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Diagnosis and Management > Orthopedics Hand/Wrist > Flashcards

Orthopedics Hand/Wrist Flashcards

1
Q

Normal Anatomy Hand/Wrist

A
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2
Q

Compartments of the Hand

A
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3
Q

Hand/Wrist PE

  • General
    • The patient is in no acute ______, mood and affect are a_____, a____ and o______ times three.
    • Note HAND D_______* (true for any upper extremity examination)
  • Inspection
    • Both hands/wrists appear sy_______.
    • S_____ is intact about both hands/wrists without erythema.
    • Generally very _____ soft tissue envelope; can use your x-ray vision!
A
  • General
    • The patient is in no acute distress, mood and affect are appropriate, alert and oriented times three.
    • Note HAND DOMINANCE (true for any upper extremity examination)
  • Inspection
    • Both hands/wrists appear symmetric.
    • Skin is intact about both hands/wrists without erythema.
    • Generally very minimal soft tissue envelope; can use your x-ray vision!
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4
Q

Tenderness to Palpation

  • _____ joint? where the metacarpal bone of the thumb meets the trapezium bone in the wrist.
  • ______ dorsal compartment?
  • Sc_____?
A
  • Basal joint?
  • First dorsal compartment?
  • Scaphoid?
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5
Q

ROM

  • Look fo ______try
  • ____ion/______ion
  • ____ation/____ination
  • Radial/Ulnar D______
  • Symmetric Finger Ex_______
  • Fi__ / Finger Cas______ / Rotational or Angular Deformities
A
  • Look for symmetry
  • Flexion/Extension
  • Pronation/Supination
  • Radial/Ulnar Deviation
  • Symmetric Finger Extension
  • Fist / Finger Cascade / Rotational or Angular Deformities
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6
Q

Strength, Sensation, Stability

  • Strength
    • Finger Extension (______)
    • Finger Abduction/Adduction (______)
    • Thumb IP flexion (______)
  • Sensation
    • Medial / Radial / Ulnar
  • Stability
    • Hand / Wrist / DRUJ Instability = (1)?
A
  • Strength
    • Finger Extension (Radial)
    • Finger Abduction/Adduction (Ulnar)
    • Thumb IP flexion (Median)
  • Sensation
    • Medial / Radial / Ulnar
  • Stability
    • Hand / Wrist / DRUJ Instability = Distal radioulnar joint instability is the abnormal orientation or movement of the radius and ulna bones at the wrist in relation to one another
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7
Q

Common Conditions

  • _______ Tunnel Syndrome
  • Tr______ Finger
  • De Q_____’s Tenosynovitis
  • _____ Joint Arthritis
  • G_____ Cyst
  • D_______’s Disease
  • Some acute injuries / conditions appropriate to review here:
    • Infectious flexor teno_____
    • S_____ Fracture
    • B______’s fracture
    • ______ radius fracture (Colles, Smith)
    • ______keeper’s thumb
    • M_______ finger
A
  • Carpal Tunnel Syndrome
  • Trigger Finger
  • De Quervain’s Tenosynovitis
  • Basal Joint Arthritis
  • Ganglion Cyst
  • Dupuytren’s Disease
  • Some acute injuries / conditions appropriate to review here:
    • Infectious flexor tenosynovitis
    • Scaphoid Fracture
    • Boxer’s fracture
    • Distal radius fracture (Colles, Smith)
    • Gamekeeper’s thumb
    • Mallet finger
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8
Q

Carpul Tunnel Syndrome

  • Co_______ neuropathy of the _____ nerve at the wrist (the carpal tunnel)
  • Very common
    • Up to 10% of general population
  • Pain, numbness, tingling
  • Causes
    • R______ motion / vi_______
    • Certain athletic activities (e.g. cycling, tennis, throwing)
  • Associated conditions (4)
A
  • Compressive neuropathy of the median nerve at the wrist (the carpal tunnel)
  • Very common
    • Up to 10% of general population
  • Pain, numbness, tingling
  • Causes
    • Repetitive motion / vibration
    • Certain athletic activities (e.g. cycling, tennis, throwing)
  • Associated conditions
    • DM, hypothyroid, RA, pregnancy
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9
Q

