Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

*Medicine: Rheumatology & Orthopaedics > Hand + Wrist Pathology > Flashcards

Hand + Wrist Pathology Flashcards

1
Q

What do scaphoid fractures result from?

A
  • Common + easily missed on X-ray
  • Results from a fall on the hand (FOOSH)
  • Contact sports (football + rugby)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How does scaphoid fracture present clinically?

A
  • Tender in ANATOMICAL SNUFFBOX
  • Pain along radial aspect of wrist + at base of thumb
  • Loss of grip/pinch strength
  • Wrist joint effusion
  • Pain elicted by telescoping of thumb
  • Pain on ulnar deviation of wrist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which investigations for scaphoid fracture?

A
  • Plain film radiographs → sensitivity in first week only 80%
  • CT scan superior to radiograph
  • MRI is definitive investigation to confirm/exclude diagnosis → NICE says to use first-line, but it is actually commonly used second-line when radiographs are inconclusive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the initial management of suspected or confirmed scaphoid fracture?

A
  • Immobilisation → Futuro splint or standard below-elbow backslab
  • Referral to orthopaedics
  • Clinical review w/ further imaging should be arranged for 7-10d later when initial radiographs are inconclusive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the orthopaedic management of scaphoid fractures?

A

Dependent on pt and type of fracture:

  • Undisplaced of scaphoid waist →
    • cast for 6-8 wks
    • union is achieved in > 95%
    • certain groups eg. professional sports people may benefit from early surgical intervention
  • Displaced fractures → requires surgical fixation
  • Proximal pole fractures → require surgical fixation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the main complication to worry about from scaphoid fracture?

A

Avascular necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a boxer’s fracture?

A
  • Fracture of the 5th metacarpal neck
  • Caused by clenched fist striking hard object
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is Bennett’s fracture?

A
  • Fracture of 1st metacarpal base
  • Caused by forced hyperabduction of thumb
  • Defined as intra-articular two-part fracture
  • Extends to first carpometacarpal joint → instability + subluxation of joint
  • Often needs surgical repair
  • Rolando fracture is similar but completely intra-articular
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are different types of phalangeal fractures?

A
  • Proximal phalanx → spiral or oblique fractures lead to rotation deformity; corrected with open reduction and fixation
  • Middle phalanx → manipulate; splint in flexion over a malleable metal splint strapping finger to neighbour; aim is to control rotation, which interferes with lateral finger flexion
  • Distal phalanx → caused by crush injuries; often open; if closed, symptoms may be relieved by trephining the nail
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which tendons may be injured in the hand?

A
  • Flexor digitorum profundus → finger flexion (MCP + IP joints)
  • Flexor digitorum supeficialis → finger flexion (PIP joints)
  • Flexor pollicis longus → flexes IP joint of thumb
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the treatment for flexor tendon injuries?

A
  • Primary repair (most are open injuries)
  • If loss of tendon substance or delayed presentation → staged repair with silastic implant to keep tendon sheath open, followed by tendon graft
  • Intensive hand physio with supervision is essential
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Fractures of the distal radius (and/or ulnar) are commonly seen in A+E. Wrist fractures are mostly caused by FOOSH.

What is a Colles’ fracture?

A
  • Extra-articular fracture of distal radius w/ dorsal displacement of distal radius
  • Common in females over 50yrs (osteoporosis) following a FOOSH
  • Classic dinner fork deformity visible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the management of Colles’ fracture?

A
  • Reduction of fracture under regional anaesthesia (Bier’s block) or LA (haematoma block) to reverse deformities
  • Area is held in plaster backslab from elbow to metatarsophalangeal joints for 6wks
  • Intra-articular involvement, failed reduction or malunion require surgical intervention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are complications of Colles’ fractures?

A
  • Carpel tunnel syndrome
  • Malunion
  • Stiffness
  • Rupture of extensor pllicis longus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is a Smith’s fracture?

