Hand & Wrist MSK Problems Flashcards
1
Q
Name the carpal bones
A
Some lovers try positions that they can’t handle
Scaphoid, lunate, triquetrum, pisiform
Trapezium, trapezoid, capitate, hamate
2
Q
______ make up 25% of all metacarpal fractures
A
5th metacarpal fracture
3
Q
Boxer’s fracture
A
5th metacarpal fracture
4
Q
Common mechanism of injury for Boxer’s fracture
A
Punching object
5
Q
Volar angulation of _____ is acceptable in Boxer’s fracture but _____ is not acceptable
A
up to 40 degrees
Rotational deformity
6
Q
When is surgery indicated for Boxer’s fracture?
A
Volar angulation >45 deg.
7
Q
Position of UE in thumb spica cast
A
Wrist at 25 deg extension
8
Q
Indications for thumb spica cast
A
- Scaphoid fx
- Bennett’s fracture dislocation
- Extra-articular fx of 1st metacarpal
- UCL injury
- Post-reduction of thumb dislocation
9
Q
Bennett fracture-dislocation
A
Intra-articular 2-part fracture of base of 1st metacarpal
10
Q
Mechanism of injury of Bennett fracture-dislocation
A
Forced abduction of 1st metacarpal
11
Q
Most frequent thumb fx
A
Bennett fracture-dislocation
12
Q
Rolando fracture
A
Comminuted fracture of 1st metacarpal base
13
Q
Indications for CRPP fixation of Bennett fracture-dislocation
A
- <3mm displacement
- Beak of fragment <50% palmar slope of metacarpal
- Concave dome of metacarpal maintained
14
Q
When is ORIF w/ AO cortical screw indicated in Bennett fracture-dislocation
A
When CRPP is not possible
15
Q
Most frequently fractured carpal bone
A
Scaphoid (waist > proximal 3rd > distal 3rd)
Distal 3rd most common in kids
16
Q
Mechanism of injury of scaphoid fracture
A
FOOSH
17
Q
Clinical presentation of scaphoid fracture
A
- FOOSH w/ tenderness in anatomical snuff box
- Limited wrist flexion/extension
- Pain on radial side of wrist w/ radial and ulnar deviation
18
Q
80% of blood supply to scaphoid is from _______
A
Retrograde blood flow from radial artery
19
Q
How does the time to union differ depending on the location of a scaphoid fracture?
A
Distal 3rd = 6-8 wks
Middle 3rd = 8-12 wks
Proximal 3rd = 12-23 wks
20
Q
Risk of AV necrosis is highest for ______ scaphoid fractures
A
Proximal
21
Q
Tx non-displaced scaphoid fx
A
- Thumb spica cast for 6 wks followed by short cast until signs of union seen
- Cast change q10-14 days for first 6 wks to adjust for atrophy
22
Q
Tx displaced scaphoid fx
A
ORIF followed by thumb spica cast for 6-8 wks
23
Q
Basal joint arthritis
A
Arthritis of 1st CMC joint
24
Q
Epidemiology of basal joint arthritis
A
Postmenopausal white women
25
Clinical presentation of basal joint arthritis
- Insidious radial thumb pain, worse w/ use
- Decreased ADLs, strength, dexterity
- Pain w/ opposition (writing, opening jars)
- Dorsoradial prominence of thumb metacarpal base
26
Conservative tx for basal joint arthritis
- Tylenol +/- NSAIDs
- Splinting
- Ice
- Cortisone injection
27
Definitive tx for basal joint arthritis
Total joint replacement → Excise distal half of trapezium, replace space with reconstructed flexor carpi radialis tendon or allograft via "anchovy technique"
28
Boutonniere deformity
Flexion of PIP w/ hyperextension of DIP
29
What condition is Boutonniere deformity commonly associated with?
Rheumatoid arthritis
30
Tx Boutonniere deformity
- Splinting
| - Surgery → must try at least 3 months splinting first
31
Swan neck deformity
Hyperextension of PIP joint & compensatory flexion of DIP joint
32
50% of swan neck deformity cases are associated with _____
Rheumatoid arthritis
33
Tx swan neck deformities
- Silver ring splints
- Joint fusion
- Joint arthroplasty
34
Carpal tunnel syndrome
Median n. compressed d/t decreased space under transverse carpal ligament
35
What special tests suggest carpal tunnel syndrome
+Tinel's sign
| +Phalen's sign
36
Tx carpal tunnel syndrome
- Wrist splint (esp. at night)
- PT
- Steroid injections
- Surgery
37
Epidemiology of deQuervain's tenosynovitis
Women of childbearing age (esp. during pregnancy)
38
Special tests for deQuervain's tenosynovitis
+Finkelstein test
39
Definitive tx for deQuervain's tenosynovitis
Surgical decompression of 1st dorsal compartment
40
Gamekeeper's thumb
Injury to UCL of thumb at MCP joint
41
Imaging for Gamekeeper's thumb
- Stress views on X-ray
| - MRI if surgery planned
42
Tx gamekeeper's thumb
- Partial tear → thumb spica cast/splint immobilization for 4-6 wks
- Full tear → surgery followed w/ cast for 3-6 wks and OT
43
Kanavel's 4 cardinal signs of infectious flexor tenosynovitis
- Tenderness along flexor tendon
- Edema
- Pain with passive extension*
- Flexed resting posture
44
Common causes of hand infections
- Cat bite
- Human bite
- Puncture wounds (IVDA)
45
Usual bacteria involved in hand infections
- Staph
- Strep
- Pasteurella
- Oral anaerobes
46
Tx hand infection
- Targeted IV abx
- Pain management
- Surgical washout
47
What is important in treating finger dislocation?