Carpal Tunnel Syndrome History/Symptoms

  • _____ness and t_____ in radial (1) digits
  • C______ness
  • Pain and paresthesias that awaken patient at ______
A
  • Numbness and tingling in radial 3-1/2 digits
  • Clumsiness
  • Pain and paresthesias that awaken patient at night
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10
Q

Carpel Tunnel Syndrome PE

  • _____ness in median distribution
    • Loss of __-point discrimination
  • Thenar ______
  • Special Tests (3)
A
  • Numbness in median distribution
    • Loss of 2-point discrimination
  • Thenar atrophy
  • Special Tests
    • Durkan
      • Carpal compression test - paresthesia
    • Phalen
    • Tinel - tapping and getting paresthesia
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11
Q

Carpal Tunnel Syndrome Studies

  • (1)/Imaging:
    • Not necessary or helpful
  • (1)/(1)
    • Provides objective evidence of a compressive neuropathy
    • Not needed to establish diagnosis
    • NCV
      • ______ conduction
  • (1)
    • Tests the electrical activity of individual muscle fibers and motor units
  • Severe NCV/EMG findings tend to improve less than patients with moderate findings
A
  • XR/Imaging:
    • Not necessary or helpful
  • EMG/NCV
    • Provides objective evidence of a compressive neuropathy
    • Not needed to establish diagnosis
    • NCV
      • Slowed conduction
  • EMG
    • Tests the electrical activity of individual muscle fibers and motor units
  • Severe NCV/EMG findings tend to improve less than patients with moderate findings
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12
Q

Carpal Tunnel Syndrome Non-Operative Treatment

  • NSAIDs
  • Night _______
    • We tend to sleep with wrists flexed
  • Activity Modification
    • Avoid / modify agg_______ activities
  • S______ injections
    • If initial treatments are not helping
    • Sometimes useful (diagnostic utility) in clinically and EMG/NCV-equivocal cases
    • Failure to improve with an injection is a poor prognostic indicator for ______
A
  • NSAIDs
  • Night Splints
    • We tend to sleep with wrists flexed
  • Activity Modification
    • Avoid / modify aggravating activities
  • Steroid injections
    • If initial treatments are not helping
    • Sometimes useful (diagnostic utility) in clinically and EMG/NCV-equivocal cases
    • Failure to improve with an injection is a poor prognostic indicator for surgery
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13
Q

Carpal Tunnel Syndrome Operative Treatment

(1)

A

Carpal tunnel release (open or endoscopic; no difference) - just making room for the nerve

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14
Q

Carpal Tunnel Syndrome When to Refer

  • Symptoms not responsive to N_____, sp______, ______modification
  • (1)/weakness (although results of surgery are less favorable in these advanced stages)
A
  • Symptoms not responsive to NSAIDs, splints, activity modification
  • Thenar atrophy / weakness (although results of surgery are less favorable in these advanced stages)
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15
Q

Trigger Finger

  • The inhibition of smooth tendon ______ due to mechanical _______ at the level of the _ _ p_____that causes progressive p____, cl____, ca____, and lo______ of the digit.
  • Trigger Finger = St_______ Ten______
  • Very common
    • 2-3% of general population
    • 10% of d______ population
    • (3) fingers are most commonly affected
  • Sw______, and sometimes a n______ on the flexor tendon
A
  • The inhibition of smooth tendon gliding due to mechanical impingement at the level of the A1 pulley that causes progressive pain, clicking, catching, and locking of the digit.
  • Trigger Finger = Stenosing Tenosynovitis
  • Very common
    • 2-3% of general population
    • 10% of diabetic population
    • Ring Finger, Middle Finger, and Thumb are most commonly affected
  • Swelling, and sometimes a nodule on the flexor tendon
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16
Q

