L27: Clinical Reasoning in Examination of the Hand Flashcards
What are the 6 major pathologies of the hand?
- Hook of hamate
- TFCC Tears
- PIP dislocations
- Phalangeal fractures
- Metacarpal fractures
- Stenosing Tenosynovitis (Trigger Finger)
What is the MOI of the Hook of Hamate Fracture?
Abutment of hook against an object, or a shearing force of the 4-5th FTS
- Common in golfers, baseball, racquet sports
What is the symptom of the hook of hamate fracture?
Tenderness over hook in palm
What are 4 features of ulnar wrist pain?
- Acute traumatic
- Chronic overuse
- Common in athletes (tennis)
- Need stability to sustain grip
What are 4 structures that contribute to DRUJ stability?
- TFCC
- ECU
- Interosseous membrane
- Pronator quadratus
What are 2 management of hook of hamate fractures?
- Conservative: Wrist splint 6 weeks
- Surgery: ORIF, excision
What is the conservative management of hook of hamate fractures?
Wrist splint 6 weeks
What is the surgical management of hook of hamate fractures?
ORIF, excision
Where is pain in TFCC?
Ulnar sided pain
What is MOI for TFCC?
FOOSH with wrist E + extreme rotation + UD
- Gymnastics, hockey, racquet/batting sports, boxing, and pole vaulting
What are 5 TFCC classifications?
What are the 3 injuries in Class 1 (traumatic) for TFCC?
- 1A Central disk
- 1B Avulsion from insertion on ulna
- 1C Detachment from lunate
What are the 2 injuries in Class 2 (degenerative) for TFCC?
- 2A Thinning & wearing without perforation
- 2B Chondromalacia of lunate and/or ulnar
What are 8 conservative managements for class 1 TFCC tears?
- Rest/immobilisation 2-3 weeks in wrist splint depending on severity & longevity of symptoms
- Progressive pain-free ROM
- Avoid aggravating activities
- Isometric loading of pronator quadratus (stabiliser)
- Restricted sports 4-6 weeks
- Strapping as needed
- Wrist splint
- Acute pain: Circumferential wrist splint to restrict rotation
- Mild pain: Oapl, wrist widget to stabilise DRUJ
- HCLA
____ is the most common dislocated joint in body
PIP
What is poor management of PIP dislocations?
Poor management: Often underestimated or immobilized for too long > long term stiffness, pain, instability
What happens when there is a large fragment of PIP dislocation?
If large fragment, then refer to hand surgeon
What are 2 types of PIP dislocations?
- PIP Dorsal Dislocation
- PIP Lateral Dislocations
What are 4 characteristics of PIP Dorsal Dislocation?
- Volar plate ruptures from distal attachment +/- avulsion fracture
- Dorsal dislocation MOI: Axial loading with PIP hyperextension
- Ball handling sports
- PIP dislocation is often associated with fracture - difficult to manage
- May have associated collateral ligament tear.
What is the MOI for PIP Dorsal Dislocation?
Dorsal dislocation MOI: Axial loading with PIP hyperextension
- Ball handling sports
What are 4 managements of PIP Dorsal Dislocations?
- Control oedema +++: Compression for a few weeks
- Tendency for PIP to develop fixed flexion deformity (FFD) or extensor lag, but also want to avoid ongoing instability
- FFD develops due to excessive oedema bending the fingers
- Early F AROM is important
- Monitor closely to ensure progressive increase in ROM F/E
What are the 3 stability splints for PIP dorsal dislocation?
What are 4 characteristics of PIP Lateral Dislocations?
- Rupture of the collateral ligament on one side and partial avulsion of the volar plate
- Can have a subluxation or dislocation injury
- Often stable once reduced
- X-ray to check no large bony fragment
What are 4 Management of PIP Lateral Dislocations?
- Oedema control
- Resting PIP extension splint (night) to stop FFD
- Early AROM - buddy
- RTP - buddy strap
