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PHTY3120 > L27: Clinical Reasoning in Examination of the Hand > Flashcards

L27: Clinical Reasoning in Examination of the Hand Flashcards

1
Q

What are the 6 major pathologies of the hand?

A
  1. Hook of hamate
  2. TFCC Tears
  3. PIP dislocations
  4. Phalangeal fractures
  5. Metacarpal fractures
  6. Stenosing Tenosynovitis (Trigger Finger)
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2
Q

What is the MOI of the Hook of Hamate Fracture?

A

Abutment of hook against an object, or a shearing force of the 4-5th FTS

  • Common in golfers, baseball, racquet sports
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3
Q

What is the symptom of the hook of hamate fracture?

A

Tenderness over hook in palm

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4
Q

What are 4 features of ulnar wrist pain?

A
  1. Acute traumatic
  2. Chronic overuse
  3. Common in athletes (tennis)
  4. Need stability to sustain grip
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5
Q

What are 4 structures that contribute to DRUJ stability?

A
  1. TFCC
  2. ECU
  3. Interosseous membrane
  4. Pronator quadratus
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6
Q

What are 2 management of hook of hamate fractures?

A
  1. Conservative: Wrist splint 6 weeks
  2. Surgery: ORIF, excision
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7
Q

What is the conservative management of hook of hamate fractures?

A

Wrist splint 6 weeks

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8
Q

What is the surgical management of hook of hamate fractures?

A

ORIF, excision

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9
Q

Where is pain in TFCC?

A

Ulnar sided pain

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10
Q

What is MOI for TFCC?

A

FOOSH with wrist E + extreme rotation + UD

  • Gymnastics, hockey, racquet/batting sports, boxing, and pole vaulting
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11
Q

What are 5 TFCC classifications?

A
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12
Q

What are the 3 injuries in Class 1 (traumatic) for TFCC?

A
  1. 1A Central disk
  2. 1B Avulsion from insertion on ulna
  3. 1C Detachment from lunate
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13
Q

What are the 2 injuries in Class 2 (degenerative) for TFCC?

A
  1. 2A Thinning & wearing without perforation
  2. 2B Chondromalacia of lunate and/or ulnar
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14
Q

What are 8 conservative managements for class 1 TFCC tears?

A
  1. Rest/immobilisation 2-3 weeks in wrist splint depending on severity & longevity of symptoms
  2. Progressive pain-free ROM
  3. Avoid aggravating activities
  4. Isometric loading of pronator quadratus (stabiliser)
  5. Restricted sports 4-6 weeks
  6. Strapping as needed
  7. Wrist splint
    • Acute pain: Circumferential wrist splint to restrict rotation
    • Mild pain: Oapl, wrist widget to stabilise DRUJ
  8. HCLA
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15
Q

____ is the most common dislocated joint in body

A

PIP

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16
Q

What is poor management of PIP dislocations?

A

Poor management: Often underestimated or immobilized for too long > long term stiffness, pain, instability

17
Q

What happens when there is a large fragment of PIP dislocation?

A

If large fragment, then refer to hand surgeon

18
Q

What are 2 types of PIP dislocations?

A
  1. PIP Dorsal Dislocation
  2. PIP Lateral Dislocations
19
Q

What are 4 characteristics of PIP Dorsal Dislocation?

A
  1. Volar plate ruptures from distal attachment +/- avulsion fracture
  2. Dorsal dislocation MOI: Axial loading with PIP hyperextension
    • Ball handling sports
  3. PIP dislocation is often associated with fracture - difficult to manage
  4. May have associated collateral ligament tear.
20
Q

What is the MOI for PIP Dorsal Dislocation?

A

Dorsal dislocation MOI: Axial loading with PIP hyperextension

  • Ball handling sports
21
Q

What are 4 managements of PIP Dorsal Dislocations?

A
  1. Control oedema +++: Compression for a few weeks
  2. 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
  3. Early F AROM is important
  4. Monitor closely to ensure progressive increase in ROM F/E
22
Q

What are the 3 stability splints for PIP dorsal dislocation?

A
23
Q

What are 4 characteristics of PIP Lateral Dislocations?

