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pt momints ver 2.0 > MS1: Affectations of the Wrist and Hand > Flashcards

MS1: Affectations of the Wrist and Hand Flashcards

1
Q

describe the distal radioulnar joint

A

uniaxial - pivot jint

formed by distal radius, articulating disc and ulna

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2
Q

what is the articulating disc of the DRUJ

A

TFCC - triangular fibrocartilage complex

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3
Q

where is the TFCC located

A

betw medial and proximal carpal row and distal ulna

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4
Q

what is the composition of TFCC

A

articular disc - for cushion or shock absorber so ulna will not hit carpals

meniscus homologue

origin of ligaments

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5
Q

which ligaments originate from the TFCC

A

ulnocarpal - unlolunate and unlotriquetral

ulnar collateral and ECU tendon sheath

radioulnar - dorsal and palmar

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6
Q

what is the function of TFCC

A

covers nd protects ulnar head

load transmission across ulnocarpal joint and cushion against compression

allows forearm rotation

supports ulnar portion of carpus

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7
Q

how does injury on TFCC typically occur

A

falling on supinated outstretched wrist

chronic repetitive rotational loading

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8
Q

what are the 2 types of TFCC injury

A

type 1 - traumatic

type 2 - degenerative

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9
Q

signs and symptoms of TFCC injury

A

medial wrist pain distal to ulna increased by pronation-supination and gripping

painful click during wrist motions

tenderness on posterior distal to ulnar head

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10
Q

how to test for TFCC injury

A

mcmurrays test - passive or active ulnar deviation causes pain or snap = +

passive supination w/ ulnar deviation can reproduce pain

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11
Q

sports related to TFCC injury

A

GOLF, boxing, tennis, waterskiing, gymnastics, pole vaulting, hockey

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12
Q

diagnosis of TFCC injury

A

imaging

radiograph - usually negative; done to rule out fractures

triple injection arthrography - low specificity; might see tear

MRI - high specificity; identify tear

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13
Q

treatment of TFCC injury

A

conservative
- modification of lifestyle to remove inciting force
- ice-heat and immobilization for 3-6 weeks then PT

surgical - if may pain after 6 wks
- type 1
- immobilized for 1 wk post op then ROM exercises
- light activity at 3 wks
- normal sports activity at 4-6 wks

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14
Q

management of TFCC injury

A

conservative
- NSAID
- steroid injections
- physical therapy
- exercises

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15
Q

discuss the differential diagnosis for TFCC injury

A

TFCC tear - pain on ulnar deviation - negative on xray

ulnar styloid fracture - pain over styloid - fx on xray

ulnar nerve trap at guyons - numbness nd weakness of grip

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16
Q

what makes up the wrsit

A

distal radius and ulna, 8 carpal bones, 5 base of metacarpals

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17
Q

describe the radiocarpal joint

A

betw distal raduis and scaphoid, lunate, triquetrum and TFCC

condyloid - main wrist joiny

listers tubercle - dorsal at center of radius

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18
Q

what is the significance of listers tubercle

A

EPL tendon passes that causes friction

common site of microtears

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19
Q

what are the carpal bones lateral to medial

A

proximal
- scaphoid, lunate, triquetrum, pisiform

distal
- trapezium, trapezoid, capitate, hamate

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20
Q

what is colle’s fracture

A

fracture of distal radius with dorsal displacement

due to fall from outstretched hand

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21
Q

what is the epidemiology of colle’s fracture

A

high in women over 50 - menopausal nd osteoporotic
- bc predictor of other fractures - high chance na osteoporotic

high impact - skiing nd horseback riding

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22
Q

signs and symtoms of colle’s fracture

A

dinner fork deformity - posterior displacement of distal radial fragment

  • dorsal wrist pain
  • swelling
  • increased angulation of distal radius
  • inability to grasp
  • numbness
  • tenderness
  • bruising
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23
Q

management of colle’s fracture

A

operative - ORIF to normal length of radius
- Fx displaced intra-articular
- volar/dorsal comminution
- severe osteoporosis
- more than 5mm of radial shortening
- dorsal angulation more than 5 degrees
- progression after closed reduction nd casting
- w/ ulnar styloid fracture

non operative - closed reduction and cast immobilization
- less than 5mm of radial shortening
- dorsal angulation less than 5 degrees

