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Clin Med 4 > MSK Hand/Wrist > Flashcards

MSK Hand/Wrist Flashcards

1
Q

metacarpal fx’s result of what trauma?

A

direct trauma

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2
Q

what is a boxer’s fx? how does it occur? what angulation do see on PE?

A

fx thru the 5th metacarpal neck

occurs when an object is struck with a closed fist

have volar angulation (up to 40 deg) is acceptable

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3
Q

what should be assessed with boxer’s fx? why?

A

assess to see if there is rotational deformity - rotational deformity is NOT acceptable

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4
Q

tx of boxer’s fx?

A

If >45 deg volar angulation: reduce

Orthoglass splint first, then ulnar gutter cast 3-4 weeks

Surgical repair if rotated or >45 degrees volar angulation -> cast 3-6 weeks

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5
Q

what is a Bennett fx dislocation?

A

intra-articular (break crosses into surface of joint) two-part fx of the base of 1st metacarpal d/t forced abduction of 1st metacarpal

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6
Q

what is the most frequent thumb fx?

A

Bennet fx dislocation

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7
Q

what is seen on imaging for Bennet fx?

A

2-piece fracture dislocation at the base of 1st metacarpal

Intra-articular extension

Dorsolateral dislocation
-lateral retraction of the first metacarpal shaft by abductor pollicus longus

Small fragment of 1st metacarpal continues to articulate with trapezium

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8
Q

what is a Rolando rx?

A

comminuted Bennet’s fx (at least 3 parts) -> worse prognosis

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9
Q

CRPP tx of Bennet fx if?

A

CRPP fixation if:

  • < 3mm of displacement
  • When break of the fragment <50% of plamar slope of the metacarpal
  • When concave dome of the metacarpal maintained
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10
Q

what type of cast for Bennet fx?

A

thumb spica cast for 4-6 weeks

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11
Q

if CRPP of Bennet fx is not possible, then what’s the tx?

A

ORIF with AO cortical screw

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12
Q

what common fx’s use thumb spica cast?

A

Bennet fx-dislocation

Scaphoid fx’s

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13
Q

what is the MOST frequently fx carpal bone?

A

scaphoid

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14
Q

what part of the scaphoid is most commonly fx?

A

waist

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15
Q

scaphoid suspected with what fall?

A

FOOSH

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16
Q

what part of scaphoid is most commonly fx in kids?

A

distal pole d/t ossification sequence

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17
Q

tenderness with what compression and towards what in scaphoid fx?

A

Tenderness with axial compression of thumb toward the snuff box

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18
Q

limitation of what wrist movements with scaphoid fx? radial and ulnar deviation results in pain on what side of wrist?

A

wrist flexion and extension

pain on radial side of wrist

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19
Q

forced ___ elicits significant tenderness in scaphoid fx

A

Forced dorsiflexion usually elicits significant tenderness in scaphoid fx

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20
Q

what is the blood supply of the scaphoid? 80% of scaphoid via ___ blood flow

A

dorsal carpal branch of radial artery

-80% of scaphoid via retrograde blood flow

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21
Q

time to union of scaphoid fx’s is greater for what scaphoid fx’s/

A

proximal scaphoid fx’s

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22
Q

fx of distal third of scaphoid heals when? fx of middle third heals when? fx of proximal third heals when?

A

Fracture of distal third heal in approx. 6-8 weeks

Middle third fractures heal in 8-12 weeks

Fracture of proximal third heal in 12-23 weeks

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23
Q

at what location is the incidence of avascular necrosis 100% with scaphoid fx? 33%

A

proximal 5th AVN rate of 100%

proximal 3rd AVN rate of 33%

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24
Q

tx of non-displaced scaphoid fx?

A

thumb spica splint/cast x6 weeks followed by short thumb spica splint/cast until signs of union are seen on radiograph

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25
Q

tx of displaced scaphoid fx?

A

ORIF followed by thumb spica cast 6-8 weeks

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26
Q

what is basal joint arthritis?

A

arthritis of the 1st CMC joint

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27
Q

what is the most common form of OA of the hand?

A

basal joint arthritis

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28
Q

basal joint arthritis more common in what people?

A

post-menopausal women

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29
Q

what do ppl with basal joint arthritis complain of?

