MSK Wrist Flashcards
Normal ROM for wrist Flexion: extension: Ulnar deviation radial deviation
F: 80
E: 70
UD 30
RD 20
Name the carpal bones radial —> ulnar
proximal - scaphoid, lunate, triquetrum, pisiform
Distal - trapezium, trapezoid, captitate, hamate
Name the 6 wrist flexors
- FCR (median from MC/LC C6/7)
- FCU (ulnar from MC C8/T1)
- Palmaris longus (Median from MC/LC C7/8)
- FDS (Median from MC/LC C7-T1)
- FDP (median from MC/LC C7-T1 2nd and 3rd digit; ulnar from MC C7-T1 to 4th and 5th digit)
- Flexor Pollicis longus (median from MC/LC C8/T1)
name the 7 wrist extensors
- ECR-L (radial from PC C6/7)
- ECR-B (radial from PC C6/7)
- ECU (radial from PC C7/8)
- Ext dig communis (radial from PC C7/8)
- Ext Dig Minimi (ulnar from MC C8/T1)
- Extensor indicis (radial from PC C6-8)
- Extensor pollicis longus (radial from PC C6-8)
Name the two muscles responsible for ulnar deviation of the wrist
- FCU (ulnar from MC C8/T1)
2. Ext Carpi ulnaris (radial from PC C7/8)
Name the two muscles responible for radial deviation of the wrist
- FCR (median from MC/LC C6/7)
2. ECR-L (radial from PC C6/7)
Name the six tendon sheath compartments of the dorsal wrist
from radial to ulnar
1st - Abductor pollicus longus, Extensor pollicis brevis
2nd - ECR-L, ECR-B
3rd - Extensor pollicus longus
4th - Extensor digitorum communis, extensor indices proprius
5th - extensor digiti minimi
6th Extensor carpi ulnaris
OA is common in ______ of the thumb
1st Carpal-metacarpal joint of the thumb (CMC joint)
In the hand
OA affects ____ and ____
RA affects ____ and ____
OA affects DIP (heberden) and PIP (Bouchard)
RA affects MCP and PIP joints
in RA \_\_\_\_ wrist deviation occurs \_\_\_\_ MCP deviation occurs \_\_\_\_ subuluxation of the ulna \_\_\_\_ at end stage
radial deviation at the wrist
ulnar deviation of the MCPs
Dorsal subluxation of the ulna
erosion of the ulnar styloid at end stages
Describe swan neck deformity (4)
- shortening an dcontracture of intrinsic muscles of the hand
- Flexion at MCP
- hyperextension of PIP
- Flexion at DIP
describe boutonniere deformity (4)
- tearing of extensor hood
- hyperextension of MCP
- Flexion at PIP
- Hyperextensino of DIP
_____ is repetitive or direct trauma to the sheath of the extensor pollicis brevis and abductor pollicis longus tendons, causing a tenosynovitis and inflammation
de quervains tenosynovitis - will have pain and tenderness in radial side of wrist
involves tendons of the 1st compartment of the wrist
what is the provocative test for de quervains tenosynovitis
finkelsteins test - flex the thumb into the palm of the hand with the fingers, making a fist over the thumb. Then passively ulnar deviate the wrist. test is positive if pain is elicited. May also be positive in RA
Treatment of De Quervains tenosynovitis (3)
- thumb spica splint to immobilize the thumb
- NSAIDs
- CSI
surgical release of the tight sheath eliminates the friction that worsens the inflammation, thus restoring the tendon’s smooth gliding capability
ganglion cyst is a fluid filled cyst which arises from ____
synovial sheath of the joint space - typically a small smooth mass on the dorsal or volar aspect of the wrist that occurs on the dorsal apsect in 60% of cases
90% of ganglion cysts are treated by
aspiration of the cyst
____ is known as Kienbock’s disease
osteonecrosis of the lunate
_____ is idiopathic loss of blood supply to the lunate, which causes avascular necrosis of the bone
Kienbocks disease
Name the stages of Kienbocks disease
osteonecrosis of the lunate
Stage 1 - no visible change in the lunate
Stage 2 - sclerosis of the lunate
Stage 3A - sclerosis and fragmentation of the lunate
Stage 3B - 3A with proximal migration of the capitate or fixed rotation of the scaphoid
