 piece intraarticular fx at base of thumb
  • dorsolateral dislocation
  • sm fragment of 1st mc continues to articulate with trapezium
  • lateral reduction of 1st mc shaft by abductor pollicis longus
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5
Q

rolando fx

A
  • comminuted bennett fx dislocation
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6
Q

bennett fx treatment

A
  • CRPP fixation
  • thumb spica for 4-6 weeks
  • if reduction not possible then ORIF with cortical screw
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7
Q

scaphoid fx

A
  • most frequently fx carpal bone
  • usually in waist of scaphoid
  • cannot miss these fx- can cause necrosis
  • usually d/t foosh
  • time for union takes longer in proximal fx
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8
Q

major blood supply to scaphoid

A
  • retrograde flow from dorsal carpal branch of radial artery
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9
Q

clinical findings for scaphoid fx

A
  • TTP over anatomical snuff box
  • TTP over scaphoid tuberosity
  • limited wrist flex/ext
  • radial and ulnar deviation cause pain on radial side
  • forced dorsiflexion= very painful
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10
Q

treatment for scaphoid fx

A
  • nondisplaced- thumb spica cast for 6 weeks then short thumb spica until signs of union
  • immobilization 16 weeks- 6 months
  • cast changes q10-14 days for 1st 6 weeks
  • if displaced ORIF then thumb spica
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11
Q

basal joint arthritis

A
  • more common in post-menopausal women
  • insidious onset radial thumb pain worsens with use
  • decrease ADLs, strength, dexterity
  • pain with thumb opposition
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12
Q

clinical presentation of basal joint arthritis

A
  • dorsoradial prominence of thumb mc base secondary to subluxation
  • TTP at trapexiometacarpal joint and scaphtrapezial joint
  • crepitus
  • grind test -> pain
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13
Q

treatment of basal joint arthritis

A
  • NSAIDs
  • splinting
  • ice
  • intraarticular cortisone inj
  • total joint replacement via anchovy technique
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14
Q

carpal tunnel syndrome

A
  • most common compressive neuropathy of UE
  • median nerve compressed by transverse ligament
  • d/t decreased canal size or increased volume of soft tissue
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15
Q

diagnosis for carpal tunnel

A
  • tinel sign- tap over transverse ligament

- phalen sign- have pt press backs of hands against each other for a few min

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16
Q

treatment for carpal tunnel

A
  • wrist splint- 20 degrees ext
  • pt
  • ergonomics
  • steroid injection
  • surgery
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17
Q

dequervain’s syndrome

A
  • stenosing tenosynovitis of 1st dorsal compartment
  • abductor pollicis longus and extensor pollicus brevis
  • most common in women on dominant hand
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18
Q

clinical presentation of dequervain’s syndrome

A
  • pain
  • swelling
  • TTP over dorsal radial aspect of wrist
  • worse with activity
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19
Q

diagnosis of dequervain’s sydnrome

A
  • finkelstein test- fist made with thumb inside fingers then ulnar deviate
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20
Q

treatment for dequervain’s syndrome

A
  • rest/ activity modification
  • thumb spica
  • NSAIDs
  • PT
  • steroid inj
  • surgical decompression
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21
Q

gamekeeper’s thumb

A
  • injury to ulnar collateral ligament of them at MCP joint
  • instability of MCP joint and decreased grip strength
  • aka skier’s thumb
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22
Q

diagnosis of gamekeeper’s thumb

A
  • plain films may not show deviation
  • perform stress test
  • MRI for surgical planning
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23
Q

treatment of gamekeeper’s thumb

A
  • conservative for partial tear- thumb spica for 4-6 weeks
  • surgical repair for full tears
  • surgery required for stener lesion
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24
Q

stener lesion

A
  • piece of first metacapral gets avulsed off with a gamekeeper’s thumb
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25
Q

