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Pance Re-Up > MSK Re-Up #3 (Finger and Hand) > Flashcards

MSK Re-Up #3 (Finger and Hand) Flashcards

1
Q

Explain the sensory parts of the median, radial, and ulnar nerves.

A

-Palmar Side: Median (thumb, index, middle, half of ring). Ulnar (half of ring, pinky)

-Dorsal Side: Ulnar (Pinky, ring, lower half of middle), Radial (lower half of middle, lower half of index, lower half of thumb), Median (Tips of middle, index, and thumb)

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2
Q

What is the motor function of the following nerves:
-Radial Nerve:
-Median Nerve:
-Ulnar Nerve:

A

Radial: Thumb extension (extensors)

Median: Thumb Opposition (flexors)

Ulnar: Criss cross fingers (intrinsics)

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3
Q

Name the bones of the wrist in order (Palmar side)

A

-Scaphoid
-Lunate
-Triquetrum
-Pisiform
-Trapezium
-Trapezoid
-Capitate
-Hamate

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4
Q

What is the MC fractured carpal bone? What is it from?

What is one common symptom of this condition?

A

Scaphoid (Navicular) Fracture
FOOSH

Pain along radial surface of wrist with anatomical snuffbox tenderness

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5
Q

With a scaphoid (navicular) fracture, it may not show up on radiographs for 2 weeks. Therefore, if the patient has snuffbox tenderness, you should treat as a fracture because there is a high risk of _____ and ________.

What is the treatment for a scaphoid fracture if:
-Nondisplaced:
-Displaced > 1 mm:

A

-High risk of avascular necrosis and nonunion

-Nondisplaced: thumb spica split
-Displaced: ORIF or percutaneous pin placement

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6
Q

Scapholunate dissociation is a widened space between the scaphoid and lunate bones. This occurs due to a FOOSH. What is seen on radiographs?

What is a symptom of this condition?

A

-Radiographs: Widened scapholunate spaces > 3 mm (Terry Thomas Sign)

-Pain on dorsal radial side of wrist with minimal swelling. Pain with dorsiflexion. May have a click with wrist movement.

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7
Q

What is done initially for scapholunate dissociation and what should be done definitively?

A

Initially: Radial gutter splint
Definitively: surgical repair of scapholunate ligament

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8
Q

What occurs in a lunate dislocation (explain it)?

A

Lunate doesn’t articulate with the radius and the capitate.

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9
Q

Explain what can be seen on radiographs with a lunate dislocation.

A

-Lunate appears triangular (piece of pie sign)
-Displacement and tilt of lunate (spilled teacup sign)

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10
Q

What is the treatment for lunate dislocation?

A

-Emergent closed reduction and splint followed by ORIF
–This is an orthopedic emergency!

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11
Q

The most serious carpal fracture is _________ because _______.

A common complication of this condition, like a scaphoid fracture is ________.

A

-Lunate fracture
-Because it occupies 2/3 of the radial articular surface

-Avascular necrosis of the lunate bone (Kienbock’s Disease)

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12
Q

What should you do with a lunate fracture?

A

-Immobilize and ortho follow up

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13
Q

What is a Mallet (Baseball) Finger and how does it occur?

What is a physical exam finding of this condition?

A

-Avulsion of extensor tendon after blow to tip of finger causing forced flexion of an extended finger (hyperextension of DIP joint)

-Unable to actively extend the DIP joint

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14
Q

What are the three joints of the metacarpals?

A

-DIP (Distal)
-PIP (Middle)
-MCP (Knuckle)

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15
Q

What is the management for a mallet (baseball) finger?

A

-Uninterrupted extension splint (mallet finger splint) of DIP joint x 6-8 weeks

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16
Q

On the other hand, what is a boutonniere deformity of the finger?

A

Finger flexed at PIP joint and hyperextended at DIP joint

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17
Q

How about a swan neck deformity?

A

-Finger flexed at DIP joint and hyperextended at PIP joint

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18
Q

What is a gamekeeper’s (skier’s) thumb and how does it occur?