Trigger Finger History and Symptoms

  • Usually pro_____
  • P_____ at the level of the _ _ pulley
  • Cl_____/ Ca______
  • Finger becomes “_____” in ______ position at the _ _ _ joint
  • May have referred pain to ________ _ _ P/_ _ P region
A
  • Usually progressive
  • Pain at the level of the A1 pulley
  • Clicking / Catching
  • Finger becomes “locked” in flexed position at the proximal interphalangeal (PIP) joint
  • May have referred pain to dorsal MCP/PIP region
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17
Q

Trigger Finger PE

  • Palpation
    • T____ness at level of A1 _____
    • Palpable n______ of the flexor tendon
  • Motion
    • Triggering with digit _____ and _____
    • Fixed ______ of _IP joint
  • Provocative test
    • Flexion and extension of the digit may reproduce symptoms
A
  • Palpation
    • Tenderness at level of A1 pulley
    • Palpable nodule of the flexor tendon
  • Motion
    • Triggering with digit flexion and extension
    • Fixed flexion of PIP joint
  • Provocative test
    • Flexion and extension of the digit may reproduce symptoms
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18
Q

Trigger Finger Imaging

?

A

No X-rays or other studies needed

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19
Q

Trigger Finger Non-Op Treatment

  • (1)
    • (1) the hand and avoiding activities that make it worse may be enough to resolve the problem.
  • NSAIDs
  • (1)
    • Wearing one at night to keep the affected finger or thumb in a straight position
  • Exercises
    • Gentle st______ exercises can help decrease _____ness and improve range of motion in the involved digit.
  • Steroid injections
    • If ____ injections do not help the problem, surgery may be considered.
A
  • Rest
    • Resting the hand and avoiding activities that make it worse may be enough to resolve the problem.
  • NSAIDs
  • Splints
    • Wearing a splint at night to keep the affected finger or thumb in a straight position
  • Exercises
    • Gentle stretching exercises can help decrease stiffness and improve range of motion in the involved digit.
  • Steroid injections
    • If two injections do not help the problem, surgery may be considered.
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20
Q

Trigger Finger Operative Treatment

(1)

A

Trigger Finger Release (release A1 pulley)

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21
Q

Trigger Finger When to Refer?

  • Symptoms not responsive to (3)
A
  • Symptoms not responsive to NSAIDs, splints, activity modification
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22
Q

De Quervain’s Tenosynovitis

  • De Quervain’s Tenosynovitis is a st_______ tenosynovial inflammation of the (1) compartment.
  • Risk Factors
    • _____use (esp. Golfers and racquet sports)
    • After hand in_______
    • Post______
  • Etiology
    • Th______ and sw______ of the (1) causing increased tendon friction
A
  • De Quervain’s Tenosynovitis is a stenosing tenosynovial inflammation of the 1st dorsal compartment.
  • Risk Factors
    • Overuse (esp. Golfers and racquet sports)
    • After hand injuries
    • Postpartum
  • Etiology
    • Thickening and swelling of the extensor retinaculum causing increased tendon friction
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23
Q

De Quervain’s Tenosynovitis Prevalence

  • Very common
    • ~1 per 1000 people annually
    • Women _ Men
    • __ - __ years old
    • More commonly ________ wrist
A
  • Very common
    • ~1 per 1000 people annually
    • Women > Men
    • 30 - 50 years old
    • More commonly dominant wrist
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24
Q

De Quervain’s Tenosynovitis

  • Diagnosis is made cl_______ with ______ sided _____ pain made worse with the _______ maneuver.
  • Treatment is generally conservative with thumb spica _____, in_____ and in refractory cases, 1st dorsal compartment surgical ______.
A
  • Diagnosis is made clinically with radial sided wrist pain made worse with the Finkelstein maneuver.
  • Treatment is generally conservative with thumb spica braces, injections and in refractory cases, 1st dorsal compartment surgical release.
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25
Q

