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Clin Med 3- Exam 2 > MSK 3 > Flashcards

MSK 3 Flashcards

1
Q

What is the most frequently injured portion of the hand?

A

Fingertips

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2
Q

What is nail trephination and what disorder is it useful for?

A

Putting a hole in the nail plate to allow instant relief to the pts b/c it releases all the pressure and blood; useful for subungual hematomas

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3
Q

Why is a ring block not suggested for laceration repair?

A

b/c of the possibility of cutting off blood supply

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4
Q

What are the names of the 2 adhesives that can be used instead of stitches in lac repair?

A

Indermil and Histoacryl

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5
Q

What area are simple lacerations confined to?

A

Nail bed (do not extend into peripheral soft tissue)

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6
Q

What are 5 steps to repairing a complex stellate lac?

A

1) Need to remove nail plate
2) Any free tissue should be put back in place
3) Suture nail bed w/small, absorbable sutures
4) Suture nail plate back
5) Trephination of the nail

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7
Q

What image do you always want to order with complex stellate lac and why?

A

X-ray b/c likely to find a fx underneath (most likely dealing with open fx and will want to put on abx)

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8
Q

What do you do before suturing a displaced fx?

A

Reduce them (if needed)

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9
Q

What is mallet finger and what finger is most commonly affected?

A

An injury to the extensor digitorum tendon at the DIP usually caused by trauma to the distal phalanx; middle finger most common

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10
Q

What is the etiology of mallet finger?

A

Axial loading of finger; causes sudden forced flexion of distal phalanx→ flexion damages the extensor tendon

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11
Q

What are the 4 findings on clinical presentation/PE of mallet finger?

A

(1) unable to extend distal phalanx after trauma
(2) pain over DIP
(3) swelling
(4) ecchymosis

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12
Q

What is the tx of mallet finger?

A

Splinting in full extension or hyperextension for 6-8 weeks 24/7 (or tx has to restart)

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13
Q

What ruptures in rugger-jersey finger and which finger is most commonly affected?

A

The flexor digitorum profundus; ring finger (75%)

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14
Q

Why does rugger-jersey finger need to be fixed promptly?

A

b/c if not fixed promptly, pt can be left with FDP finger where they won’t be able to flex that finger again

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15
Q

What is the etiology of rugger-jersey finger?

A

Forced hyperextension

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16
Q

What are the 3 findings on clinical presentation/PE of rugger-jersey finger?

A

(1) acute pain
(2) swelling volar aspect of DIP (palmar side)
(3) inability to flex the distal phalanx

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17
Q

What is the tx in almost all cases of rugger-jersey finger?

A

surgery

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18
Q

What are ganglions and what do they contain?

A

Fluid filled swelling overlying a joint or tendon sheath; contain mucinous or gelatinous fluid

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19
Q

Where are flexor tendon ganglions usually located? Where are joint ganglions usually located?

A

Flexor tendon: usually on palms and fingers

joint: usually on dorsal wrist

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20
Q

What are 2 etiologies of ganglions?

A

(1) degeneration of periarticular structures like synovial lining
(2) repetitive movements

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21
Q

What are 4 possible findings on clinical presentation/PE of ganglions?

A

(1) obvious swelling
(2) without swelling, just joint pain
(3) cyst typically smooth, firm, rounded and rubbery
(4) sometimes tender

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22
Q

What are the 3 tx options of ganglions?

A

(1) observation

(2) needle aspiration w/18 G needle w/3 cc syringe (3) surgical removal for recurrent cysts

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23
Q

What is the location of a mucous cyst?

A

Usually at the DIP on the dorsal surface

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24
Q

What disorder are mucous cysts usually associated with?

A

osteoarthritis

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25
Q

Differentiate mucous cysts from Heberden’s nodes.

A

Mucous cysts typically only present on 1 finger, Heberden’s nodes present on multiple fingers

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26
Q

What are 4 possible findings on clinical presentation/PE of mucous cysts?

A

(1) typically visible swelling on dorsal side of finger
(2) translucent nodule
(3) may be painful
(4) groove in fingernail d/t pressure on the matrix

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27
Q

What are 2 tx options for mucous cysts?

A

(1) intralesional corticosteroid injections-triamcinolone

2) surgical removal (risk of septic osteoarthritis

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28
Q

What is trigger finger and in what 2 populations is there a higher prevalence?