A
  1. Rupture of the collateral ligament on one side and partial avulsion of the volar plate
  2. Can have a subluxation or dislocation injury
  3. Often stable once reduced
  4. X-ray to check no large bony fragment
24
Q

What are 4 Management of PIP Lateral Dislocations?

A
  1. Oedema control
  2. Resting PIP extension splint (night) to stop FFD
  3. Early AROM - buddy
  4. RTP - buddy strap
25
Q

What is the management of PIP Fixed Flexion Deformity?

A

Unlikely to respond to manual therapy/exercise, will require splintage to provide prolonged gentle stretch

26
Q

What does the static progressive splint look like?

A
27
Q

What are 2 characteristics of Phalangeal Fractures?

A
  1. X-ray to assess alignment, position
  2. Refer to surgeon if failed reduction, displacement, or any rotation present
28
Q

What are 4 types of Phalangeal Fractures?

A
  1. Small unicondylar fracture are usually stable
  2. Bicondylar fractures are usually unstable
  3. Shaft fractures (transverse/spiral) need surgery
  4. Stable/nondisplaced fractures
    1. Resting extension splint 4 weeks
    2. Active motion as stability allows
    3. Buddy strap
    4. Oedema control
29
Q

What are 3 characteristics of Distal Phalanx Fractures?

A
  1. Usually a crush injury
  2. Pain and swelling +++
  3. If intra-articular joint space 30% , then refer to hand surgeon
30
Q

What are 3 management of Distal Phalanx Fractures?

A
  1. Splint for ~3 weeks
  2. Oedema control
  3. AROM depending on stability
31
Q

What are 7 characteristics of Metacarpal Fractures?

A
  1. Divided into fractures of metacarpal head, neck, shaft, base
    • Metacarpal neck is most common site of fracture
    • Fifth metacarpal is most commonly injured
  2. Incidence: Metacarpal fractures account for 40-50% of all hand fractures
  3. Demographics: Men 10-29 yos have highest incidence of metacarpal injuries (punch injury)
  4. Relatively quick healing (3-5 weeks)
  5. Treatment based on which metacarpal is involved and location of fracture
  6. Acceptable angulation varies by location
  7. No malrotation is acceptable. (e.g. 5°rotation results in 1.5 cm digital overlap)
32
Q

What are 3 managements of Boxer’s Fracture (5th Metacarpal)?

A
  1. Oedema control
  2. Splint to inmmobilise MP in F and IP in E because hand tends to stiffen into a claw
  3. Malunion can lead to extensor tendon lag
33
Q

What are 5 Managements of Metacarpal Neck Fractures?

A
  1. Hand based fracture brace (Sarmiento) to stabilise metacarpal, joint above and below
    1. MCP 40-60°
    2. CMC stabilised
    3. Can move fingers in splint
  2. Ensure metacarpal head well supported volarly.
  3. Gentle AROM MP joint
  4. Buddy strap usually required.
  5. Wean from splint 4-6 weeks.
  6. May continue with buddy strap for longer
34
Q

What is Stenosing Tenosynovitis (Trigger Finger)?

A

Inflammation of flexor synovial sheath +/- annular 1 (Al) pulley

35
Q

What are symptoms of Stenosing Tenosynovitis (Trigger Finger)?

A

Symptoms vary from intermittent catching to locking

36
Q

What are associated with overuse of flexor tendons of Stenosing Tenosynovitis (Trigger Finger)?

A

Associated with overuse of flexor tendons

  1. Tendon thickens, pulley catches - pain, lodged finger
  2. e.g. Knitting
37
Q

Whta are the different stages of the Stenosing Tenosynovitis (Trigger Finger)?

A

Different stages from mild triggering to finger locking down

38
Q

What are 5 features of mild to moderate cases in the management of trigger finger?

A
  1. Splint to restrict MCP F, IP joints free for 2-3 weeks
  2. Full PROM daily with splint off
  3. Oedema control
  4. Education to avoid aggravating activities oedema till settle down
  5. US guided HCLA if unresponsive to treatment
39
Q

What is a feature of severe cases in the management of trigger finger?

A

Surgery: Cut the pulley - more space for tendon to glide

PHTY3120 (29 decks)

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