De Quervain’s Tenosynovitis History and Symptoms

  • Pain over (1) compartment
  • Usually gradual
  • Worse pain with g____ing, r_____ objects with wrist in _____ position
A
  • Pain over first dorsal compartment
  • Usually gradual
  • Worse pain with gripping, raising objects with wrist in neutral position
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26
Q

De Quervain’s Tenosynovitis PE

  • T_______ness over first dorsal compartment
    • Especially at level of radial st_____
  • Usually normal wrist ROM but pain with re______ radial de_____
  • _____ neurovascular examination
A
  • Tenderness over first dorsal compartment
    • Especially at level of radial styloid
  • Usually normal wrist ROM but pain with resisted radial deviation
  • Normal neurovascular examination
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27
Q

De Quervain’s Tenosynovitis Finkelstein’s Test

  • On grasping the _____ and quickly ___ducting the hand towards the _____, the pain over the styloid tip is painful
  • More indicative of ___ > ___ tendon pathology
A
  • On grasping the thumb and quickly abducting the hand ulnarward, the pain over the styloid tip is painful
  • More indicative of EPB (extensor pollicis brevis) > APL (abductor pollicis longus) tendon pathology
28
Q

De Quervain’s Tenosynovitis Imaging

(1)

A

Usually not necessary BUT can be useful to rule out basal joint arthritis of the tumb

29
Q

De Quervain’s Tenosynovitis Non-Op Treatment

  • Non-operative
    • NSAIDs
    • Thumb Spica ______
    • R____/ A______ Modification
    • ______ injections
      • If initial treatments are not helping
A
  • Non-operative
    • NSAIDs
    • Thumb Spica Splints
    • Rest / Activity Modification
    • Steroid injections
      • If initial treatments are not helping
30
Q

De Quervain’s Tenosynovitis Operative Treatment

(1)

Usually considered how long after non-op managment?

A

Release of first dorsal compartment

Usually considered only after 6-months of failed non-op management

31
Q

De Quervain’s Tenosynovitis When to Refer

Symptoms not responsive to (3)

A

Not responsive to NSAIDs, splints, activity modification

32
Q

Basal Joint Arthritis

  • Basal Joint = Base of Thumb
    • (1) Joint
  • Pain at the _____ of the thumb and difficulty with pi____ and gr_____
  • Diagnosis is made clinically with a painful CMC _____ test and radiographs of the hand showing ________of the 1st CMC joint.
  • Treatment can be conservative (bracing, injections) or operative depending on the severity of symptoms and the stage of disease.
A
  • Basal Joint = Base of Thumb
    • CMC joint
  • Pain at the base of the thumb and difficulty with pinching and grasping
  • Diagnosis is made clinically with a painful CMC grind test and radiographs of the hand showing osteoarthritis of the 1st CMC joint.
  • Treatment can be conservative (bracing, injections) or operative depending on the severity of symptoms and the stage of disease.
33
Q

Basal Joint Arthritis

  • Common
    • 2nd most common hand arthritis
      • __ IP > Thumb CMC > _IP > _ _P
    • Seen in __% of men and __% of women aged > __ years old
  • Risk Factors
    • _____ gender
    • E____-D_____ syndrome
    • ______ BMI
  • Etiology
    • Thought to be related to inst____/sub_____ of the CMC joint
A
  • Common
    • 2nd most common hand arthritis
      • DIP > Thumb CMC > PIP > MCP
    • Seen in 25% of men and 40% of women aged > 75 years old
  • Risk Factors
    • Female gender
    • Ehler-Danlos syndrome
    • Increased BMI
  • Etiology
    • Thought to be related to instability/subluxation of the CMC joint
34
Q

Basal Joint Arthritis History

  • History / Symptoms
    • _____ at base of thumb
    • Difficulty ______/______
    • Differentiate from (1)
A
  • History / Symptoms
    • Pain at base of thumb
    • Difficulty pinching/grasping
    • Differentiate from De Quervain’s
35
Q