A

Stenosing flexor tenosynovitis; a painless snapping, catching, or locking of the finger(s) that occurs during flexion→ pts have to manually extend their fingers
-higher in diabetics and RA pts

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29
Q

What are the 5 tx and management options for trigger finger?

A

1) Start conservatively
2) NSAIDs
3) Splinting
4) Glucocorticoid injection
5) Surgery to release the A1 pulley

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30
Q

What is Bennett’s fracture?

A

A fracture dislocation of the base of the metacarpal

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31
Q

What are 3 etiologies of Bennett’s fractures?

A

(1) axial load on the thumb
(2) hyper abduction +/or hyperextension after fall
(3) torsional injuries

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32
Q

What are 3 possible findings on clinical presentation/PE of Bennett’s fractures?

A

(1) pain
(2) swelling over dorsal base of thumb
(3) difficulty w/thumb ROM

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33
Q

What is crucial in tx of Bennett’s fractures?

A

Integrity of the CMC joint of the thumb

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34
Q

What type of splint is applied in a Bennett’s fracture?

A

thumb spic splint

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35
Q

What is basal joint arthritis?

A

Arthritis of the CMC joint of the thumb

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36
Q

What are 6 possible findings on clinical presentation/PE of basal joint arthritis?

A

1) Pain
2) Tenderness
3) Stiffness
4) Swelling
5) Dec strength
6) Pain w/twisting motions (unlocking doors)

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37
Q

What are 5 tx options for basal joint arthritis?

A

1) NSAIDs
2) Splinting
3) Ice
4) Intra-articular cortisone injections
5) Total joint replacement

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38
Q

What is gamekeeper’s thumb and what is it also known as?

A

Ulnar collateral ligament injury; skier’s thumb

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39
Q

What are 3 etiologies of gamekeeper’s thumb?

A

(1) forced abduction of the MCP joint
(2) falling
(3) ski pole injury

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40
Q

What are 2 possible findings on clinical presentation/PE of gamekeeper’s thumb?

A

1) Pain, tenderness, swelling over the UCL and MCP joint of the thumb ulnar side
2) Stener lesion: usually a sign of complete rupture

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41
Q

How do you tx gamekeeper’s thumb? How do you tx if there is complete rupture?

A

Splinting-thumb spica cast 4 weeks; complete ruptures require surgical repair

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42
Q

What is herpetic whitlow?

A

Fingertip infection involving 1 or more fingers that is intensely painful

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43
Q

What is a dead giveaway finding of herpetic whitlow?

A

Vesicular lesions on fingertips

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44
Q

What is the #1 cause and #2 cause of herpetic whitlow?

A

HSV-1 and HSV-2

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45
Q

What are the 2 most common digits affected?

A

Thumb and index fingers

46
Q

T/F: herpetic whitlow may have a prodrome of fever and malaise.

A

True

47
Q

If dx unable to made clinically, what 3 tests can be ordered to confirm herpetic whitlow dx?

A

(1) Tzank smear
(2) viral culture
(3) serum antibody titers

48
Q

What are 3 drug options for tx of herpetic whitlow?

A

(1) acyclovir
(2) famciclovir
(3) valacyclovir

49
Q

What is felon?

A

An infection of fingertip pulp

50
Q

What 2 conditions can felon lead to?

A

Ischemic necrosis and osteomyelitis

51
Q

What are 4 possible findings on clinical presentation/PE of felon?

A

(1) throbbing pain
(2) tension
(3) edema
(4) erythema

52
Q

What are 3 bacterial etiologies of felon?

A

(1) Staphlococcus
(2) MRSA
(3) Eikenella corrodens (diabetics who bite their nails)

53
Q

What are the 2 tx of felon?

A

(1) I&D

(2) abx directed at MRSA and Staph

54
Q

What are 6 abx options to tx felon?

A

1) Dicloxacillan
2) Cephalexin
3) Bactrim
4) Clindamycin
5) Nafcillin
6) Doxycycline

55
Q

What is a partial amputation?

A

When bone and tissue keep the part attached still

56
Q

What should you place an amputated finger in and what should you avoid contact with?

A

Place finger in saline soaked gauze, in a watertight container (Ziploc bag); avoid direct contact w/ice

57
Q

What should you always do to an amputated part before reattaching it?

A

X-ray it to make sure it is still viable and able to be reattached

58
Q

What is a boutonniere deformity?

A

Pathologic flexion of the PIP and hyperextension of the DIP; disruption of central slip

59
Q

What are 3 common causes of boutonniere deformities?

A

Trauma, RA, and burns

60
Q

What are 4 possible findings on clinical presentation/PE of boutonniere deformities?

A

(1) obvious deformity
(2) muscle atrophy
(3) traumatic injury will present w/tenderness
(4) pain and swelling

61
Q

What are 2 tx options for boutonniere deformities?

A

(1) splinting (2) surgery to repair central slip with w K-wire

62
Q

What is a swan neck deformity?

A

The DIP is flexed and the PIP is hyperextended; volar plate stretches

63
Q

What are the 3 etiologies of swan neck deformities?

A

(1) injury
(2) inflammatory conditions like RA
(3) congenital condition- Ehlers-Danlos syndrome

64
Q

What are 3 tx and management options of swan neck deformities?

A

(1) silver ring splints
(2) joint fusion
(3) joint arthroplasty

65
Q

What are 3 common conditions of the hand?

A

(1) Dupuytren’s contracture (2) boxer’s fracture

(3) hand infections

66
Q

What are dupuytren’s contractures?

A

Progressive fibrosis of the palmar fascia that is benign; a loss of full extension of the hand and fingers

67
Q

Which 2 digits are affected earliest with dupuytren’s contractures?

A

4th and 5th fingers

68
Q

What are 4 tx and management options for dupuytren’s contractures?

A

1) Cortisone injections into sheath
2) Surgery w/open fasciotomy
3) Collagenase injections to reduce contractures and improve ROM
4) Prophylactic external beam radiation therapy to slow progression

69
Q

A boxer’s fracture is a fx of which metacarpal?

A

5th

70
Q

What 5 things do you use to classify a boxer’s fracture?

A

1) Fracture location
2) Degree of displacement
3) Angulation
4) Shortening
5) Rotation

71
Q

What must you always pay attention to with boxer’s fractures and why?

A

Skin integrity (ex: teeth marks) b/c almost always turn into an infection

72
Q

What are the 5 tx options for boxer’s fractures?

A

1) Splint non-displaced, well aligned fractures
2) Analgesics
3) Reduction w/local anesthesia
4) Surgical intervention
5) Bite injuries w/fractures: get IV abx, possible washout, and surgery

73
Q

What are Kanavel’s 4 cardinal signs of flexor tenosynovitis?

A

(1) tenderness along flexor tendon
(2) edema
(3) pain with passive extension
(4) flexed resting posture

74
Q

What are the 4 usual bacteria that cause hand infections, and which one is found in cat bites?

A

(1) Staph
(2) Strep
(3) Pasterella- cat bites
(4) oral anaerobes

75
Q

What is the sign of a spreading infection on clinical presentation of hand infections?

A

Lymphangitis

76
Q

What are 5 abx options for tx of hand infections?

A

(1) Cephalexin
(2) Clindamycin
(3) Cefazolin
(4) Unasyn
(5) Vancomycin

77
Q

What are 4 common conditions of the wrist?

A

(1) Carpal Tunnel Syndrome (2) De Quervain’s tendonitis (3) Scaphoid fx
(4) Colles fx/silver fork deformity

78
Q

What is carpal tunnel syndrome indicative of?

A

Median nerve compression

79
Q

What are 6 possible etiologies of carpal tunnel?

A

1) Repetitive movements
2) Prolonged force through the wrist
3) Pregnancy and postpartum
4) Use of wheelchairs and walking devices
5) Low aerobic fitness
6) Increased BMI

80
Q

What are 2 things found on clinical presentation of carpal tunnel?

A

(1) numbness tingling in thumb, index, and middle fingers

(2) thenar atrophy: wasting and weakness

81
Q

What are the LOAF muscles?

A

Lumbricals
Opponens pollicis Abductor pollicis
Flexor pollicis brevis

82
Q

What are 2 signs/tests on PE indicative of carpal tunnel?

A

(1) Phalen sign

(2) Carpal compression test

83
Q

What are 4 diagnostic tests ordered for carpal tunnel?

A

(1) EMG-electromyography (2) NCS- nerve conduction studies
(3) US
(4) MRI preop-when they open up the wrist so they know what they’re cutting into

84
Q

What are 4 tx options for carpal tunnel?

A

1) Mild disease: night splints
2) NSAIDs
3) Work-site eval (to get special keyboard, etc.)
4) Surgical intervention: release the transverse ligament

85
Q

Which 2 tendons does de quervain’s tendonitis affect and where?

A

Affects the abductor pollicis longus and extensor pollicis brevis at the radial styloid process

86
Q

What are 5 findings on clinical presentation of de quervain’s?

A

(1) radial side pain
(2) swelling
(3) difficulty holding or gripping
(4) radiation to thumb and forearm
(5) x-rays normal

87
Q

Which test would be positive if de quervain’s is present?

A

Finkelsteins

88
Q

What are 4 tx options of de quervain’s?

A

1) Thumb spica splint
2) NSAIDs
3) Local glucocorticoid injections
4) Surgery: cutting the first extensor dorsal compartment

89
Q

What most commonly causes a scaphoid fracture?

A

FOOSH- fall on outstretched hand

90
Q

What are 4 findings on clinical presentation of a scaphoid fx?

A

(1) snuffbox tenderness
(2) swelling
(3) pain
(4) grip strength decreased

91
Q

What are 4 tx options of scaphoid fractures?

A

(1) splinting
(2) casting
(3) bone stimulation
(4) surgical intervention

92
Q

A colles fracture is a fracture of what?

A

Fracture of the distal radius

93
Q

What are the 2 common causes of a colles fracture?

A

FOOSH and direct blow

94
Q

What are 3 tx options for a colles fracture?

A

(1) reduction
(2) casting
(3) surgery

95
Q

What are 3 common conditions of the forearm?

A

(1) Galeazzi fracture
(2) Monteggia
(3) Compartment syndrome

96
Q

What is a galeazzi fracture and what is it associated with?

A

A midshaft forearm fracture of the radius associated w/instability or dislocation of distal radioulnar joint-DRUJ

97
Q

What are the 2 types of traumas that cause galeazzi fractures?

A

1) High energy trauma (direct blow):
- Falls from height
- Motor vehicle accident
- Sport injuries

2) Low energy trauma (osteoporosis)
- Falls from standing

98
Q

What is anterior interosseous nerve palsy?

A

Damage to flexor pollicis longus and flexor digitorum profundus; loss of pinch

99
Q

What type of splint do you use to fix galeazzi fractures?

A

Sugar tong splint

100
Q

What is monteggia?

A

A fracture of the proximal third of the ulnar shaft + dislocation of the radial head

101
Q

What is monteggia commonly associated with?

A

Outstretched hand with forced pronation

102
Q

What are 6 possible findings on clinical presentation?

A

1) Significant deformity
2) Elbow pain
3) Pain with elbow flexion and forearm rotation
4) Tenderness
5) Swelling
6) Paresthesia and numbness from radial nerve impingement

103
Q

What are 4 tx options for monteggia and which ones are specific to adults and children?

A

1) Splint w/sugar tong
2) Closed reduction and long arm casting for children-ketamine for sedation
3) Adult: associated with significant instability so need surgery
4) Open reduction internal fixation (ORIF)

104
Q

What is compartment syndrome?

A

Increased pressure in a compartment that compromises the circulation; occurs following trauma and is a surgical emergency

105
Q

Compartment syndrome is usually caused by what?

A

Fractures of the radius and ulna (any fx involving long bones)

106
Q

What 2 things happen in compartment syndrome that cause it to worsen?

A

Fascia prevents expansion of tissue and venous outflow decreases

107
Q

What are 5 nontraumatic causes of compartment syndrome?

A

(1) animal envenomation (snake and spider bites) (2) injection of rec drugs-Heroin
(3) prolonged compression
(4) thrombosis
(5) vascular disease

108
Q

What are 9 findings on clinical presentation/PE of compartment syndrome?

A

1) Rapid progression of symptoms
2) Tense, painful muscles red flag
3) Compartment pressures 10-30 mmHg compromise perfusion
4) Neurologic or vascular compromise
5) Pain out of proportion to injury
6) Deep burning ache
7) Paresthesia
8) Muscle weakness
9) Paralysis

109
Q

How do you dx compartment syndrome?

A

Measuring compartment pressures via handheld manometers, insertion of catheter into compartment, or an 18G needle attached to an arterial pressure monitor

110
Q

How do you tx compartment syndrome?

A

Surgical emergency and fasciotomy (to relieve pressure- pack and dress wound after procedure)

111
Q

How long after onset of acute compartment syndrome is neuromuscular damage irreversible

A

4-6 hours→ limb can become useless w/in 24-48 hrs

Clin Med 3- Exam 2 (15 decks)

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