Orthopedic Principles: Hand and Wrist

Question 1

which fingers give the hand “grip strength”

Answer 1

the ulnar digits. the thumb gives dexterity.

Question 2

SOCRATES pain history acronym

Answer 2

Question 3

SEADS physical exam acronym

Answer 3

Question 4

a man presents with

– Left wrist pain and numbness for 1.5 – 2 years
– Worst at night
– Shooting pain
– Numbness to fingers
Pt: ‘I shake it out and it goes away after a few minutes’ Dr: ‘Like when you fall asleep on your arm’ Pt: ‘Exactly’

what could this be?

Answer 4

thenar eminence is wasting. this is possibly a carpal tunnel syndrome.

Question 5

carpal tunnel causes pain because of compression of the -__ nerve

Answer 5

median

Question 7

nonsurgical and surgical treatments for carpal tunnel syndrome

Answer 7

1. non surgical. night time splinting with wrist in neutral position. Injections
2. surgical
   - carpal tunnel releease.

Question 8

Kanavals signs can indicate Flexor Tenosynovitis. What are the 4 hallmarks?

Answer 8

1. fusiform swelling
2. pain on proximal palpation
3. flexed posture
4. pain with passive stretch.

Question 9

first treatment for Flexor Tenosynovitis

Answer 9

GET THE PUS OUT

Question 10

post op complications for purulent Flexor Tenosynovitis

Answer 10

HIGH incidence of post-operative stiffness. we need aggressive rehabilitation starting immediately post op

Question 11

which bones does the scaphoid articulate with?

Answer 11

radius

lunate

capitate

trapezoid

trapezium

Question 12

T/F the scaphoid ridge has muscle and tendon attachments

Answer 12

false. however, the radial artery will move up the scaphoid to the dorsl bracn and to the volar scaphoid branch.

Question 13

which arteries provide most of wrist blood perfusion

Answer 13

branches of the radial artery

1. dorsa carpal branch over the top of the scaphoid : 7-80% of blood supply
2. volar (superfiical palmar branch): 20-30% of blood supply.

Question 14

main cause of scaphoid fracture

Answer 14

usually because of wrist hyperextension.

causes radial-side wrist pain.

the scaphoid can be broken at the tubercle, distal pole, waist, or proximal pole.

Question 15

a person presents with swliing and pain in the antomical snuff box. it hurts more on the volar tuberosirty. pain with ulnar deviation.

Answer 15

recall these hand movements in terms of what ulnar deviation is lol.

• this is probably a scaphoid fracture. cast for 2 weeks. repeat physical exam and x ray.

Question 16

the more ___ the scaphoid fracture, the higher risk of non union and compromised/ tenuous blood supply

Answer 16

the more PROXIMAL the fracture

ex/ the fracture below will have a higher risk of non union

Question 18

pattern of a SNAC (scaphoid non-union advanced collapse)

Answer 18

progressively degenerative arthritis

Question 19

what happens if the scaphoid fracture becomes a SNAC wrist?

Answer 19

basically you just gotta remove the scaphoid and majority of first carpal row. that sucks.

Question 20

if there is a laceration to the flexor tendons, what should you check for?

Answer 20

if there is a tendon laceration, make sure you chekc neurovascular status, it’s easy to rupture the arteries of the finger. also, after surgery, get into rehab or else you will get stiffness and reduced dexterity/avoid tenolysis

Question 22

a skiiers thumb damages the __ ___ ligament.

Answer 22

the ulnar collateral ligament.

Question 23

a skiiers thumb injury in which the UCL is fully torn off is called a ___ lesion; the ligament tears off and doesn’t sit where it’s supposed to– it gets flicked up over another layer of connective tissue instead of sitting on the bone. It won’t heal onto the bone, creating chornic instaiblity of the joint.

Answer 23

stennes lesion

Question 24

treatment of a partial or complete UCL injury to the thumb

Answer 24

partial– cast/spline

complete tear – surgery to repair

Question 25

In dupuytren’s contracture, one or more fingers become permanently bent in a ____ position. It usually begins as small hard ___ just under the skin of the ____. It then worsens over time until the fingers can no longer be straightened.

Answer 25

• Partial tear – cast/ splint
• Complete tear – surgery to repair

Question 26

treatmens for dupuytrens contracture

Answer 26

surgical once contracture develops

Question 27

How owuld you correct this?

Answer 27

Mallet finger. need a spllint. the DIP and PIP will get stiff and you gotta have physio

Question 28

A mallet finger is a deformity of the finger caused when the ____ tendon is damaged. When a ball or other object strikes the tip of the finger or thumb and forcibly bends it, the force tears the tendon

Answer 28

A mallet finger is a deformity of the finger caused when the EXTENSOR tendon is damaged. When a ball or other object strikes the tip of the finger or thumb and forcibly bends it, the force tears the tendon

Question 29

what’s going on?

Answer 29

distal radius fracture. possible intraarticulation fractue. probs need a surgical reduction.

Question 30

does this person need sugery?

Answer 30

probs not. this is also a distal radius fracture but it is extra-articular and won’t require joint reconstruction.

Question 31

what should you look for when you scan your reduction of a distal radius fracture?

Answer 31

raidal length– if the raidus is down below the ulna and the ulna is above the radius–that is shortening and will cause problems. and arthritis

dorsal tilt– the radius- lunate- carp bone is crooked.

Question 32

does this reduction require surgery?

Answer 32

no. the radius and ulna look the same length and there i s no dorsal tilt.

Question 33

does this reduction need surgery?

Answer 33

yes. there is an evident tilt.

Radius is short. The ulna is longer than radius. There is also a dorsal tilt. This needs internal fixation.

Question 34

the most common site of cubital tunnel syndrome is at the ___. you are compressing the ___ nerve

Answer 34

elbow, causing compression of ulnar nerve.

Question 35

symptoms of CUBITAL tunnel syndrome

Answer 35

numbness and tingling in ulnar two fingers during activities with elbow bent.

• hurts hwen talking on the phone, leaning of elbow against window, sleeping with elbow bent, worse when they flex their elbow

Question 36

what type of wasting would you see in someone with ulnar nerve compression?

Answer 36

interosseous and hypothenar wasting.

Question 37

what’re these signs and what do they indicate

Answer 37

they indicate ulnar nerve compression/cubital tunnel syndrome.

Question 38

treatment of cubital tunnel syndrome

Answer 38