Basal Joint Arthritis Physical Exam

  • Sw_____ / Cr_____ basal joint
  • Tenderness over ____ joint, not over course of ____ dorsal _______
  • Metacarpal __duction / MCP fixed hy____extension (later findings)
A
  • Swelling / Crepitus basal joint
  • Tenderness over CMC joint, not over course of first dorsal compartment
  • Metacarpal adduction / MCP fixed hyperextension (later findings)
  • Special Test
36
Q

CMC Grind Test

Combined axial com_____ and cir___duction

Positive test =

A

Combined exial compression and circumduction

Positive if pain and crepitus is elicited

37
Q

Basal Joint Arthritis Imaging

  • XR/Imaging:
    • (2) Views +
    • (1) View
      • X-ray beam is centered on trapezium and metacarpal with thumb flat on cassette and thumb hyperpronated
A
  • XR/Imaging:
    • AP
    • Lateral
    • Roberts view
      • X-ray beam is centered on trapezium and metacarpal with thumb flat on cassette and thumb hyperpronated
38
Q

Basal Joint Arthritis Non Op Treatment

  • N_____s
  • Thumb Spica _____
  • R___ / A______ Modification
  • ______ injections
    • If initial treatments are not helping
A
  • NSAIDs
  • Thumb Spica Splints
  • Rest / Activity Modification
  • Steroid injections
    • If initial treatments are not helping
39
Q

Basal Joint Arthritis Operative Tx

  • CMC arthro_____, fu____
    • Many different techniques…
A
  • CMC arthroplasty, fusion
    • Many different techniques…
40
Q

Basal Joint Arthritis When to Refer

Symptoms not responsive to (3)

A

Symptoms not responsive to NSAIDs, splints, activity modification

41
Q

Ganglion Cyst

  • Most common mass or lump in the hand
  • _____-filled synovial _____
  • ______ to do with nerve ganglion…
  • Not dangerous, usually ____less
  • Only reason to address is pain/discomfort, sometimes cos______
A
  • Most common mass or lump in the hand
  • Mucin-filled synovial cysts
  • Nothing to do with nerve ganglion…
  • Not dangerous, usually harmless
  • Only reason to address is pain/discomfort, sometimes cosmesis
42
Q

Ganglion Cyst

  • Most frequently develop on the back of the wrist (d_____ carpal ganglion)
  • Causes
    • Tr_____
    • De______ changes
  • Rises out of a joint, like a “ba_____ on a stalk”
  • Note: Called a mucous cyst if it affects DIP joint
  • Not only hand (feet too…rare)
A
  • Most frequently develop on the back of the wrist (dorsal carpal ganglion)
  • Causes
    • Trauma
    • Degenerative changes
  • Rises out of a joint, like a “balloon on a stalk”
  • Note: Called a mucous cyst if it affects DIP joint
  • Not only hand (feet too…rare)
43
Q

Ganglion Cyst History and Symptoms

  • Usually __symptomatic?
  • Can cause p____/dis_____ (e.g. push-ups)
  • Can cause compressive neur______
  • ____mesis issues
A
  • Usually asymptomatic
  • Can cause pain / discomfort (e.g. push-ups)
  • Can cause compressive neuropathies
  • Cosmesis issues
44
Q

Ganglion Cyst Physical Exam

  • Trans_______! (Special Test)
  • F____ and well cir________
  • Often fi___ to deep tissue but not to overlying skin
A
  • Transilluminates!
  • Firm and well circumscribed
  • Often fixed to deep tissue but not to overlying skin
45
Q

Ganglion Cyst Imaging

  • XR/Imaging ?
  • MRI/Ultrasound?
    • Sometimes, an MRI or ultrasound is needed to find an occult ganglion that is not ____, or to distinguish the cyst from other tu_____.
A
  • XR/Imaging:
    • Not necessary or helpful
  • MRI/Ultrasound
    • Very rarely done/needed
    • Sometimes, an MRI or ultrasound is needed to find an occult ganglion that is not visible, or to distinguish the cyst from other tumors.
46
Q