A

-Sprain or tear of ulnar collateral ligament –> MCP joint instability

-Forced abduction of the thumb (from a fall)

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19
Q

What exam finding would suggest a gamekeeper’s thumb?

What is the treatment?

A

-Thumb far away from other digits, weakness in pinch strength

-Thumb spica splint and referral to hand surgeon

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20
Q

What is a Boxer’s Fracture?

How does it occur?

A

-Fracture through the fifth metacarpal neck (maybe the fourth as well)

-Direct trauma to a closed fist against a hard surface (wall)

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21
Q

What is the treatment for a Boxer’s Fracture?

A

Initial: Ulnar gutter splint with joints at 60’ of flexion

ORIF if > 40 degrees angulation of 5th metacarpal

22
Q

With a Boxer’s Fracture, what should you always remember to check for? What is the treatment?

A

-Check for bite wounds
–If present, treat with Amox-Clavulanate (Augmentin)

23
Q

Explain what a Bennett Fracture and a Rolando Fracture is (what is the difference)?

A

-Bennett: non-comminuted partial intra-articular fracture of the base of the thumb

-Rolando: comminuted complete intra-articular fracture of the base of the thumb

24
Q

What is one symptom to remember for a Bennett/Rolando Fracture?

What is one unique finding on radiograph for a Rolando fracture?

A

-Tenderness to CMC joint (base of thumb)

-Y sign: splitting of first metacarpal base into dorsal and solar fragments (shaped like a Y)

25
Q

Management for Bennett/Rolando Fractures if:
-Immediate:
-Bennett:
-Rolando:

A

-Immediate: thumb spica splint
-Bennett: immobilization, closed reduction with pin, ORIF if displaced
-Rolando: ORIF, external fixation, or closed reduction with percutaneous pinning

26
Q

What is pronator teres syndrome?

What are some symptoms of this condition (think about where the affected nerve sits).

A

-Median nerve compression where the nerve transverses the pronator teres muscle

-Paresthesia or pain of lateral palmar aspect of the first 3 (and radial half of the fourth) digits.
-Symptoms NOT worse at night (compared to carpal tunnel syndrome)
-Tenderness over proximal median nerve aggravated by pronation of forearm

27
Q

Management for pronator teres syndrome

A

-Reduce symptom inducing activities
-NSAIDs for pain
-Steroid injections
-Surgical decompression

28
Q

Similarly, carpal tunnel syndrome is _____________. There is increased incidence in this condition in what populations?

A

-Median nerve entrapment and compression at the carpal tunnel

-Women, Diabetics, Pregnancy, Hypothyroidism, RA, Occupations with repetitive extension and flexion of wrists (typing)

29
Q

Symptoms of carpal tunnel syndrome?

What two diagnostic exam tests can be done to diagnose carpal tunnel syndrome?

A

-Paresthesias or pain on palmar aspect of first 3 and radial half of fourth digits ESPECIALLY at night
-Thenar muscle wasting in advanced cases

-Tinel Test: percussion of median nerve
-Phalen Test: flexion of both wrists for 30-60 seconds produces symptoms

30
Q

Management for carpal tunnel syndrome

A

-Volar splint initial management, NSAIDs, avoid movements
-Corticosteroid injections
-Surgery if refractory

31
Q

What is a dupuytren contracture?

What are some risk factors associated with this condition?

A

Progressive fibrosis of the palmar fascia leading to contractures as a result of nodules or longitudinal bands in the palm

-Men, > 40 years old, Northern Europeans, ETOH abuse, cirrhosis, DM, Smoking

32
Q

Symptoms of a Dupuytren Contracture

A

-Visible or palpable nodules over distal palmar crease or proximal phalanx (especially ring or little finger) along course of flexor tendons
-Fixed flexion deformity at MCP joint

33
Q

Treatment for a Dupuytren Contracture

A

-Intralesional collagenase or steroid injections
-Fasciotomy if refractory or advanced

34
Q

A trigger finger is entrapment of a finger flexor tendon most times at ________.

