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Clin Med IV - Ortho > Hand & Wrist MSK Problems > Flashcards

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

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2
Q

______ make up 25% of all metacarpal fractures

A

5th metacarpal fracture

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3
Q

Boxer’s fracture

A

5th metacarpal fracture

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4
Q

Common mechanism of injury for Boxer’s fracture

A

Punching object

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5
Q

Volar angulation of _____ is acceptable in Boxer’s fracture but _____ is not acceptable

A

up to 40 degrees

Rotational deformity

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6
Q

When is surgery indicated for Boxer’s fracture?

A

Volar angulation >45 deg.

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7
Q

Position of UE in thumb spica cast

A

Wrist at 25 deg extension

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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
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9
Q

Bennett fracture-dislocation

A

Intra-articular 2-part fracture of base of 1st metacarpal

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10
Q

Mechanism of injury of Bennett fracture-dislocation

A

Forced abduction of 1st metacarpal

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11
Q

Most frequent thumb fx

A

Bennett fracture-dislocation

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12
Q

Rolando fracture

A

Comminuted fracture of 1st metacarpal base

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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
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14
Q

When is ORIF w/ AO cortical screw indicated in Bennett fracture-dislocation

A

When CRPP is not possible

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15
Q

Most frequently fractured carpal bone

A

Scaphoid (waist > proximal 3rd > distal 3rd)

Distal 3rd most common in kids

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16
Q

Mechanism of injury of scaphoid fracture

A

FOOSH

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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
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18
Q

80% of blood supply to scaphoid is from _______

A

Retrograde blood flow from radial artery

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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

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20
Q

Risk of AV necrosis is highest for ______ scaphoid fractures

A

Proximal

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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
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22
Q

Tx displaced scaphoid fx

A

ORIF followed by thumb spica cast for 6-8 wks

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23
Q

Basal joint arthritis

A

Arthritis of 1st CMC joint

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24
Q

Epidemiology of basal joint arthritis

A

Postmenopausal white women

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25
Q

Clinical presentation of basal joint arthritis

A
  • Insidious radial thumb pain, worse w/ use
  • Decreased ADLs, strength, dexterity
  • Pain w/ opposition (writing, opening jars)
  • Dorsoradial prominence of thumb metacarpal base
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26
Q

Conservative tx for basal joint arthritis

A
  • Tylenol +/- NSAIDs
  • Splinting
  • Ice
  • Cortisone injection
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27
Q

Definitive tx for basal joint arthritis

A

Total joint replacement → Excise distal half of trapezium, replace space with reconstructed flexor carpi radialis tendon or allograft via “anchovy technique”

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28
Q

Boutonniere deformity

A

Flexion of PIP w/ hyperextension of DIP

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29
Q

What condition is Boutonniere deformity commonly associated with?

A

Rheumatoid arthritis

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30
Q

Tx Boutonniere deformity

A
  • Splinting

- Surgery → must try at least 3 months splinting first

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31
Q

Swan neck deformity

A

Hyperextension of PIP joint & compensatory flexion of DIP joint

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32
Q

50% of swan neck deformity cases are associated with _____

A

Rheumatoid arthritis

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33
Q

Tx swan neck deformities

A
  • Silver ring splints
  • Joint fusion
  • Joint arthroplasty
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34
Q

Carpal tunnel syndrome

A

Median n. compressed d/t decreased space under transverse carpal ligament

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35
Q

What special tests suggest carpal tunnel syndrome

A

+Tinel’s sign

+Phalen’s sign

36
Q

Tx carpal tunnel syndrome

A
  • Wrist splint (esp. at night)
  • PT
  • Steroid injections
  • Surgery
37
Q

Epidemiology of deQuervain’s tenosynovitis

A

Women of childbearing age (esp. during pregnancy)

38
Q

Special tests for deQuervain’s tenosynovitis

A

+Finkelstein test

39
Q

Definitive tx for deQuervain’s tenosynovitis

A

Surgical decompression of 1st dorsal compartment

40
Q

Gamekeeper’s thumb

A

Injury to UCL of thumb at MCP joint

41
Q

Imaging for Gamekeeper’s thumb

A
  • Stress views on X-ray

- MRI if surgery planned

42
Q

Tx gamekeeper’s thumb

A
  • Partial tear → thumb spica cast/splint immobilization for 4-6 wks
  • Full tear → surgery followed w/ cast for 3-6 wks and OT
43
Q

Kanavel’s 4 cardinal signs of infectious flexor tenosynovitis

A
  • Tenderness along flexor tendon
  • Edema
  • Pain with passive extension*
  • Flexed resting posture
44
Q

Common causes of hand infections

A
  • Cat bite
  • Human bite
  • Puncture wounds (IVDA)
45
Q

Usual bacteria involved in hand infections

A
  • Staph
  • Strep
  • Pasteurella
  • Oral anaerobes
46
Q

Tx hand infection

A
  • Targeted IV abx
  • Pain management
  • Surgical washout
47
Q

What is important in treating finger dislocation?

A

Check NV status before and after reduction

48
Q

After reducing finger dislocation, what should you do?