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24
Q

what is smith’s fracture

A

fracture on distal radius with palmar displacement due to falling on the back of flexed hand

reverse colle’s

majority treated with conservatice

surgery same as colle’s

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25
what is barton fracture
intra-articular fracture of distal radius with dislocation of radiocarpal joint volar - more common dorsal - less common
26
causes of barton fracture
joint involved - direct blow to forearm sudden pronation on fixed wrist 70% common in young men
27
what is the treatment of barton fracture
conservative - closed reduction and casting on full supination, mid extension and ulnar deviation surgical - ORIF with 16 wks healing time
28
what is madelung's deformity
uncommon, congenital retardation of growth of ulna and volar distal radius = tilting of distal radius
29
what is epidiemiology of madelung's disease
common in female usually bilateral congenital and slowly progressive
30
signs and symptoms of madelung's deformity
wrist is enlarged and unstable radioulnar joint upon palpation end of radius is displaced anteriorly dorsal prominence on lower end of ulna and limitation of wrist DF wrist weakness supination lessened nd pronation can be decreased
31
treatment of madelung's deformity
unnecessary - person can adapt mild pain - temporary splinting severe cases - resection of distal ulna to allign bones
32
describe the scaphoid
palpated distal to radial styloid in anatomic snuffbox most common fractured carpal bone avascular necrosis - preiser's disease biggest in proximal row
33
describe the lunate
distal and ulnar to lister's tubercle most commonly dislocated carpal and scapholunate most common area for carpal instability osteonecrosis follows after single severe trauma to wrist spontanenous osteonecrosis - keinblock's disease due to repetitive trauma
34
describe osteonecrosis or avascular necrosis
common in 20-40 yo pain nd swelling for several days to wks localize swelling nd tenderness nd DF is limited radiographic - initially negative but later flattening = abnormally dense
35
treatment of osteonecrosis or avascular necrosis
conservative - immobilization bc bone is soft surgery - excision the replace with metal prosthetic implant
36
what is the extensor retinaculum
from lateral border of distal radius to posterior surface of distal ulna and ulnar styloid, pisiform and triquetrum prevents bow stringing of tendons nd enhances efficiency
37
what is the anatomic snuffbox
triangular depression at lateral of the wrist at compartment 1
38
what are the compartments of extensor retinaculum
1 - APL and EPB 2 - ECRL and ECRB lister's tubercle 3 - EPL 4 - extensor digitorum and extensor indicis 5 - EDM 6 - ECU
38
what are the compartments of extensor retinaculum
1 - APL and EPB 2 - ECRL and ECRB lister's tubercle 3 - EPL 4 - extensor digitorum and extensor indicis 5 - EDM 6 - ECU
39
what is de quervain's syndrome
stenosing tenosynovial inflammation of the 1st dorsal compartment - APL nd EPB
40
what is the epidemiology of de quervain's syndrome
more common in women 30 - 50 yo more common in dominant hand but can be bilateral risk factors overuse repetitive wringing, grasping clenching or pinching post-traumatic postpartum
41
what are the symptoms of de quervain's syndrome
pain on lateral wrist when moving wrist and thumb that shoots into thumb and wrist and forearm localized swelling thickening of tendon sheath and hard nodule on styloid process of radius
42
how to test for de quervain's syndrome
finklestein's test - pt will grasp thum and ulnar deviate if pain over styloid = +
43
what is treatment for de quervain's syndrome
conservative - wrist brace/cast - anti-inflammatory medication - restricted movement of wrist and thumb - ice-heat - cortisone injections - PT nd OT - avoid movement that cause pain surgical - release of constriction or partial resection of sheath
44
what is the flexor retinaculum
from tubercle of scaphoid and pisiform and hook of hamate and tubercle of trapezium aka transverse carpal ligament
45
functions of flexor retinaculum
attachment for thenar and hypothenar muscles help maintain transverse carpal arch restrain against bowstringing of extrinsic flexors protects median nerve
46
what are the structures that pass deep to the flexor retinaculum
4 FDS tendons 4 FDP tendons FPL median nerve
47
what are the structures that pass superficial to the flexor retinaculum
ulnar nerve and artery palmaris longus tendon sensory branch of medial nerve
48
describe the carpal tunnel
conduit for the medial nerve and 9 flexor tendons common location for nerve impingement