A

insidious radial thumb pain that originally worsened with use

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30
Q

when do you change casts for scaphoid fx? why?

A

cast changes q 10-14 days for 1st 6 weeks to ensure it remains firms around forearm/wrist

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31
Q

what actions increase pain in basal joint arthritis?

A

opposition (writing, opening jars, carrying heavy objects) increases pain

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32
Q

PE of basal joint arthritis

A

+TTP at trapeziometacarpal joint as well the scaphotrapezial joint in advanced stage

Grind test of the trapeziometacarpal joint will often produce pain

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33
Q

tx of basal joint arthritis?

A
  • NSAIDs
  • Splinting
  • Ice
  • Intraarticular cortisone injection
  • Total joint replacement
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34
Q

how is total joint replacement done for basal joint arthritis?

A

“anchovy technique” (excision of distal 1/2 trapezium, FCR tendon used as spacer - put in FCR tendon)

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35
Q

what is Boutonniere deformity and what is the tx?

A

seen in RA
-flexion of PIP and hyperextension of DIP

Tx:
Splinting - tried for 3 months before surgery

Surgery - strengthen, repair of central slip, and hold with K-wire

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36
Q

what is swan neck deformity and what is the tx?

A

seen in RA
-hyperextension of PIP and flexion of DIP

Tx:

  • ***silver ring splints
  • joint fusion
  • joint arthroplasty
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37
Q

what nerve is compressed in carpal tunnel syndrome? what is the compression d/t?

A

median nerve in the carpal tunnel d/t decreased canal size of increased volume of soft tissue structures in the canal

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38
Q

what are the 2 signs that are positive for carpal tunnel syndrome?

A

+ Tinel sign (tap over transverse carpal ligament to produce paresthesias)

+ Phalen’s sign

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39
Q

tx of carpal tunnel syndrome

A

Conservative

  • Wrist splint
  • PT
  • Ergonomics
  • Steroid injection
  • Surgery
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40
Q

what is deQuervain’s Tenosynovitis? what tendons are affected?

A

Stenosing tenosynovitis of 1st dorsal compartment of wrist

  • Abductor pollicus longus (APL)
  • Extensor pollicus brevis (EPB)
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41
Q

sx of deQuervain’s Tenosynovitis?

A

pain, swelling, point tenderness along dorsal aspect of wrist

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42
Q

what test is used to dx deQuervain’s Tenosynovitis?

A

Finklestein test

  • fist made with thumb inside fingers
  • ulnar deviation of wrist reproduces pain
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43
Q

tx of deQuervain’s Tenosynovitis?

A
  • Rest/activity modification
  • Thumb spica cast/splint immobilization
  • NSAIDs
  • PT
  • Steroid injections
  • Surgical decompression of first dorsal compartment
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44
Q

what is a gamekeeper’s thumb?

A

Injury to ulnar collateral ligament of thumb at MCP joint

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45
Q

what does gamekeeper’s thumb result in?

A

instability of MCP joint and decreased thumb grip strength

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46
Q

gamekeeper’s thumb aka?

A

Skier’s thumb

-injury resulting from FOOSH while gripping ski pole

47
Q

what will plain films show for gamekeeper’s thumb? what other views MUST you do?

A

Plain films may not show deviation

Will need to perform stress view

48
Q

tx of gamekeeper’s thumb? (conservative and surgical)

A

Conservative (partial tear):
-Thumb spica cast/splint immobilization for 4-6 weeks

Surgical (full tear)

  • Open repair of avulsed ligament
  • Necessary for Stener lesion
49
Q

what are the Kanavel’s 4 cardinal signs of hand infection (tenosynovitis)

A
  • Tenderness along flexor tendon
  • Edema
  • Pain with passive extension
  • Flexed resting posture
50
Q

hand infections often from what traumas?

A

cat bite, human bite, puncture wounds (always x-ray heroin users)

51
Q

usual bacterial of hand infections?

A

***staph, oral anaerobes

strep, pasteurella

52
Q

sx’s of hand infections

A
  • Erythematous, swollen, warm area
  • ***Painful to PROM
  • Decreased AROM
  • Pustule
  • Lymphangitis
53
Q

x-ray hand infections for what?