Ganglion Cyst Non-Op Treatment

  • Non-operative
    • Observation (most ______, especially in kids)
    • “Closed Rupture”
      • Hit it with a bible (!) - ?
      • _____ recurrence
    • As_____ / In_____
      • _____ recurrence
      • Avoid on the volar side (radial artery)
A
  • Non-operative
    • Observation (most resolve, especially in kids)
    • “Closed Rupture”
      • Hit it with a bible (!) - old method, to rupture it, dont’ do it, high recurrence
      • High recurrence
    • Aspiration / Injection
      • High recurrence
      • Avoid on the volar side (radial artery)
47
Q

Ganglion Cyst Operative Treatment

  • Need to resect st____ as well as adjacent cap_____ to reduce recurrence risk
  • For mucous cysts (DIP), need to resect associated osteophyte
A
  • Need to resect stalk as well as adjacent capsule to reduce recurrence risk
  • For mucous cysts (DIP), need to resect associated osteophyte
48
Q

Ganglion Cyst When to Refer

Symptoms not responsive to obs____/reass______ (surgery is not ____)

A

Symptoms not responsive to observation / reassurance (not urgent)

49
Q

Dupuytren’s Disease

  • B_____ proliferative disorder characterized by decreased hand f_______ caused by hand con______ and painful fascial n_____. Th_____ of the fascia
  • Diagnosis can be made by physical examination which shows painful n______ in the palm with associated digital con______.
  • Treatment ranges from nonoperative passive str______ to in______, needle ____neurotomy, and operative open f_____tomy if the disease progresses or affects a patient’s daily living.
A
  • Benign proliferative disorder characterized by decreased hand function caused by hand contractures and painful fascial nodules. Thickening of the fascia
  • Diagnosis can be made by physical examination which shows painful nodules in the palm with associated digital contracture.
  • Treatment ranges from nonoperative passive stretching to injections, needle aponeurotomy, and operative open fasciectomy if the disease progresses or affects a patient’s daily living.
50
Q

Dupuytren’s Disease

  • Epidemiology
    • __:__ male to female ratio
    • __th to __th decade of life
    • Most commonly in ______ (ethnicity) males of northern European descent
      • ______ in South America, Africa, China
  • _____> small > middle > index
  • Myo_______ is the dominant cell type
  • Associated conditions: H _ _, al______ism, di______, anti s______ medications
A
  • Epidemiology
    • 2:1 male to female ratio
    • 5th to 7th decade of life
    • Most commonly in caucasian males of northern European descent
      • Rare in South America, Africa, China
  • Ring > small > middle > index
  • Myofibroblast is the dominant cell type
  • Associated conditions: HIV, alcoholism, diabetes, anti seizure medications
51
Q

Dupuytren’s Disease History and Symptoms

  • Decreased _ _ _ affecting _ _ _
  • ____ful N______
A
  • Decreased ROM affecting ADL
  • Painful Nodules
52
Q

Dupuytren’s Disease PE

  • ____ful no_____ and co___
  • Usually r____ or small fingers
  • Look for __lateral involvement and ask about other possible locations (rare, but can indicate a more ______ form of Dupuytren’s)
    • Plantar Fascia: Ledderhose’s disease
    • Penis: Peyronie’s disease
A
  • Painful nodules and cords
  • Usually ring or small fingers
  • Look for bilateral involvement and ask about other possible locations (rare, but can indicate a more aggressive form of Dupuytren’s)
    • Plantar Fascia: Ledderhose’s disease
    • Penis: Peyronie’s disease
53
Q

Hueston’s Tabletop Test

Ask patient to place palm?