49
what are the boundaries of the carpal tunnel
roof - flexor retinaculum ulnar border - hook of hamate radial border - trapezium floor - radiocarpal ligaments and palmar ligament complex
50
describe the median nerve
sensory - palmar cutaneous passes superficial to flexor retinaculum or outside carpal tunnel - innervates central palm over thenar eminence enters carpal tunnel - motor: APB, OP and FPB and 1st nd 2nd lumbricals - sensory - thumb, index, middle
51
what are the causes of carpal tunnel syndrome
- synovitis or inflammation - trauma: colle's - edema: pregnancy - metabolic: diabetes, thyroid - repeated stress in hands
52
signs and symptoms of carpal tunnel syndrome
numbness or tingling in hand: thumb, index and middle paint in wrist or hand that may extend to shoulder weakness and clumsiness with grip and pinch worse at night or at driving or when holding objects, gripping severe - atrophy of thenar muscles
53
how is carpal tunnel syndrome tested
tinel test - are over median nerve is tapped an palmar surface of wrist; if produces tingling = + flick's manuever - pt sitting and shakes hand vigorously; resolution of paresthesia = + prayer's test - full wrist and finger extension; if psi on carpal tunnel inc = + phalen's test - reverse prayer's - better test
54
what is the treatment of CTS
conservative - lifestyle modifications - splinting - medication - NSAID - steroids - PT - cortisone injections surgical - carpal tunnel release
55
describe the tunnel of guyon
depression superficial to flexor retinaculum betw hook of hamate and pisiform passage of ulnar nerve and artery into hands to supply intrinsic muscles
56
boundaries of tunnel of guyon
roof - flexor retinaculum, palmaris brevis and palmar aponeurosis floor - pisohamate ligament and pisometacarpal ligament
57
describe the ulnar nerve
from inferior roots of brachial plexus (C8-T1) and branches out at forearm - palmar cutaneous: skin over hypothenar eminence - dorsal cutaneous: dorsal aspect of fingers motor branch passes cubital tunnel to supply FCU and FDP to 4th and 5th digits
58
describe the ulnar nerve as it passes the tunnel of guyon
deep motor branch - FDM, ADM, ODM, AP, palmaris brevis, 3rd and 4th lumbricals, deep head of FPB and interossei superficial sensory branch - 4ht and 5th palmary, tips dorsally
59
describe canal of guyon syndrome
distal impingement of ulnar nerve at canal of guyon
60
causes of canal of guyon syndrome
ganglion cyst hook of hamate fracture/displacement tumors repetitive trauma abberant tunnel or excess fat tissue w/in canal ulnar artery thrombosis or aneurysm
61
signs and symptoms of canal of guyon syndrome
purely motor/sensory or mixed depending on the zone of nerve lesion motor - weakness or paralysis of intrinsic muscles - weakening of grip - clawing of 4th and 5th digit: benedict sign - advanced: hypothenar atrophy
62
how to test for tunnel of guyon syndrome
froment's test - grip sheet of paper using thumb; thump IP joint flexion = + wartenberg's sign - 5th digit is over-abducted - seen in ulnar nerve palsy - sensory: pain/paresthesia of medial palm and ulnar half of 4th digit and anterior of 5th digit
63
differential diagnosis for canal of guyon syndrome
1. test for strength of muscles - intrinsic: guyon - extrinsic: ulnar 2. sparing of dorsal surface of hand and 4th and th fingers = guyon 3. tinel's - tap the nerve to identify and localiz e
63
differential diagnosis for canal of guyon syndrome and cubital fossa syndrome
1. test for strength of muscles - intrinsic: guyon - extrinsic: ulnar 2. sparing of dorsal surface of hand and 4th and th fingers = guyon 3. tinel's - tap the nerve to identify and localiz e
64
treatment for canal of guyon syndrome
conservative - avoidance of stress at guyon's canal - ergonomical handle bar - minimize wrist extension - splint wrist at neutral position at night for 12 wks - PT surgical - for high intensity trauma
65
describe the radial nerve
splits into superficial and deep as enters cubital fossa superficial: lateral border of forearm - at wrist divides into 4-5 digital branches = sensory to lateral 2/3 of dorsal hand and lateral 2 1/2 of fingers deep: motor to muscles of posterior compartment of forearm
66
what is the palmar aponeurosis
deep to subcutaneous tissue from palmaris longus tendon to fascia of thenar and hypothenar up to transverse carpal ligament continues to fingers and splits and wraps the 4 tendons around MCP protects ulnar artery and nerve and digital nerves and vessels
67
describe dupuytren's contracture
fibrotic condition of palmar aponeurosis; nodule or scarring finger flexion contracture often in men 55-75 common in ring or 5th finger or both common bilateral; if uni affects R
