Orthopaedics & Rheumatology/ Elbow, Hand And Wrist Injuries Flashcards
Soft tissue injury associated with elbow pain reproduced by resisted wrist or middle finger extension
Lateral epicondylitis (tennis elbow)
Soft tissue injury associated with - elbow pain from overuse of flexor pronator, made worse by wrist flexion
Medial epicondylitis (golfer’s elbow or little league elbow)
Soft tissue injury associated with - acute onset of medial elbow pain after throwing, worst at acceleration phase
Ulnar collateral ligament sprain
Soft tissue injury associated with - posterior elbow pain at terminal extension while throwing
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Posterior impingement
What is the most common carpal fracture in the hand?
Scaphoid fracture
How is the diagnosis of a scaphoid fracture made?
- Fracture on radiographs
- Radiographs may take 10-14 days to reveal the fracture
- clinical suspicion
- tenderness in the anatomical snuff box.
What is the treatment of an uncomplicated scaphoid fracture?
Thumb spica cast for 12 weeks
With a distal interphalangeal (DIP) joint fracture, when do you need to use open reduction/internal fixation (ORIF) to avoid degenerative change?
If >30% of the articular surface is involved
Injuries most commonly associated with - A teenage softball player hurt her finger while catching a ball yesterday. On examination, she is tender over the distal interphalangeal (DIP), and unable to extend the joint fully, without evidence of fracture.
Ruptured distal extensor tendon at distal phalanx (mallet finger)
What is the treatment of Ruptured distal extensor tendon at distal phalanx (mallet finger)?
Splint DIP joint continuously for 6 weeks
Injury commonly associated with - a football player hyperextends his fourth right finger while tackling an opposing player during practice today, and now has bruising and tenderness over the entire volar aspect of his finger and cannot flex the DIP.
Avulsion of flexor digitorum profundus (jersey finger)
What is the treatment of a jersey finger(avulsion of flexor digitorium profoundus) ?
Splint finger and immediate orthopedic referral
In commonly associated with - patient presents 2 weeks after a forced flexion injury of the proximal interphalangeal (PIP) joint. He did not see a doctor initially, but now presents with a flexion deformity of the PIP joint.
- Central slip tear of the extensor mechanism proximal to PIP (Boutonniere deformity)
What is the treatment of a Boutonniere deformity?
Splint PIP in full extension for 6 weeks
What is the treatment of a mild collateral ligament sprain of the PIP joint, with no fracture on x-ray, and slight laxity?
Buddy taping to adjacent finger for 6 weeks, NSAIDs for symptomatic relief
A patient presents to your office with swelling at the base of her thumb, and pain that is worse when she tries to make a fist or move her thumb. She has lost strength in her grip and ROM in her thumb. What is the most likely diagnosis?
De Quervain tenosynovitis
What tendons are involved in De Quervain tenosynovitis?
- Abductor pollicis longus
- extensor brevis
What physical examination test is diagnostic of De Quervain Tenosynovitis?
Finkelstein test: full flexion of thumb in the palm, then ulnar deviation of the wrist
What group of patients is most commonly affected by De Quervain Tenosynovitis?
Middle-aged women
What is the treatment of De Quervain Tenosynovitis?
- Thumb spica splint and 2-week course of NSAIDs
- With corticosteroid injection if no improvement
What nerve is entrapped at the wrist in carpal tunnel syndrome (CTS)?
Median nerve
What conditions can precipitate CTS?
- Overuse trauma
- diabetes mellitus
- thyroid dysfunction
- pregnancy
- rheumatoid arthritis
What is the differential diagnosis of pain and paresthesias in the wrist?
- Arthritis
- cervical radiculopathy at C6
- ulnar neuropathy
- ganglion cyst
- hypothyroidism
- diabetic neuropathy
- flexor carpi radialis tenosynovitis
What group of people does carpal tunnel most often affect?
Middle-aged or pregnant women