A
  • Volar Alumafoam splint w/ buddy tape
  • Tylenol, NSAIDs, ice
  • Follow up w/ hand surgeon
49
Q

Mallet finger

A

Disruption of extensor mechanism of DIP joint

50
Q

Common mechanism of injury of mallet finger

A

Sudden flexion of DIP joint while play sports

51
Q

Clinical presentation of mallet finger

A

Inability to extend DIP joint → slight flexion at rest

52
Q

Tx of Mallet finger

A
  • Stax splint for 8 wks with DIP in slight hyperextension → DO NOT allow DIP to flex at all during this time
53
Q

Jersey finger

A

Avulsion injury of flexor digitorum profundus tendon from insertion at base of distal phalanx

54
Q

Mechanism of injury of Jersey finger

A

Sudden hyperextension of flexed finger

55
Q

_______ is most commonly involved Jersey finger

A

Ring finger - FDP insertion here is anatomically weaker than others

56
Q

Clinical presentation of Jersey finger

A
  • Inability to flex finger at DIP joint → slight extension at rest
  • TTP at volar aspect of distal finger
57
Q

Imaging of Jersey finger

A
  • X-ray usually normal (may show bony avulsion if present)

- MRI best

58
Q

Tx Jersey finger

A
  • Partial tear → splint, NSAIDs, PT

- Complete tear → surgery

59
Q

Trigger finger

A

Stenosing flexor tenosynovitis from repetitive microinjury d/t frequent flexion-extension of fingers

60
Q

Trigger finger has high prevalence in ______ and _____

A

Diabetics

RA pts

61
Q

Clinical presentation of trigger finger

A

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
Q

Tx trigger finger

A
  • Conservative tx → NSAIDs, splinting, steroid injection

- Definitive tx → surgery to release A1 pulley

63
Q

Dupuytren’s contracture

A

Benign, slowly progressive fibrosis of palmar fascia leading to loss of full extension of hand and fingers

64
Q

Epidemiology of Dupuytren’s contracture

A

Northern European male

65
Q

Clinical presentation of Dupuytren’s contractures

A
  • Initial complaint of thickening or nodules in palm (painless initially)
  • 4th and 5th fingers affected earliest
66
Q

Tx Dupuytren’s contractures

A
  • Cortisone injections
  • Collagenase injections
  • Ppx external beam radiation therapy to slow progression
  • Surgery → open fasciotomy
67
Q

Ganglion cyst

A
  • Fluid-filled swelling overlying joint or tendon sheath

- Contains mucinous or gelatinous fluid (“apple jelly”)

68
Q

Usual location of ganglion cysts

A

Dorsal wrist

69
Q

Tx ganglion cyst

A
  • Rest via splinting
  • Aspiration with 18G needle and 3cc syringe
  • Surgical removal (Note: 40% still recur)
70
Q

Where are mucous cysts usually located on hand?

A

Dorsal DIP

71
Q

Clinical presentation of mucous cyst in hand

A
  • Swelling of dorsal side of finger

- Groove in fingernail d/t pressure on matrix

72
Q

Tx mucous cyst

A
  • Triamcinolone injection

- Surgical excision

73
Q

Most common cause of herpetic whitlow

A

HSV-1

74
Q

Clinical presentation of herpetic whitlow

A
  • Painful, edematous fingertip with vesicular lesions
  • Most commonly affects thumb & index finger
    +/- Prodrome of fever, malaise
75
Q

Diagnostics that can be helpful in diagnosing herpetic whitlow

A

Mostly clinical dx but can use:

  • Tzank smear
  • Viral culture
  • Serum antibody titers
76
Q

Tx herpetic whitlow

A
  • Self-limited to 3 wks
  • Symptomatic relief (e.g. unroof vesicles)
  • Acyclovir, famciclovir, valacyclovir
77
Q

Felon

A

Infection of fingertip pulp

78
Q

Most common pathogens of felon

A
  • Staphylococcus
  • MRSA
  • Eikenella corrodens in DM pts who bite nails
  • GI pathogens
79
Q

Tx felon

A
  • I&D → culture any fluid

- Abx against staph & MRSA (dicloxacillin, cephalexin, Bactrim, clinda, nafcillin, doxy)

80
Q

What’s important to know about compartment syndrome?

A

Surgical emergency!!

81
Q

Common sites of compartment syndrome

A

Leg and forearm

82
Q

What do casts have to do with compartment syndrome?

A

Casted extremity within first few days of injury can cause compartment syndrome d/t swelling

83
Q

Clinical presentation of compartment syndrome

A 
Pain out of proportion
Pallor
Paresthesia
Paralysis
Pulselessness
84
Q

Tx compartment syndrome

A

Fasciotomy → pack with dressing → return to OR for closure at later date

85
Q

Current practice limits intra-articular corticosteroid injections to _________

A

3 injections/joint in 12 month period

86
Q

Side effects of corticosteroid injections

A
  • Blanching of skin
  • Localized fat atrophy
  • Infection
  • Transient rise in blood glucose

Clin Med IV - Ortho (7 decks)

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