Orthopedics - Hand anatomy and kinematics pt 2 Flashcards
What is lumbrical plus?
What is it caused by?
It is a pathology Flexor digitorum profundus disruption, DIPJ disarticulation FDP graft too long/ lax Phalangeal osteophyte preventing FDP pull
What is FDP tension transmitted by?
lumbrical tendon
What happens if you lose distal flexor profundus flexore insertion point/
The whole tendon will shift proximal thereby increasing flexor tone and extensor tone at the IP joints
What are the causes of saggital band subluxation?
- 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)**
What is the swan neck deformity***?
- PIP joint hyperextension (attrition of volar plate over time, dorsal subluxation of the lateral bands)
- DIP joint flexion
What are the etiologies of Swan Neck syndrome?
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)
What is Boutonierre Deformity?
Basically the opposite of swan neck.
- PIP joint flexion (injury to central slip, volar subluxation of lateral bands)
- DIP joint hyperextension
What are the Etiologies of Boutonierre deformity?
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)
What is a mallet finger deformity?
What is the treatment?
- Is damage to the extensor digitorum tendon of the fingers at the DIP.
- Splinting for 10 days to heal
What is a sign of dupuytren’s disease?
Ulnar claw hand/papal benediction sign
What are the symptoms of overuse in the hand and wrist?
1) Paresthesias/tingling/numbness (carpal tunnel syndrome, radial sensory neuritis)
2) Pain (Flexor or extensor tendonitis +/- triggering, CMC thumb synovitis/arthritis
What are symptoms of Cubital tunnel syndrome?
What are some causes?
- 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
What physical exam would be used to determine Cubital tunnel syndrome?
- Tinels, elbow hyperflexion test, 1st dorsal interosseous and FCU weakness when severe, NCV/EMG usually negative except when advanced
What are the symptoms of carpal tunnel syndrome?
Treatment?
Thumb–>middle finger paresthesias, symptoms worse at night, drops things/ hand clumsiness, paresthesias while driving.
- Relieved by cock-up splints
What is the physical exam for carpal tunnel syndrome?
- Tinel’s, phalen’s, carpal tunnel compression test, APB strength, NCV/EMG usually positive 90%indicating a delayed relay in transmission.
When might a nerve test (i.e. NCV/EMG) might not be effective?
- Effective in Carpal tunnel syndrome (90%) but not in cubital tunnel syndrome bc it is not positive in a nerve test until much later.
What is the etiology of Carpal tunnel syndrome?
1) Metabolic (diabetes, hypothyroidism)
2) Pregnancy
3) Idiopathic/ Multifactorial
4) Occupational
5) Flexor tenosynovitis
What is the main muscle effected in carpal tunnel syndrome?
- abductor pollicis brevis
- making the OK sign with your finger should test the median nerve
What is the treatment of carpal tunnel syndrome?
- Cock-up splint
- Activity modification/ergonomics
- NSAID
- Injection
- Surgical release of Transverse Carpal Ligament
What are the symptoms associated with flexor tenosynovitis?
- Highly repetitive finger motions
- Prolonged gripping
- Thyroid disorders
- Diabetes
When does trigger finger occurs?
- Trigger finger occurs when flexor tendon swells (stenosis) and can’t fit under pulley.
What are the symptoms associated with trigger fingers?
- Diabetes
- hyperextension strain
- Contusion
- Overuse of digit
What are the treatment for Trigger finger disorders?
- NSAID
- Injection
- Release of A-1 pulley
What is de Quervain’s Tenosynovitis?
What is the test for de Quervain’s Tenosynovitis?
- First Dorsal Compartment tenosynovitis/impingement
Finkelstein test - radially abduct the thumb
What are the etiology for de Quervain’s Tenosynovitis?
- Trauma
- Overuse
- Retinacular ganglion cyst
- Radial Styloid spur
What are the groups effected and symptoms of de Quervain’s Tenosynovitis?
- Two hand lifting with forearms in neutral rotation
- New mother
- Trauma to radial wrist
- Ulnar deviation strain
- Tingling/burning dorsal thumb and index
What does the physical exam for de Quervain’s Tenosynovitis entail?
- Finkelstein’s Manuever
- Pain with resisted APL, EPB
- Palpatory tenderness over DC
What is the treatment for de Quervain’s Tenosynovitis?
- Long opponens splint
- NSAID
- Injection
- Release of DC
What are the Causes of Intersection Syndrome?
- Due to repetitive lifting with forearms pronated - neutral
- From repetitive wrist flexion/ extension
- Contusion to Extensor Carpi Radialis Longus and brevis/ APL-ERB intersection.
What does the physical exam for Intersection Syndrome include?
Local tenderness
Palpable/ audible crepitus
What are the symptoms of Thumb CMC (Carpometacarpal joints) Joint pathology?
- Pain at base of thumb and thenar palm
- Worse with pinching
What is the etiology of thumb CMC joint pathology?
- Synovitis
- Laxity of anterior oblique Ligament
- effects more women than men
- is a degenerative joint disease.
What are the causes of CMC synovitis thumb?
- Pain with pinching or holding
- Manipulates small parts all day
What are the clinical findings of CMC synovitis thumb?
- Palpatory joint tenderness
- Grind test
- Distraction-torgue test
- Laxity of CMC joint
What do radiographs show in CMC synovitis thumb?
Static
Stress
What are the treatments of CMC synovitis thumb?
- Modify activity (joint protection)
- Short opponents (hand-based thumb spica) splint
- NSAID
- Injection
- Surgery
What could be done surgically to repair CMC synovitis thumb?
- reconstruct ligament
- Excise Trapezium