Stage 4 - 3A or 3B with degenerative changes at adjacent joints
Risk factors for kienbocks disease - 2
- poor vascular supply to the area
2. short ulnar variance
what will you see on MRI for kienbocks disease
osteonecrosis of the lunate - decreased signal intensity on T1 imaging
____ fracture is one of the most common fractures of the wrist. ____%
scaphoid fracture - 70%
The majority of scaphoid blood supply is to the ____ portion of the bone
distal 1/3 - middle and proximal portion have large non-union rate (1/3 develop necrosis)
What are the 4 anatomical locations of scaphoid fractures
- Waist (65%)
- Tubercle (2%)
- Distal pole (10%)
- Proximal pole (15%)
With scaphoid fractures will get what clinical finding
ROM will be painful in which two directions
swelling and tenderness over thumb/wrist (anatomical snuff box)
extension nd radial deviation
what are the borders for the anatomical snuff box
- base - scaphoid bone
- lateral - abductor pollicis longus and extensor pollicis brevis (1st wrist compartment)
- madial - extensor pollicis longus (3rd wrist comparment)
XR views to order if concern for scaphoid fractrue
Posterior-anterior
oblique view of the wrist in ulnar deviation
- compare to other side
Repeat in 4-6 weeks if still symptomatic
CT scan can be done if question of fracture
bone scan can be positive as early as 24h after injury
Treatment of scaphoid fracture?
- immobilize the wrist in thumb spica cast for 10-14 days (repeat Xrays; location of fracture (prox,mid,distal) will dictate how long immobilization with casting should occur
nondisplaced (<2mm) scaphoid fractures; immobilize for _____ with wrist in neutral position
6 weeks - then change to thumb spica if healing. If no healing, will need surgery
which two situations of scaphoid fractures should be referred to ortho
- fracture of proximal 1/3
- delayed presentation (2-3 weeks)
high risk of AVN
also displaced fractures >2mm
Healing time, scaphoid fractures:
- distal 1/3
- middle portion
- proximal portion
- 8 weeks
- 3 months
- 4 months or longer
hamate fractures:
- body fractures usually due to ___
- hook fractures usually due to____
- trauma
2. end swing while holding a racquet, bat, or club
Hamate is located ____ and ___ to pisiform and forms radial border of _____
distal and radial
guyons canal
Pathology?
- ulnar and palmar wrist pain with racquet, bat or club swing
- pain worse with axial loading of 4th and 5th metacarpals
- pain just distal and radial to pisiform
hamate fracture
4 views to order if concerned for hamate fracture
PA, lateral, carpal tunnel, 45 degree supinated oblique view
CT may be required for base of hook fractures
in acute hook of hamate fractures _____% heal after prolonged casting (6 weeks to 4 months)
50% - optimal if immobilized immediately. older than 2 weeks may require excision
Typical method of trapezium fracture
typically when base of thumb metacarpal is forced by axial load into the trapezium
what are the 3 types of trapezium fractures
- body
- trapeziometacarpal
- trapezial ridge
6 views if concerned for trapezium fracture
PA, lateral, oblique, carpal tunnel, Bett’s view (thumb extended and abducted, wrist slightly pronated, beam centered on scaphotrapeziotrapezium area)
trapeziometacarpal
distal radius fractures are named for ____ and ___ of the distal bone
angulation and displacement
___ is the most common type of distal radius fracture. What is the displacement and angulation?
Colles fracture - dorsal displacement and angulation
Colles fractures are associated with ____ tears and ____ dissociation
TFCC - triangular fibrocartilage complex tear
scaphulolunate dissociation
Smith’s fracture is a distal radius fracture with ____ displacement and angulation
volar
“reverse colles fracture”
