S1_L2: Wrist and Hand Conditions Flashcards
TRUE OR FALSE: Structurally, fingernails are actually modified hairs. Nails stop growing after death
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
A. Both statements are true
The following statements are true about the Gamekeeper’s thumb, EXCEPT:
A. Also known as Skier’s thumb
B. Rupture of the collateral ligament on the radial side of the thumb at the metacarpophalangeal joint
C. Caused by a blow or fall on extended thumb or repeated abduction of thumb
D. Results to weak thumb-index pinch
E. None of the above
B. Rupture of the collateral ligament on the radial side of the thumb at the metacarpophalangeal joint
NOTE: Rupture happens on the ulnar side of the thumb
Injuries to the TFCC typically occur following a fall on the (1)_______ outstretched wrist or as the result of chronic repetitive (2)_______ loading
- supinated
- rotational
The following may cause claw hand deformity, EXCEPT:
A. Ulnar nerve palsy
B. Median nerve palsy
C. Charcot-Marie-Tooth disease
D. Compartment syndrome of the hand
E. None of the above
E. None of the above
The Claw Hand is an imbalance between strong (1)_______ and deficient (2)_______.
- extrinsics
- intrinsics
The following statements are true about the swan neck deformity, EXCEPT:
A. Characterized as hyperextension of PIP and flexion of DIP
B. Destruction of the oblique retinacular ligament of the extensor mechanism
C. Extended position of DIP stretches FDS and FDP tendon
D. Results to inability to bring tips of fingers into grasp
E. None of the above
C. Extended position of DIP stretches FDS and FDP tendon
NOTE: PIP is in extended position
Trigger Finger grade II is also called the (1)_______, while grade III is also called (2)_______
- active
- passive
Match the following trigger finger grade to its characteristics.
- PIP joint is stuck in flexion and cannot be extended
- Pain on A1 pulleys of involved finger
- Patient cannot flex finger
A. I (Pretrigger)
B. II (Active)
C. III (Passive)
D. IV (Rigid)
- D
- A
- C
Match the following trigger finger grade to its characteristics.
- PIP can be extended only with help of an external force
- Triggering noted on physical examination
- Triggering on PE but patient can extend PIP actively
A. I (Pretrigger)
B. II (Active)
C. III (Passive)
D. IV (Rigid)
- C
- C
- B
TRUE OR FALSE: Ring finger and thumb are most often affected by trigger finger
True
TRUE OR FALSE: The Distal Radio-ulnar Joint (DRUJ) is a uniaxial pivot joint. Only the DRUJ is responsible for pronation and supination of forearm.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
C. Only the 1st statement is true
This is found in the dorsal, at center of radius, and forms a pulley around which the extensor pollicis longus tendon passes
Lister’s tubercle
The term (1)_______ pertains to an injury to muscles while the term (2)_______ pertains to a ligamental injury
- strain
- sprain
Match the following fractures to its corresponding clinical details.
- complete fracture of the distal radius with palmar displacement of the distal fragment
- also known as Dinner Fork Deformity
- caused by a sudden pronation of the distal forearm on a fixed wrist
- causes the forearm to be angled posteriorly just proximal to the wrist
- an intra-articular fracture of the distal radius with associated dislocation of the radiocarpal joint
A. Colle’s Fracture
B. Smith’s Fracture
C. Barton Fracture
- B
- A
- C
- A
- C
TRUE OR FALSE: Barton Fracture may be can be described as volar or dorsal, depending on whether the volar or dorsal rim of the radius is involved. A dorsal Barton Fracture is more common.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
C. Only the 1st statement is true
Where does inflammation occur in De Quervain’s Tenosynovitis?
1st dorsal compartment
Ulnar shift and ulnar deviation at the MCP is associated with _____________
Rheumatoid Arthritis
The following statements are true about the TFCC, EXCEPT:
A. Main stabilizer of distal radioulnar joint
B. Located between the medial proximal carpal row and distal ulna
C. Composed of a meniscus homologue to increase wrist movement
D. Supports the ulnar portion of the carpus
E. None of the above
C. Composed of a meniscus homologue to increase wrist movement
NOTE: It serves as a shock absorber
Match the following boundaries of the carpal tunnel to its corresponding structure
- flexor retinaculum
- hook of hamate
- trapezium
- radiocarpal ligaments
- palmar ligament complex
A. Roof
B. Floor
C. Ulnar border
D. Radial Border
- A
- C
- D
- B
- B
The following statements are true, EXCEPT:
A. TFCC injury may be traumatic of degenerative
B. A TFCC tear is a common injury in golf, boxing, tennis, waterskiing, gymnastics, and hockey
C. Radiographs is usually positive
D. S/Sx include painful click during wrist motions
E. None of the above
C. Radiographs is usually positive
TRUE OR FALSE: A s/sx of TFCC injury is a complain of medial wrist pain just distal to the ulna, which is increased with
end-range forearm pronation/supination and with repetitive gripping. Tenderness is also palpated anterior to the distal ulnar head.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
B. Both statements are false
NOTE: Pain is aggravated with forceful gripping and tenderness is palpated posteriorly.