Check NV status before and after reduction
48
After reducing finger dislocation, what should you do?
- Volar Alumafoam splint w/ buddy tape
- Tylenol, NSAIDs, ice
- Follow up w/ hand surgeon
49
Mallet finger
Disruption of extensor mechanism of DIP joint
50
Common mechanism of injury of mallet finger
Sudden flexion of DIP joint while play sports
51
Clinical presentation of mallet finger
Inability to extend DIP joint → slight flexion at rest
52
Tx of Mallet finger
- Stax splint for 8 wks with DIP in slight hyperextension → DO NOT allow DIP to flex at all during this time
53
Jersey finger
Avulsion injury of flexor digitorum profundus tendon from insertion at base of distal phalanx
54
Mechanism of injury of Jersey finger
Sudden hyperextension of flexed finger
55
_______ is most commonly involved Jersey finger
Ring finger - FDP insertion here is anatomically weaker than others
56
Clinical presentation of Jersey finger
- Inability to flex finger at DIP joint → slight extension at rest
- TTP at volar aspect of distal finger
57
Imaging of Jersey finger
- X-ray usually normal (may show bony avulsion if present)
| - MRI best
58
Tx Jersey finger
- Partial tear → splint, NSAIDs, PT
| - Complete tear → surgery
59
Trigger finger
Stenosing flexor tenosynovitis from repetitive microinjury d/t frequent flexion-extension of fingers
60
Trigger finger has high prevalence in ______ and _____
Diabetics
| RA pts
61
Clinical presentation of trigger finger
Difficult to straighten or bend affected finger → transiently locked in flexed position with painful snapping sensation when extended → often have to manually extend finger
62
Tx trigger finger
- Conservative tx → NSAIDs, splinting, steroid injection
| - Definitive tx → surgery to release A1 pulley
63
Dupuytren's contracture
Benign, slowly progressive fibrosis of palmar fascia leading to loss of full extension of hand and fingers
64
Epidemiology of Dupuytren's contracture
Northern European male
65
Clinical presentation of Dupuytren's contractures
- Initial complaint of thickening or nodules in palm (painless initially)
- 4th and 5th fingers affected earliest
66
Tx Dupuytren's contractures
- Cortisone injections
- Collagenase injections
- Ppx external beam radiation therapy to slow progression
- Surgery → open fasciotomy
67
Ganglion cyst
- Fluid-filled swelling overlying joint or tendon sheath
| - Contains mucinous or gelatinous fluid ("apple jelly")
68
Usual location of ganglion cysts
Dorsal wrist
69
Tx ganglion cyst
- Rest via splinting
- Aspiration with 18G needle and 3cc syringe
- Surgical removal (Note: 40% still recur)
70
Where are mucous cysts usually located on hand?
Dorsal DIP
71
Clinical presentation of mucous cyst in hand
- Swelling of dorsal side of finger
| - Groove in fingernail d/t pressure on matrix
72
Tx mucous cyst
- Triamcinolone injection
| - Surgical excision
73
Most common cause of herpetic whitlow
HSV-1
74
Clinical presentation of herpetic whitlow
- Painful, edematous fingertip with vesicular lesions
- Most commonly affects thumb & index finger
+/- Prodrome of fever, malaise
75
Diagnostics that can be helpful in diagnosing herpetic whitlow
Mostly clinical dx but can use:
- Tzank smear
- Viral culture
- Serum antibody titers
76
Tx herpetic whitlow
- Self-limited to 3 wks
- Symptomatic relief (e.g. unroof vesicles)
- Acyclovir, famciclovir, valacyclovir
77
Felon
Infection of fingertip pulp
78
Most common pathogens of felon
- Staphylococcus
- MRSA
- Eikenella corrodens in DM pts who bite nails
- GI pathogens
79
Tx felon
- I&D → culture any fluid
| - Abx against staph & MRSA (dicloxacillin, cephalexin, Bactrim, clinda, nafcillin, doxy)
80
What's important to know about compartment syndrome?
Surgical emergency!!
81
Common sites of compartment syndrome
Leg and forearm
82
What do casts have to do with compartment syndrome?
Casted extremity within first few days of injury can cause compartment syndrome d/t swelling
83
Clinical presentation of compartment syndrome
```
Pain out of proportion
Pallor
Paresthesia
Paralysis
Pulselessness
```
84
Tx compartment syndrome
Fasciotomy → pack with dressing → return to OR for closure at later date
85
Current practice limits intra-articular corticosteroid injections to _________
3 injections/joint in 12 month period
86
Side effects of corticosteroid injections
- Blanching of skin
- Localized fat atrophy
- Infection
- Transient rise in blood glucose