treatment for finger dislocations

A
  • reduce
  • volar alumafoam splint
  • buddy tape with gauze between fingers
  • tylenol, NSAIDs
  • ice
  • follow up with hand surgeon
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26
Q

mallet finger

A
  • disruption of ext mechanism of finger at DIP joint
  • occurs when DIP undergoes sudden flexion
  • often when ball strikes tip of finger
  • can cause bony avulsion injury or tendinous injury
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27
Q

clinical presentation of mallet finger

A
  • inability to extend DIP

- slight flexion at rest

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28
Q

treatment for mallet finger

A
  • stax splint for 6-8 weeks with DIP in 10 degrees hyperextension to be worn AT ALL TIMES
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29
Q

jersey finger

A
  • avulsion of flexor digitorum profundus from insertion at base of distal phalanx
  • results from sudden hyperext of actively flexed finger
  • mainly seen in ring finger
30
Q

clinical presentation of jersey finger

A
  • inability to flex finger at DIP
  • TTP over volar aspect of distal finger
  • xrays usually normal
  • may have bony avulsion fragment at distal phalanx
  • MRI- disruption of FDP at volar vase of distal phalanx
31
Q

treatment for jersey finger

A
  • conservative for partial tear

- surgical intervention for all complete tears

32
Q

trigger finger

A
  • stenosing flexor tenosynovitis
  • d/t repetitive micro-injury from frequent flexion or extension
  • causes thickening of flexor tendon/ sheath and A1 pulley
  • common in adult women 50-60
33
Q

clinical presentation of trigger finger

A
  • difficulty straightening or bending affected finger
  • transiently locked into flexed position
  • with a painful snap can go into extension
  • often have to manually extend finger
34
Q

treatment for trigger finger

A
  • NSAIDs
  • splinting
  • steroid injection
  • surgery to release A1 pulley- very successful and is an OP procedure
35
Q

Dupuytren’s contractures

A
  • palmar fibromatosis -> firm nodule on volar surface of hand
  • results in loss of full ext of hand and fingers
  • usually in older males
36
Q

associated diseases of Dupuytren’s contractures

A
  • DM
  • epilepsy
  • alcoholism
  • keloids
  • plantar fibromatosis
37
Q

clinical presentation of dupuytren’s contractures

A
  • thickening or nodules on palm
  • painless at first -> eventually inflamed and painful
  • ulnar side of both palms frequently involved
  • 4th and 5th digits affected earliest
38
Q

treatment for dupuytren’s contractures

A
  • cortisone inj into sheath
  • collagenase inj
  • prophylactic external beam radiation to slow progression
  • surgery with open fasciotomy
39
Q

ganglion cyst

A
  • most common soft tissue tumor of hand
  • usually dorsal aspect of wrist
  • fluid filled swelling over a joint or tendon
  • gelatinous or mucinous fluid
  • d/t over use near the affected joint
40
Q

clinical presentation of ganglion cyst

A
  • swelling
  • joint pain +/- tenderness
  • smooth, firm, rounded
41
Q

treatment for ganglion cyst

A
  • splinting
  • needle aspiration- apply jelly like appearance
  • surgical removal
  • may reoccur with needle aspiration and surgery
42
Q

mucous cysts

A
  • benign cyst usually at DIP on dorsal surface
  • associated with OA
  • dev later in life
43
Q

clinical presentation of mucous cysts

A
  • visible swelling on dorsal side of finger
  • translucent nodule that may be painful
  • groove in finger nail d/t pressure on matrix
44
Q

treatment for mucous cysts

A
  • steroid injection- triamcinolone

- surgical excision only when really necessary

45
Q

nail bed injuries/ lacerations

A
  • most nailbed injuries also involve DIP fx
  • usually d/t crush injury
  • can have simple lac or stellate lac
  • simple lacs dont extend into peripheral tissue
46
Q