Which finger is MC?

Symptoms?

Treatment?

A

-Most times at the A1 pulley
-Ring finger MC
-Finger clicks or gets locked in flexed position, +/- pain, pain over metacarpal head

-Splint, NSAIDs, Steroid injections

35
Q

A subungal hematoma is ________

What is the treatment for this? There is a specific procedure

A

-Blood under the nail plate secondary to trauma

-Trephination (paperclip, 18G needle, #11 blade)
-Dry sterile dressing, wound care

36
Q

When should you refer a patient to ortho for a subungal hematoma?

A

-If open wound
-or if 50% diameter of hematoma

37
Q

A paronychia is _____ and is usually due to what bacteria?

What are some etiologies?

A

-Infection of lateral nail fold usually due to Staph A

Due to hang nail, local trauma, biting nails, etc.

38
Q

Treatment for a paronychia

A

-I&D with digital block
-Wound care (warm soaks, dressing)
-ABX (Cephalexin, Dicloxacillin)
—MRSA: Bactrim, Clinda

39
Q

On the other hand, a felon is _________

This is MC due to what bacteria?

Treatment is the same as a paronychia.

A

-Subcutaneous abscess of volar finger pad due to puncture wound (nail, puncture, etc.)

-Staph A

40
Q

De Quervain Tenosynovitis is entrapment tendinitis of the first dorsal compartment. What two muscles are entrapped?

Who is this seen in (what is the MOA)?

A

-APL and EPB
–Abdutor pollicus longus
–Extensor pollicus brevis

-Excessive thumb use and repetitive action. Golfers, clerical workers, women postpartum (from lifting newborn), diabetics

41
Q

Symptoms of De Quervain’s Tenosynovitis

What test can be done to diagnose this condition?

A

-Pain along radial aspect of wrist and base of thumb radiating to forearm especially with thumb extension or gripping

-Finkelstein Test: pain with ulnar deviation while thumb is flexed in the palm

42
Q

Management for De Quervain’s Tenosynovitis?

A

-Thumb spica splint initially
-NSAIDs, PT
-Steroid injections
-Surgical release if refractory

43
Q

A ganglion cyst is a ______ filled synovial cyst. Explain symptoms of this.

What can you do for it?

A

-Mucin-filled cyst

Firm, well circumscribed painless mass, fixed to deep tissue. Translucent with illumination.

Observe, Aspirate, Surgery if decreased ROM

44
Q

What is a Colles Fracture?

MOA?

Explain what is seen on physical examination (how does this fracture look)

A

-Distal radius fracture with dorsal angulation

-FOOSH with wrist extension

-Dinner fork deformity appearance to the wrist

45
Q

Management for a Colles Fracture?

A

-Closed reduction followed by sugar tong splint or cast
-ORIF if unstable (>20 degrees angulation, intraarticular, etc.)

46
Q

What is the MC complication of a Colles Fracture?

A

Extensor pollicus longus tendon rupture MC complication

47
Q

On the other hand, what is a Smith Fracture?

MOA?

Explain what is seen on physical examination (what does this fracture look like)

A

-Distal radius fracture with ventral angulation of distal fragment

-FOOSH with wrist flexed

-Garden spade deformity appearance to the wrist

48
Q

Management for Smith Fracture

A

-Closed reduction followed by sugar tong splint
-ORIF if comminuted or unstable

49
Q

Suppurative Flexor Tenosynovitis is infection of a flexor tendon sheath of a finger. What is the MCC and what is the MC etiology?

A

-Staph A from a penetrating injury

50
Q

Symptoms of Suppurative Flexor Tenosynovitis (FLEX)

A

-Kanavel’s Signs (FLEX)
–Finger held in flexion
–Length of tendon sheath tender
–Enlarged Finger
–Xtension of finger causes pain

51
Q

How do you diagnose Suppurative Flexor Tenosynovitis?

Treatment?

A

-Aspirate and biopsy

-Treatment: I&D, ABX

Pance Re-Up (76 decks)

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