TRUE OR FALSE: The Radiocarpal joint is between the distal radius and the scaphoid and lunate and TFCC. It is a condyloid joint
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
A. Both statements are true
Match the following condition to its signs and symptoms.
- TFCC tear
- Ulnar styloid fracture
- Ulnar nerve entrapment at
Guyon’s
A. Pain over ulnar styloid
B. Paresthesia or weakness
C. Ulnar deviation of wrist
McMurray’s
- C
- A
- B
The (1)_______ is a carp[al bone also known as the navicular bone of the hand. It is part of the (2)_______ row.
- scaphoid
- proximal
TRUE OR FALSE: Colle’s fracture has a high incidence in men over 60.
False.
NOTE: This condition has a high incidence in menopausic women 50.
If 50+ yr old woman had a fracture, there is an (1)______ likelihood of fractures in other areas because of (2)_______
- increased
- osteoporosis
The following statements are true the s/sx seen in colle’s fracture, EXCEPT:
A. dorsal wrist pain
B. bruising
C. numbness
D. decreased angulation of distal radius
E. None of the above
D. decreased angulation of distal radius
TRUE OR FALSE: The best way to diagnose Colle’s fracture is through an X-ray.
True
TRUE OR FALSE: In Colle’s fracture, >5mm radial shortening is an indication for a surgical fixation. A dorsal angulation >10° or >30° of contralateral distal radius also calls for this.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
C. Only the 1st statement is true
TRUE OR FALSE: Smith’s Fracture is also called reverse Colle’s fracture. The usual mechanism is fall on the back of a
flexed hand.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
A. Both statements are true
The following statements are true about the Barton Fracture, EXCEPT:
A. an intra-articular fracture of the distal radius
B. common in young men
C. cannot be seen initially
D. close reduction cast will have the wrist in full supination, mid extension and ulnar deviation
E. None of the above
C. cannot be seen initially
TRUE OR FALSE: Madelung’s deformity happens when ulnar growth is slower than that
of the radial growth
True
Gender wise, Madelung’s deformity is common in (1)_______. In terms, of laterality, it is usually (2)_______.
- females
- bilateral
Avascular necrosis of scaphoid is called?
Preiser’s disease
Spontaneous osteonecrosis of the lunate is called?
Kienbock’s disease
A 50 year-old carpenter came in pain on the wrist. Pain is noted when he tries to move the wrist. What will be the best special test to use in this case?
Finkelstein’s Test
The vein on your ring finger is called (1)______. It has a direct line with the human heart and is known as the (2)_____. That’s why we wear an engagement ring on the (3)_____’s hand finger
1.Vena Amoris
2. vein of love
3. left
A 40 year old left handed female, known diabetic for 1 year, non-hypertensive, complained of pain on the left hand. Pain is described as dull, aching pain on the left palm and fingers with associated numbness on the fingers. Patient usually wakes up early morning because of the numbness and stiffness. What is the most plausible diagnosis?
Ulnar nerve neuropathy in canal of Guyon
A 50 year-old carpenter came in pain on the wrist. Pain is noted when he tries to move the wrist. What is the most plausible diagnosis?
De Quervain’s Tenosynovitis
A 50 year old mother, complained of pain on the 2nd digit of thev R hand especially when closing and opening the fingers Complains of a locking sensation prominent in the morning. What is the most plausible diagnosis?
Trigger finger
A 38 year old diabetic bank teller complained of pain on the left hand described as tingling sensation especially at night for the past 3 months. She reports that shaking hands relieves her pain. What is the most plausible diagnosis?