A

foreign bodies and osteomyelitis

54
Q

tx of hand infections

A

IV Abx
-Cephalexin, Clindamycin, Cefazolin, Unasyn, Vanco

Pain management

Surgical wash out

55
Q

tx for finger dislocation?

A
  • Recheck NV status
  • Volar alumafoam splint
  • Buddy-tape
  • APAP, NSAIDs, and ice
  • Follow-up with hand surgeon
56
Q

what is mallet finger?

A

Disruption of extensor mechanism of finger at DIP joint

57
Q

mallet finger classically occurs playing ___ and when what happens to DIP?

A

sports when DIP undergoes sudden flexion (extended finger is struck at the tip of an object I.e. baseball or basketball)

58
Q

mallet finger includes what 2 injuries?

A

both bony avulsion injury and tendinous injury without avulsion

59
Q

sx’s of mallet finger?

A

Inability to extend the DIP joint

Slight flexion at rest, which is where the term “mallet” comes from

60
Q

tx of mallet finger?

A

Stax splint for 6-8 weeks with DIP in slight hyperextension

DIP joint splint (puts DIP in 10 degrees of hyperextension for tissue contact)

61
Q

what must you explain to pt about DIP joint splint for mallet finger?

A

that the DIP joint splint CAN’T BE REMOVED for 8 weeks

62
Q

what’s a jersey finger?

A

Avulsion injury of flexor digitorum profundus tendon from insertion at base of distal phalanx

63
Q

jersey finger classically occurs during what activities and what motion?

A

during certain sports resulting from sudden hyperextension of actively flexed finger (i.e. grabbing opponent’s jersey during rugby)

64
Q

what finger is involved with jersey finger? why?

A

Ring finger

-FDP insertion into ring finger anatomically weaker than middle finger

65
Q

sx’s of jersey finger?

A

Inability to flex the finger at DIP joint

Slight extension at joint

+TTP over volar aspect distal finger

66
Q

what does MRI show for jersey finger?

A

disruption of flexor digitorum profundus (FDP) at volar base of distal phalanx +/- avulsion fragment

67
Q

tx for jersey finger? (conservative and surgical)

A

Conservative for partial tear (i.e. splinting, NSAIDs, PT)

Surgical intervention: all complete flexor tendon injuries should be surgically repaired

68
Q

what is trigger finger?

A

Stenosing flexor tenosynovitis

69
Q

what is trigger finger d/t? what does it result in?

A

repetitive microinjury from frequent flexion-extension movements of the fingers

results in thickening of the flexor tendon sheath and tendon

70
Q

trigger finger more prevalent among pts with what diseases?

A

DM, RA

71
Q

sx’s of trigger finger

A
  • Difficult to straighten or bend affected finger
  • Finger transiently gets locked in the flexed position and then with a painful snapping sensation goes into extension
  • Patients often say they have to manually extend their fingers
72
Q

what do pts with trigger finger say they have to do to their fingers?

A

have to manually extend their fingers

73
Q

tx of trigger finger?

A

surgery - release the A1 pulley

74
Q

what is dupuytren’s contracture?

A

slowly progressive fibrosis of the palmar fascia

75
Q

loss of what in dupuytren’s contracture?

A

loss of full extension of the hand and finger

76
Q

sx’s of dupuytren’s contracture? what side of palms affected? which fingers affected earliest?

A

Initially complain of thickening or nodules in palm

May be painless at first

Ulnar side of both palms

4th and 5th fingers affected earliest

77
Q

tx of dupuytren’s contracture?

A

***Cortisone injections into sheath

Surgery with open fasciotomy

Collagenase injections- reduces contractures improves ROM

Ppx external beam radiation therapy- slowed progression

78
Q

what is a ganglion cyst?

A

soft tissue tumor of hand (M/C)

flexor tendon and joint (dorsal wrist)

fluid filled swelling overlying a joint or tendon sheath (contains mutinous or gelatinous fluid)

79
Q

sx’s of ganglion cyst?

A

Obvious swelling

Can have NO swelling but HAVE joint pain

Cyst is smooth, firm, rounded, rubbery

80
Q

tx of ganglion cyst?

A

splinting

needle aspiration with 18G needle and 3cc syringe

surgical removal for recurrent cysts

81
Q

what is a mucous cyst? associated with?

A

benign cysts usually at the DIP (dorsal surface)

associated with OA

82
Q

sx’s of mucous cyst?

