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Musculoskeletal Exam 1 > Orthopedics - Hand anatomy and kinematics pt 2 > Flashcards

Orthopedics - Hand anatomy and kinematics pt 2 Flashcards

1
Q

What is lumbrical plus?

What is it caused by?

A 
It is a pathology 
Flexor digitorum profundus disruption, 
DIPJ disarticulation 
FDP graft too long/ lax
Phalangeal osteophyte preventing FDP pull
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2
Q

What is FDP tension transmitted by?

A

lumbrical tendon

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3
Q

What happens if you lose distal flexor profundus flexore insertion point/

A

The whole tendon will shift proximal thereby increasing flexor tone and extensor tone at the IP joints

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4
Q

What are the causes of saggital band subluxation?

A
  • Rheumatoid arthritis with MPJ synovitis
  • Trauma:
    • ->most common in middle finger (radial saggital band tear)
    • ->Sudden forced flexion of extended MPJ
    • ->Most common in middle finger (radial saggital band tear- if it ruptures than it will go ulnar)**
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5
Q

What is the swan neck deformity***?

A
  • PIP joint hyperextension (attrition of volar plate over time, dorsal subluxation of the lateral bands)
  • DIP joint flexion
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6
Q

What are the etiologies of Swan Neck syndrome?

A

1) Rheumatoid arthritis - PIP synovitis with dorsal displacement of lateral bands
2) Late result of Mallet injury - Proximal retraction of lateral bands due to loss of distal anchor (terminal tendon)

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7
Q

What is Boutonierre Deformity?

A

Basically the opposite of swan neck.

  • PIP joint flexion (injury to central slip, volar subluxation of lateral bands)
  • DIP joint hyperextension
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8
Q

What are the Etiologies of Boutonierre deformity?

A

1) Rheumatoid arthritis (PIP joint synovitis with central slip ruptrue or volar sublux of lateral bands)
2) Trauma: axial load injury (triangular ligament tear, central slip extensor tear)

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9
Q

What is a mallet finger deformity?

What is the treatment?

A
  • Is damage to the extensor digitorum tendon of the fingers at the DIP.
  • Splinting for 10 days to heal
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10
Q

What is a sign of dupuytren’s disease?

A

Ulnar claw hand/papal benediction sign

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11
Q

What are the symptoms of overuse in the hand and wrist?

A

1) Paresthesias/tingling/numbness (carpal tunnel syndrome, radial sensory neuritis)
2) Pain (Flexor or extensor tendonitis +/- triggering, CMC thumb synovitis/arthritis

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12
Q

What are symptoms of Cubital tunnel syndrome?

What are some causes?

A
  • Numbness and tingling in the ring and little finger, 1st doral interosseous/ADM wasting, +/- medial elbow soreness
  • activity where elbow flexed for prolonged periods, Activity leaning on medial elbow, triceps loading activities
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13
Q

What physical exam would be used to determine Cubital tunnel syndrome?

A
  • Tinels, elbow hyperflexion test, 1st dorsal interosseous and FCU weakness when severe, NCV/EMG usually negative except when advanced
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14
Q

What are the symptoms of carpal tunnel syndrome?

Treatment?

A

Thumb–>middle finger paresthesias, symptoms worse at night, drops things/ hand clumsiness, paresthesias while driving.
- Relieved by cock-up splints

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15
Q

What is the physical exam for carpal tunnel syndrome?

A
  • Tinel’s, phalen’s, carpal tunnel compression test, APB strength, NCV/EMG usually positive 90%indicating a delayed relay in transmission.
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16
Q

When might a nerve test (i.e. NCV/EMG) might not be effective?

A
  • Effective in Carpal tunnel syndrome (90%) but not in cubital tunnel syndrome bc it is not positive in a nerve test until much later.
17
Q

What is the etiology of Carpal tunnel syndrome?

A

1) Metabolic (diabetes, hypothyroidism)
2) Pregnancy
3) Idiopathic/ Multifactorial
4) Occupational
5) Flexor tenosynovitis

18
Q

What is the main muscle effected in carpal tunnel syndrome?

A
  • abductor pollicis brevis

- making the OK sign with your finger should test the median nerve

19
Q

What is the treatment of carpal tunnel syndrome?

A
  • Cock-up splint
  • Activity modification/ergonomics
  • NSAID
  • Injection
  • Surgical release of Transverse Carpal Ligament
20
Q

What are the symptoms associated with flexor tenosynovitis?

A
  • Highly repetitive finger motions
  • Prolonged gripping
  • Thyroid disorders
  • Diabetes
21
Q

When does trigger finger occurs?

A
  • Trigger finger occurs when flexor tendon swells (stenosis) and can’t fit under pulley.
22
Q

What are the symptoms associated with trigger fingers?

A
  • Diabetes
  • hyperextension strain
  • Contusion
  • Overuse of digit
23
Q

What are the treatment for Trigger finger disorders?

A
  • NSAID
  • Injection
  • Release of A-1 pulley
24
Q

What is de Quervain’s Tenosynovitis?

What is the test for de Quervain’s Tenosynovitis?

A
  • First Dorsal Compartment tenosynovitis/impingement

Finkelstein test - radially abduct the thumb

25
Q

What are the etiology for de Quervain’s Tenosynovitis?

A
  • Trauma
  • Overuse
  • Retinacular ganglion cyst
  • Radial Styloid spur
26
Q

What are the groups effected and symptoms of de Quervain’s Tenosynovitis?

A
  • Two hand lifting with forearms in neutral rotation
  • New mother
  • Trauma to radial wrist
  • Ulnar deviation strain
  • Tingling/burning dorsal thumb and index
27
Q

What does the physical exam for de Quervain’s Tenosynovitis entail?

A
  • Finkelstein’s Manuever
  • Pain with resisted APL, EPB
  • Palpatory tenderness over DC
28
Q

What is the treatment for de Quervain’s Tenosynovitis?

A
  • Long opponens splint
  • NSAID
  • Injection
  • Release of DC
29
Q

What are the Causes of Intersection Syndrome?

A
  • Due to repetitive lifting with forearms pronated - neutral
  • From repetitive wrist flexion/ extension
  • Contusion to Extensor Carpi Radialis Longus and brevis/ APL-ERB intersection.
30
Q

What does the physical exam for Intersection Syndrome include?

A

Local tenderness

Palpable/ audible crepitus

31
Q

What are the symptoms of Thumb CMC (Carpometacarpal joints) Joint pathology?

A
  • Pain at base of thumb and thenar palm

- Worse with pinching

32
Q

What is the etiology of thumb CMC joint pathology?

A
  • Synovitis
  • Laxity of anterior oblique Ligament
  • effects more women than men
  • is a degenerative joint disease.
33
Q

What are the causes of CMC synovitis thumb?

A
  • Pain with pinching or holding

- Manipulates small parts all day

34
Q

What are the clinical findings of CMC synovitis thumb?

A
  • Palpatory joint tenderness
  • Grind test
  • Distraction-torgue test
  • Laxity of CMC joint
35
Q

What do radiographs show in CMC synovitis thumb?

A

Static

Stress

36
Q

What are the treatments of CMC synovitis thumb?

A
  • Modify activity (joint protection)
  • Short opponents (hand-based thumb spica) splint
  • NSAID
  • Injection
  • Surgery
37
Q

What could be done surgically to repair CMC synovitis thumb?

A
  • reconstruct ligament

- Excise Trapezium

Musculoskeletal Exam 1 (11 decks)

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