Carpal Tunnel Syndrome
This condition is characterized by MCP flexion and IP extension
Intrinsic plus hand
When the swan-neck deformity occurs in the thumb, it is known as what?
zigzag deformity
This is most commonly dislocated carpal bone
Lunate
This is the most commonly fractured carpal bone
Scaphoid
This serves to prevent tendons from bow string when the tendons turn a corner at the wrist
Extensor Retinaculum
What makes up the lateral border of the anatomic snuffbox?
tendons of the abductor pollicis longus and extensor pollicis brevis
TRUE OR FALSE: De Quervain’s is most commonly in the dominant
wrist. It typically occurs between ages 40-60.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
C. Only the 1st statement is true
TRUE OR FALSE: It is possible to palpate a hard tender nodule over styloid process of the
radius in De Quervain’s Tenosynovitis.
True
This is also known as Transverse carpal ligament
Flexor Retinaculum
The following are structures that pass deep to the flexor
retinaculum, EXCEPT:
A. Flexor digitorum superficialis tendons
B. Flexor pollicis longus tendon
C. Ulnar nerve
D. Median nerve
E. Flexor carpi radialis tendon
C. Ulnar nerve
The carpal tunnel serves as a conduit for how many flexor tendons?
9
What nerve supplies the carpal tunnel?
Median nerve
The following may cause carpal tunnel syndrome, EXCEPT:
A. gout
B. colle’s fracure
C. pregnancy
D. thyroid disease
E. none
E. none
The following are signs and symptoms of carpal tunnel syndrome, EXCEPT:
A. Tingling in the hand (thumb, and index)
B. Aggravated during volleyball
C. Problems with grip and pinch
D. Worse at night
E. None
B. Aggravated during volleyball
SCENARIO: The patient is positioned in sitting and is asked to vigorously shake his or
her hands. The patient reports of a resolution of the paresthesia symptoms during or following administration of the motion.
Yes or no, is the test considered positive?
Yes
SCENARIO: The patient is positioned in sitting and is asked to vigorously shake his or
her hands. The patient reports of a resolution of the paresthesia symptoms during or following administration of the motion.
What special test was done?
Flick’s maneuver
This is a depression superficial to the flexor retinaculum located between the hook of the hamate and pisiform bone
Tunnel of Guyon
TRUE OR FALSE: The floor of the Tunnel of Guyon is bounded by the pisohamate ligament and pisometacarpal ligament
True
This is referred to as the nerve of fine movements of the hand
Ulnar nevrve
Enumerate the 2 special tests done for confirming a canal of Guyon syndrome
- Froment’s test
- Wartenberg’s sign
This is the most important joint of the thumb
Carpometacarpal joint of the
thumb
This is a fibrotic condition of the palmar aponeurosis that results in nodule formation or scarring of the aponeurosis
Dupuytren’s Contracture
The following are true about Dupuytren’s Contracture, EXCEPT:
A. Commonly affects the ring and 5th finger or both
B. Commonly bilateral but if unilateral mostly affects R hand
C. Chronic inflammation of the palmar fascia with progressive fibrosis and contracture
D. May cause finger flexion contracture
E. None
E. None
The central bone is located at which zone?
3
This band rejoin over the middle phalanx in to the terminal tendon the inserts at the base of distal phalanx
Lateral bands
When the lateral bands are ruptured, what deformity will occur?
Mallet finger
Determine the flexor zones of the hand.
- No Man’s Zone
- Lumbrical Zone
- under the carpal ligament and carpal tunnel
A. Zone I
B. Zone II
C. Zone III
D. Zone IV
E. Zone V
- B
- C
- D
Determine the flexor tendon injuries affects which zones of the hand.
- Flexor digitorum superficialis
- Flexor pollicis longus
- Median nerve
A. Zone I
B. Zone II
C. Zone III
D. Zone IV
E. Zone V
- B or D
- D
- D
Determine the extensor tendon zones of the hand.
- DIP
- PIP
- MCP
A. Zone I
B. Zone II
C. Zone III
D. Zone IV
E. Zone V
F. Zone VI
G. Zone VII
H. Zone VIII
- A
- C
- E
Determine the extensor tendon injuries affects which zones of the hand.
- buttonhole deformity
- mallet finger
- fight bite
A. Zone I
B. Zone II
C. Zone III
D. Zone IV
E. Zone V
F. Zone VI
G. Zone VII
H. Zone VIII
- C
- A
- E
What is the most commonly injured extensor zone
Zone 6
The 2nd cruciate pulley of the hand is between which annular ligaments?
A3 and A4
A5 is at the level of the?
DIPs
A2 is at the level of the?
proximal phalanx
Which fingers are most commonly affected by the trigger finger?
- ring finger
- thumb