Look for (2)

A

Ask patient to place palm flat on table

Look for MCP or PIP contracture

54
Q

Dupuytren’s Disease Imaging

______ Diagnosis, Imaging?

A

Clinical Diagnosis, No imaging

55
Q

Dupuytren’s Disease Non-Operative Treatment

  • R _ _ exercises
  • C________ Injection (Xiaflex)
    • Causes lysis and _______ of cords
    • Low activity against type IV collagen (in basement membrane of blood vessels and nerves) explaining the ___ neurovascular complication rate
    • Works best for _______ contractures (MCP more than PIP)
  • Needle ________
    • Percutaneous needle technique; mostly for _____ contractures
A
  • Range of motion exercises
  • Collagenase Injection (Xiaflex)
    • Causes lysis and rupture of cords
    • Low activity against type IV collagen (in basement membrane of blood vessels and nerves) explaining the low neurovascular complication rate
    • Works best for smaller contractures (MCP more than PIP)
  • Needle aponeurotomy
    • Percutaneous needle technique; mostly for smaller contractures
56
Q

Dupuytren’s Disease Operative Treatment

  • Surgical resection / ______tomy
  • MCP flexion contractures > ___-degrees
  • _____ PIP flexion contracture
  • Note: painful nodules are ____ an indication for surgery
A
  • Surgical resection / fasciectomy
  • MCP flexion contractures > 30-degrees
  • ANY PIP flexion contracture
  • Note: painful nodules are not an indication for surgery
57
Q

Acute hand injuries / conditions…1 slide each!

(6)

A

Infectious flexor tenosynovitis

Scaphoid Fracture

Boxer’s fracture

Distal radius fracture (Colles, Smith)

Gamekeeper’s thumb

Mallet finger

58
Q

Infectious flexor tenosynovitis

  • Py_____ flexor tenosynovitis is an infection of the synovial sh____ that surrounds the flexor tendon.
  • Diagnosis is made clinically with the presence of the 4 K_____ signs.
  • Treatment is urgent irr_____ and de______ of the flexor tendon sheath with (1)*
A
  • Pyogenic flexor tenosynovitis is an infection of the synovial sheath that surrounds the flexor tendon.
  • Diagnosis is made clinically with the presence of the 4 Kanavel signs.
  • Treatment is urgent irrigation and debridement of the flexor tendon sheath with IV antibiotics.
59
Q

Kanavel signs (4 total)

  1. f_____ posturing of the involved digit
  2. _______ to palpation over the tendon sheath
  3. marked pain with passive ______ of the digit
  4. ____form sw______ of the digit (“_____ digit”)
A
  1. flexed posturing of the involved digit
  2. tenderness to palpation over the tendon sheath
  3. marked pain with passive extension of the digit
  4. fusiform swelling of the digit (“sausage digit”)

Note: fusiform = spindle shaped, tapering at both ends

60
Q

Scaphoid Fracture

  • Scaphoid Fractures are the ______ common carpal bone fracture, often occurring after a ____ onto an ____stretched hand.
  • Diagnosis can generally be made by dedicated radiographs but (1) or (1) may be needed for confirmation.
  • Treatment may require a prolonged period of ____ immobilization, per______ surgical fixation, or o___ reduction and in_____ fixation
A
  • Scaphoid Fractures are the most common carpal bone fracture, often occurring after a fall onto an outstretched hand.
  • Diagnosis can generally be made by dedicated radiographs but CT or MRI may be needed for confirmation.
  • Treatment may require a prolonged period of cast immobilization, percutaneous surgical fixation, or open reduction and internal fixation
61
Q

Scaphoid Fracture

  • Can be ______ on plain x-rays
  • ____mobilize and refer if snuff box T _ _
    • Thumb spica
  • _____ healing due to tenuous retrograde blood flow
  • Non-un____ can lead to future _____ degenerative changes
A
  • Can be missed on plain x-rays
  • Immobilize and refer if snuff box TTP
    • Thumb spica
  • Poor healing due to tenuous retrograde blood flow
  • Non-union can lead to future early degenerative changes
62
Q