A

swelling on dorsal side of finger

translucent nodule

groove in fingernail d/t pressure on the matrix

83
Q

tx of mucous cyst?

A

Intralesional corticosteroid injections (triamcinolone)

Surgical excision

84
Q

what is Herpetic Whitlow? involves what part of finger?

A

intensely painful fingertip infection

involves distal phalanx

85
Q

what is herpetic whitlow d/t?

A

HSV-1 (60%)

HSV-2 (40%)

86
Q

why are toddlers more susceptible to herpetic whitlow?

A

d/t thumb-sucking

87
Q

sx’s of herpetic whitlow?

A

Painful, edematous fingertip with vesicular lesions

Most common digits are thumb and index finger

88
Q

assessment for herpetic whitlow?

A
  • Clinical
  • Tzank smear
  • Viral culture
  • Serum antibody titers
89
Q

tx for herpetic whitlow?

A

it’s self-limited

Acyclovir PO or Topical

90
Q

what is felon? what fingers most affected? what can it lead it?

A

infection of fingertip pulp

thumb and index fingers most affected

can lead to ischemic necrosis and osteomyelitis

91
Q

what can lead to felon?

A

untreated paronychia

92
Q

sx’s of felon?

A
  • Throbbing pain
  • Tension
  • Edema
  • Erythema
93
Q

assessment of felon?

A

Culture any fluid

-Staph, MRSA, Eikenella corrodens found in diabetics who bite their nails, GI pathogens

94
Q

tx of felon?

A

-I&D

  • **Abx directed at Staph and MRSA
  • Dicloxacillin
  • Cephalexin
  • Bactrim
  • Clindamycin
  • Nafcillin
  • Doxycycline
95
Q

most nail bed injuries involve what else?

A

the finger tips

96
Q

nail bed injuries from what injury?

A

crush injury

97
Q

tx for nail bed injuries?

A

Anesthesia- finger block or sedation

  • No ring block
  • NO EPI

Adhesives can be used instead of stitches

Simple laceration
-Not extending into peripheral soft tissue

Subungal hematoma
-Trephination

98
Q

complex stellate repair for nail bed injuries?

A

need to remove nail plate

99
Q

if crush injury causing nail bed injury, what part of finger is fx?

A

distal phalanx fx

100
Q

what is compartment syndrome? occurs when?

A

Increased pressure in a compartment compromises the circulation

occurs following trauma

101
Q

common sites of compartment syndrome?

A

leg and forearm

102
Q

compartment syndrome is a complication associated with what injuries?

A

closed injuries to extremities

103
Q

what is the tip off of compartment syndrome? suspect in what pts?

A

pain level higher than expected

suspect in pts with casts and in pain

104
Q

early sx’s of compartment syndrome?

A

pain out of proportion to injury

paresthesia - pins and needles sensation

105
Q

late sx’s of compartment syndrome?

A

5 P’s

  • pain
  • pallor
  • pulselessness
  • paresthesia
  • paralysis
106
Q

compartment syndrome often caused by fx’s in what bones?

A

radius and ulna

107
Q

what prevents expansion of tissue in compartment syndrome?

A

muscle fascia

108
Q

tx for compartment syndrome

A

Fasciotomy

  • surgical intervention required to relieve pressure in compartment
  • return to OR for closure at later date
109
Q

limit of how many intra-articular corticosteroid injections per joint?

A

limit of 3 injections per joint in a 12-month period

110
Q

adrs of intra-articular corticosteroid injections

A
  • Blanching of skin
  • Localized fat atrophy
  • Infection
  • Transient rise in blood glucose levels
111
Q

dose of intra-articular corticosteroid injections in shoulder/knee

A

1ml of 80 mg of Depo-Medrol, 2ml of 1% lidocaine without epi, and 2ml of .5% Marcaine

112
Q

dose of intra-articular corticosteroid injections in greater trochanteric bursitis

A

1ml of 80 mg of Depo-Medrol, 1ml of 1% lidocaine without epi, and 1ml of .5% Marcaine

113
Q

dose of intra-articular corticosteroid injections in elbow epiconylitis

A

.5ml of 80 mg of Depo-Medrol, .5ml of 1% lidocaine without epi, and .5ml of .5% Marcaine

Clin Med 4 (11 decks)

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