treatment for nail bed injuries

A
  • repair, can be complex
  • anesthesia- finger block or sedation
  • NO epi
  • adhesives may be used instead of stitches
  • subungual hematomas require trephination
  • if nail elevation dont remove nail
  • suture distal portion of nail bed
47
Q

complex stellate nail bed repair

A
  • need to remove nail plate
  • any free tissue put back into place
  • suture nail bed and plate back
  • small absorbable sutures used
  • trephination of nail
48
Q

crush injuries to nail bed

A
  • can cause tuft fx or distal phalanx fx
  • repair nail bed and replace nail plate
  • if displaced then reduce and suture
49
Q

missing nail plate repair

A
  • repair nail bed
  • reinforce silicone or sterile petroleum gauze
  • new nail will eventually grow
50
Q

compartment syndrome

A
  • muscle fascia prevents expansion of tissue
  • surgical emergency in acute setting- limb threatening
  • usually assoc with closed injuries of extremities
  • can occur in casted extremity
  • venous outflow decreases as arterial flow increases
51
Q

common sites for compartment syndrome to occur

A
  • leg and forearm
  • radius
  • ulna
  • proximal tibia
  • especially when casted
52
Q

what causes acute compartment syndrome

A
  • usually trauma
53
Q

what causes chronic compartment syndrome

A
  • usually in athletes
54
Q

what causes nontraumatic compartment syndrome

A
  • animal bite
  • IVDU
  • prolonged compression of a limb i.e. after a fall when pt cannot get up
  • thrombosis vascular disease
55
Q

five P’s of compartment syndrome

A
  • pain*** out of proportion to injury
  • pallor
  • pulselessness
  • paresthesias
  • paralysis
56
Q

treatment for compartment syndrome

A
  • fasciotomy of each compartment

- return to OR for closure at later date

57
Q

what are the most common organisms involved in ortho infections?

A
  • staph
  • strep
  • MRSA
58
Q

imaging for ortho infections

A
  • xray affected area- FB or periosteal thickening
  • early septic arthritis shows joint space widening
  • US if suspect abscess
59
Q

what does periosteal thickening plus boney erosions indcate

A
  • osteomyelitis
60
Q

treatment for ortho infections

A
  • empiric abx
  • I&D
  • splint
  • elevate hand/ extremity
  • moist hot pack
  • pain control
  • tetanus if needed
61
Q

hand infections

A
  • can be limb threatening
  • often from cat bite, human bite, puncture wounds
  • always xray IVDU to look for needle tip
62
Q

what is the bacteria associated with cat bites?

A
  • pasturella
63
Q

kanavel’s four cardinal signs of infective flexor tenosynovitis

A
  • swelling of entire finger
  • partially flexed position
  • tenderness limited to course of flexor tendon sheath
  • disproportionate pain on passive ext of finger
64
Q

tx for hand infections

A
  • IV abx for specific pathogens
  • pain mgmt
  • surgical wash out
  • keflex, cefazolin, clinamycin, unasyn, vanco
65
Q

herpetic whitlow

A
  • caused by HSV
  • intensely painful finger tip
  • usually distal phalanx
  • toddlers more susceptible d/t thumb sucking
66
Q

clinical presentation of herpetic whitlow

A
  • painful, edematous finger tip with vesicular lesion
  • often on thumb and index finger
  • clinical dx
67
Q

treatment of herpetic whitlow

A
  • generally self limited
  • symptomatic
  • unroof tense vesicles
  • acyclovir either PO or topical
68
Q

felon

A
  • infection of fingertip pulp
  • thumb and index finger most common
  • can lead to ischemic necrosis and osteomyelitis
  • can be d/t untreated paronychia
69
Q

clinical presentation of felon

A
  • throbbing pain
  • tension
  • edema
  • erythema
  • dx clinically
70
Q

treatment of felon

A
  • I&D
  • abx for staph and MRSA coverage
  • cephalexin, bactrim, clinda, dicloxacillin, doxycycline

Clin Med I (16 decks)

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