Boxer’s Fracture

  • ________ Fractures are the most common hand injury and are divided into fractures of the head, neck, or shaft.
  • Diagnosis is made by orthogonal ______ the hand.
  • Treatment is based on which metacarpal is involved, lo______ of the fracture, and the ro_____/ang_____ of the injury.
A
  • Metacarpal Fractures are the most common hand injury and are divided into fractures of the head, neck, or shaft.
  • Diagnosis is made by orthogonal radiographs the hand.
  • Treatment is based on which metacarpal is involved, location of the fracture, and the rotation/angulation of the injury.
63
Q

Boxer’s Fracture Non-Operative Tx

  • Generally non-op if:
    • No ro_______ deformity
    • Shaft angulation
      • ____ finger: 40-degrees
      • _____ finger: 30-degrees
      • _____ finger: 20-degrees
      • _____ finger: 10-degrees
A
  • Generally non-op if:
    • No rotational deformity
    • Shaft angulation
      • Little finger: 40-degrees
      • Ring finger: 30-degrees
      • Middle finger: 20-degrees
      • Index finger: 10-degrees
64
Q

Distal radius fracture (Colles, Smith)

  • Distal radius fractures are one of the most common orthopaedic injuries and generally result from ___ on an _______ hand.
  • Diagnosis is made ______ and _______ with orthogonal radiographs of the wrist
  • Treatment can be nonoperative or operative depending on fracture st____ and fracture dis_____ as well as patient a___ and a______demands
  • Appropriate to refer ____ fractures
A
  • Distal radius fractures are one of the most common orthopaedic injuries and generally result from fall on an outstretched hand.
  • Diagnosis is made clinically and radiographically with orthogonal radiographs of the wrist
  • Treatment can be nonoperative or operative depending on fracture stability and fracture displacement as well as patient age and activity demands
  • Appropriate to refer all fractures
65
Q

Gamekeeper’s Thumb (AKA Skier’s thumb)

  • Most thumb sprains involve the (1) ligament, which is located on the _____ of the knuckle joint.
  • Treatment for a sprained thumb usually involves wearing a sp____or c___ to keep the thumb from moving while the ligament heals.
  • For more severe sprains, _____ may be needed to restore stability to the joint.
  • Thumb _____ brace
  • Referral appropriate if s/p injury and there is any concern for ins______
A
  • Most thumb sprains involve the ulnar collateral ligament, which is located on the inside of the knuckle joint.
  • Treatment for a sprained thumb usually involves wearing a splint or cast to keep the thumb from moving while the ligament heals.
  • For more severe sprains, surgery may be needed to restore stability to the joint.
  • Thumb spica brace
  • Referral appropriate if s/p injury and there is any concern for instability
66
Q

Mallet Finger (Baseball Finger) Definition

  • Deformity caused by disruption of the _______ extensor tendon _____ to the (1) joint
    • Usually caused by a traumatic imp______ blow (i.e. sudden forced _____) to the tip of the finger in the ______ position
A
  • Deformity caused by disruption of the terminal extensor tendon distal to DIP joint
    • Usually caused by a traumatic impaction blow (i.e. sudden forced flexion) to the tip of the finger in the extended position
67
Q

Mallet Finger (Baseball Finger)

  • Diagnosis is made clinically with a presence of a distal phalanx that rests at ~___° of _______ with lack of active DIP _______.
  • Treatment
    • Usually extension sp______ of DIP joint for _-_ weeks.
    • Surgical management is indicated for volar sub______ of the distal phalanx, ch_____ injuries, or with the presence of significant ar_______.
    • Bony Mallet: usually surgery if
      • >___% articular surface
      • >__ mm articular gap
  • FYI…”jersey finger” is flexor tendon _______…
A
  • Diagnosis is made clinically with a presence of a distal phalanx that rests at ~45° of flexion with lack of active DIP extension.
  • Treatment
    • Usually extension splinting of DIP joint for 6-8 weeks.
    • Surgical management is indicated for volar subluxation of the distal phalanx, chronic injuries, or with the presence of significant arthritis.
    • Bony Mallet: usually surgery if
      • >50% articular surface
      • >2 mm articular gap
  • FYI…”jersey finger” is flexor tendon rupture…

Diagnosis and Management (36 decks)

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