A
  • Reverse of Colles’ fracture with anterior angulation and tilt
  • Uncommon

Tx → manipulation under anaesthesia and a plaster cast above elbow for 6wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is Barton’s fracture?

A
  • Intra-articular fracture of wrist
  • Causes hand and part of distal raidus to displace proximally

Tx → ORIF

17
Q

What is a chauffeur’s fracture?

A

Fracture of radial styloid

18
Q

What is the commonest cause of hand pain at night?

A
  • Carpal tunnel syndrome
  • Due to compression of median nerve as it passes under flexor retinaculum
19
Q

What are clinical features of carpal tunnel syndrome?

A
  • Tingling or pain felt in thumb, index and middle finger
  • When pain at worst, pt flicks or shakes wrist to bring relief
  • Pain especially common at night and after repetitive actions
  • Wasted thenar eminence + reduced sensation over lateral 3.5 digits
  • Lateral palmar sensation is spared as its supply (palmar cutaneous branch of median nerve) does not pass through tunnel
  • Phalen’s test → holding the wrist hyperflexed for 1min reproduces the symptoms
20
Q

Which investigations for carpal tunnel syndrome?

A
  • Usually a clinical diagnosis
  • Nerve conduction studies can be helpful in complex or mixed symptoms as well as monitoring responses to surgery
  • USS + MRI can help identify lesions
21
Q

What are associations of carpal tunnel syndrome?

A
  • Hypothyroidism
  • Pregnancy / the pill
  • Gout + pseudogout
  • Diabetes + obesity
  • Acromegaly
  • Rheumatoid arthritis
  • Amyloidosis
22
Q

What is the management of carpal tunnel syndrome?

A
  • Treat any association
  • 1st line → rest, weight reduction, wrist splints
  • Splinting in a neutral position alone was sufficient to relieve symptoms + avoid surgery in 37% pts
  • Medical → corticosteroid injections (for short-term 10wk pain relief)
  • Surgical → carpal tunnel decompression (release of flexor retinaculum)
23
Q

What are wrist ganglions and their treatment?

A
  • Smooth, multilocular cysts containing jelly-like fluid in communication w/ joint capsules or tendon sheaths
  • Treatment not needed unless pain or pressure
  • They may appear spontaneously
  • Aspiration may work, but surgical dissection gives less recurrence
24
Q

What is DeQuervain’s tenosynovitis?

A

Refers to stenosing tenosynovitis (thickening + tightening) of the 1st extensor compartment, abductor pollicis longus and extensor pollicis brevis tendons (at the anterior border of anatomical snuffbox) as they cross distal radial styloid

25
Q

What is the clinical presentation of DeQuervain’s tenosynovitis?

A
  • Pain is worst when these tendons are stretched (eg. lifting a teapot), and is more proximal than that from osteoarthritis of the 1st CMC joint
  • Finkelstein’s sign → pain elicted by gripping the thumb into the palm of the same hand with passive ulnar deviation
  • Cause is unknown but symptoms can be exacerbated by overuse of tendons (eg. wringing clothes)
26
Q

What is the treatment for DeQuervain’s tenosynovitis?

A
  • 1st-line = REST (thumb spica splint) + ICE + NSAIDs
  • Corticosteroid injection at tendon site during the first 6 months of symptoms is effective in 90% of patients
  • If conservative measures fail, decompression of the tendons is provided by splitting the tendon sheath
27
Q

What is trigger finger?

A
  • Common condition associated with abnormal flexion of the digits
  • Caused by a disparity between size of tendon and pulleys through which they pass
  • Associations (idiopathic in most) → women / RA / DM
28
Q

What are clinical features of trigger finger?

A
  • More common in thumb, middle or ring finger
  • Initially stiffness + snapping (‘trigger’) when extending a flexed digit
  • A nodule may be felt at the base of affected finger
29
Q

What is the management of trigger finger?

A
  • Steroid injection is successful in the majority of pts
  • Finger splint may be applied afterwards

*Medicine: Rheumatology & Orthopaedics (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions