MSK Hand Teaching Flashcards
what is a Colles #
distal fragment of the radius is displaced dorsally
extra articular #
low energy injury
tends to be from FOOSH
what is a smiths #
volar displacment of the distal fragment of the radius
exta-articular #
fall onto flexed hand or direct blow to posterior hand
low energy injury
what is a bartons fracture
fracture-dislocation of radiocarpal joint
intra-articular fracture
The hand and the fragment of distal radius undergo a proximal and volar displacement.
what is a die punch fracture
intra-articular #
depressed fracture of the lunate fossa of the distal radius
also known as a bennets fracture
occurs due to vertical load through the lunate
what do you need to assess for wrist injuries
mechanism of injury
reason for fall
examine neurovascular status
soft tissue damage
when are CT and MRI suitable in wrist injuries
CT:
evaluate intra-articular involvement and for surgical planning
MRI:
soft tissue injury, ligamentous injury, nerve entrapment
what analgesic options are available for wrist #
biers block
haematoma block - LA introduced to haematoma
inhaled - pentorex, gas and air
what is a biers block
tourniquet and IV local anaesthetic
is prefered to haematoma block
how are stable displaced fractures of the wrist managed
manipulation: exaggerate deformity, realign bone, splint fracture and XR post reduction
what is measured to assess if a wrist fracture is stable
radial inclination
radial shortening
volar tilt
what is radial inclincation
around 23 degress
what is radial height
around 12 mm
what is volar tilt
between 2 -20 degrees
what are the operative timings for intra/extra-articular fractures
intra-articular - 72 hours
extra-articular - 1 week
when is conservative management appropriate for wrist fractures
radiologically stable, extra-articular
first line for over 65
involved closed reduction and immbolisation
what are operative options for wrist #
closed reduction and percutaneous pinning can be used for colles
DRAFTF trails show no difference between K wires and plates and are quicker and less expensive
when would you use ORIF for a wrist fracture
severe angulation
intra-articular #
insability
when can they restore function post wrist operation
light use within 2 week
more vigorous activity 6 weeks
which nerve is affected in cubital tunnel syndrome and what are its nerve roots
ulnar nerve
C8 and T1
what is the route of the ulnar nerve
ulnar nerve descends in a plane between the axillary artery (lateral) and the axillary vein (medial).
It proceeds down the medial aspect of the arm with the brachial artery located lateral.
At the mid-point of the arm it enters the posterior compartment of the arm.
through the ulnar tunnel (small space between the medial epicondyle and olecranon).
In the forearm, the ulnar nerve pierces the two heads of the flexor carpi ulnaris, and travels deep to the muscle, alongside the ulna
what does the muscular branch of the ulnar nerve supply
flexor capri ulnaris
flexor digitorum profundus (ulnar part)
what does the superficial branch of the ulnar nerve supply
palmaris brevis
what does the deep branch of the ulnar nerve supply
hypothenar muscles
adductor pollicis
interossei muscles
what can cause cubital tunnel syndrome
compression of the ulnar nerve at the medial malleolus by:
normal motions
fractures
arthritis
what’s the presentation of cubital tunnel syndrome
muscular atrophy of the first dorsal web space
ulnar distribution paraesthesia (5th and half of 4th digit and palm)
elbow pain radiating to the forearm
what are the signs of cubital tunnel syndrome
froments test
- difficulty holding paper between finger and thumb
ulnar claw
- paralysis of 4th and 5th lumbrical
hyperextension of MCP and IPJs
what investigations can be done for cubital tunnel syndrome
XR
nerve conduction studies
what is there for conservative treatment of cubital tunnel syndrome
activity modification
NSAIDs and steriods aren’t benefiscial
what surgical options are there to treat cubital tunnel syndrome
ulnar nerve decompression
with or without anterior transposition or medial epicondylectomy
which nerve is affected in carpal tunnel syndrome and what are its nerve roots
median nerve
all 5 roots; C5 C6 C7 C8 T1
what sensory does the median nerve provide
digital cutaneous branch - tips of fingers
palmar cutaneous branch - palm, is spared in CTS
which muscles does the median nerve supply
all flexors except the ulnar ones
by the recurrent branch in the hand:
thenar muscles and radial lumbrical
what are risk factors/ causes for carpal tunnel
MEDIAN TRAP
m - myxoedema
e - oedema premenstrually
d - diabetes
i - idiopathic
a - acromegaly
n - neoplasm
t - trauma
r - RA
a - amyloidosis
p - pregnancy
what are sign/symptoms of carpal tunnel syndrome
paraesthesia of the digital cutaneous area
positive phalens and tinnels test
hand of benediction
ape hand deformity
what is the management of carpal tunnel syndrome
lifestyle - physio
surgery - carpal tunnel release
what are some risk factors of dupuytrens contractions
FHx
smoking
alcohol
diabetes
epilepsy - anticonvulsant drugs
management of Dupuytren’s
collagenase injection
fasciotomy - division of the cord
fasciectomy - removal of the cord
dermofasciectomy - removal of the cord, skin and subcut fat, then skin graft
what is cubital fossa syndrome
compression of the ulnar nerve at the medial malleolus