68
clinical appearance of dupuytren's contracture
small nodular in palmar fascia at MCP joint flexion of MCP and PIP; DIP sparred less or no pain - splints and stretching non-functional or non-correctable - surgery then splint
69
what is the differential diagnosis for dupuytren's contracture
rule out flexion from: - congenital malformation - spasticity - trauma and infection
70
describe the extensor hood and extensor expansion
distal part of the hood receives tendons from lumbricals and distal phalanx central band - band inserts in proximal dorsal edge of middle phalanx and insert at extensor hood on lateral slide and splits going to distal lateral bands - rejoins over middle phalanx into terminal tendon and inserts at distal phalanx
71
what are the flexor tendon zones
1 - tip of finger to middle phalanx; FDP 2 - middle of middle phalanx to distal palmar crease; flexor tendon superficialis and flexor tendon profundus - no man's land bc repair is difficult 3 - distal palmar crease to distal edge of flexor carpal ligament; lumbrical zone 4 - under carpal tunnel ligament and carpal tunnel 5 - proximal to wrist joint from origin of flexor tendons to muscle bellies to proximal carpal tunnel - vv small in thum
72
what are the extensor tendon zones
1 - DIPJ 2 - middle phalanx 3 - PIPJ 4 - proximal phalanx 5 - MCPj 6 - metacarpals 7 - wrist joint 8 - distal 1/3 of forearm 9 - proximal 2/3 of forearm
73
what are the extensor tendon injuries
1 - mallet finger 2 - disruption of EPL 3 - central slip; boutonniere's deformity 5 - fight bite
74
describe mallet finger
rupture or avulsion of terminal extensor tendon DIP flex while PIP extended; baseball
75
what is swan neck deformity
hyperextended PIP and flexed DIP related to arthritis injury to extensor tendon insetion
76
describe boutonierre's deformity
affectation of central slip tendon; nothing holds PIP PIP flexed but DIP extended central slip rupture
77
what are the flexor pulleys from proximal to distal
A1 A2 C1 A3 C2 A4 C3 A5
78
what is trigger finger
pain, stiffness or locking when you bend or straighten finger ring and thumb are most affected swelling of flexor tendon - A1 pulley becomes inflamed = hard for tendon to glide - FDP nodule = same effect
79
what are the classifications of trigger finger
1 - pain on A1 pulley 2 - triggering on PE can extend PIP active 3A - PIP extended passively 3B - patient cannot flex 4 - rigid or stuck in flexion or extension
80
etiology of trigger finger
2-3% of gen pop 10% of diabetic popu - common in diabetic more common in females over 50
81
treatment of trigger finger
non-operative: - splinting - modify activity - NSAID - corticosteroid injections - PT operative: - percutaneous release of A1 pulley - open surgical debridement and release of A1
82
describe swan neck deformity
most frequent deformity in fingers - if thumb = zigzag deformity hyperextention of PIP and flexion of DIP inability to grasp
82
causes of swan neck deformity
lax volar plate imbalance of extension > flexion force on PIP = passive flexion of DIP rupture of FDS
83
describe ulnar drift
ulnar shift and deviation at MCP w rheumatoid arthritis more common than radial bc of opening bottles, doors MCP capsule and ligaments are stretched = loosens collateral ligaments and dec joint stability
84
describe intrinsic minus deformity
claw hand - strong extrinsic; no intrinsic MCP hyperextension and PIP and DIP flexion
85
causes of intrinsic minus deformity
ulnar nerve palsy - cubital or ulnar tunnel median nerve palsy - volkmann's ischemic fracture - leprosy: hansen's - failure to splint in intrinsic plus charcot-marie-tooth disease - hereditry compartment syndrome of hand
86
describe intrinsic plus hand
spastic intrinsics and weak extrinsics MCP flexion and PIP and DIP extension
87
describe gamekeeper's thumb
rupture of collateral ligament on ulnar side of thumb at MCPJ overextended and abducted skier's thumb; deals w cards
88
what are the causes of gamekeeper's thumb
blow or fall on extended thumb repeated abduction of thumb
89
signs and symptoms of gamekeeper's thumbs
pain at base of thumb swelling at base difficulty grabbing and throwing unstable or wobbly thumb brusing weak thumb-index pinch
90
what is the treatment of gamekeeper's thumb
incomplete acute tears - immobilize for 4-6 wks acute complete and chronic fracture - surgery
91
decribe the piano key sign
floating ulnar styloid due to damage to radioulnar ligament ulnar styloid moves when applying pressure to finger causes: arthtritic conditions ligament laxity trauma overuse

pt momints ver 2.0 (14 decks)

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