SCS Study Guide- EWH Flashcards
where is the A1 pulley in the finger
A1 is at the MCP joint, responsible for trigger finger
what are the most improtant pulleys for prevention of bowstringing in the finger
A3-4
what innervates the thenar side of the thumb
all of them are median nerves, except adductor pollicus which is the ulnar nerve
hypothenar innervation
ulnar nerve
what innervates the lumbricals, DABS/PADS
DABS/PADS are ulnar
lumbricals are the median and ulnar
what is a bishop sign
ulnar nerve palsy, flexion of the 4th and 5th fingers due to hypothenar eminence wasting
drop wrist is a palsy of what
radial nerve
claw hand is an issue with which nerve
ulnar
ape hand happens from
palsy of the median nerve
boutonniere deformity
hyperextension at DIP, flexion at PIP
swan neck deformity
hyperextension at PIP, flexion at DIP
dupuytren contracture
tightening of fascia in creating claw like hand
FCR, PL, FDS, FPL, PQ are innervated by what
median nerve
FDP (goes to the ??) innervated by what
innervated by median and ulnar, and goes to DIP
FCU innervated by
ulnar nerve
ECRL/B
AbPL
EPB
innervated by the radial nerve
ED, EDM, ECU, EPL, EI innervated by
radial nerve
finkelsteins
dequervains
tinel
CTS
Phalen
CTS
lunotriquetral ballotment test
LT joint instab/dislocation
allen;s
issue with radial or ulnar arteries
MP grind/torsion/compression
possible fracture
bunnel littler test
intrinsic capular tightness. MCP flex and PIP flex, then MCP ext and PIP flex and check for restricitons
murphy’s sign
dislocated lunate: make a fist and check alignment of knuckles, if 2nd knuckle is in line, then lunate issue. should be higher
froment’s sign
adductor pollicus paralysis
shuck test
shear test
press test
lunotriquetral pathology
TFCC grind test
TFCC
piano key sign
laxity at radioulnar joint
Wartenberg sign
neuritis of superficial radial nerve
trigger finger causes and exam and treatment
causes: FDP/FDS unable to glide in teh A1 pulley
exam: painful snapping, triggers after making a fist then extending. tendon at A1 thicker
treatment: injection of corticosteroids
jersey finger: causes, exam and treatment of
FDP avulsion from forced extension of the DIP during flexion (caught in jersey)
exam: pain and swelling at volar DIP, unable to flex
treatment: splint and refer
how do you splint the wrist after a jersey finger repair
wrist in 30 degrees flexion, MCP at 70 flexion and PIP and DIP in full extension
first 10 days.
after 10 days: to 3 weeks, wrist in neutral and MCP at 50 flexion
when can splint be D/c after jersey finger surgery
6 weeks (night splint till 8 weeks)
when can tendon gliding and strengthening begin for jersey finger repair
5-10 weeks
mallet finger cause, exam and treatment
what zone
cause: extensor injury to zone one.
cause: avulsion of extensor at DIP, forced flexion of finger
exam: extensor lag at the dorsal DIP
treatment: continuous splinting for DIP for 6-10 weeks with PIP free
at 6 weeks: there needs to be night splint for 3+ more weeks. then if at 6 weeks and sports, additional splinting for 6 more weeks
if the finger drops into flexion with mallet finger splinting what happens
splinting clock starts over
central slip extensor tendon injury (possible _____ deformity)
case, exam, treatment
boutonniere
cause: PIP forcibly flexed while extended.
exam: will be no active extension
treatment: splint for 6 weeks, but if after 6 weeks cannot extend, see MD
collateral ligament injuries are usually ______, at the ___
cause, exam and treatment
jammed fingers, at the PIP
cause: forced UD/RD at IP joints
exam: pain at ligament and inc valgus/varus
Treatment: buddy tape
T or F: radiographic healing lags behind clinical presentation
true
after a MC of phalange fracture, MCP joints are positioned how
in flexion to avoid extension contractions
after a MC of phalange fracture, IPjoints are positioned how
full extension
how long does a metacrapal fx take to heal
6 weeks due to good blood supply
splinting for metacarpal fractures
in position of function
wrist 30-60 extension, MCP 70 flexion, IP 0-10 degree flexion
is wrist positioned functionally for boxer fractrue
no, usually in ulnar gutter, 3 weeks (MCP at 80 flex, PIP straight, DIP free)
what degree of displacement means surgery for boxers fracture
over 40 degrees displacement
post ORIF for boxer, how long in a splint
3 weeks
Causes and exam and imaging for boxers
cause: punch that doesnt land on 2nd/3rd MC
exam: malposition with fist
x-ray: lateral view
coaches finger is a dislocation at the ____ and is usually a ___ direction dislocation
at the PIP, usually dorsally
TTP at volar plate and reduced and splinted in flexion and extension
CMP dislocation cause, exam and treatment
cause: foce dorsally or volarly, pain and swelling, and splint to avoid full extension
bennet fracture cause, exam and treatment
cause: add or sligthly flexed finger, fall. lateral x-ray, treat with open or closed reduction and casting
gamekeeper thumb cause, exam and treat
cause: valgus at thumb, exam, weakened key pinch and valgus stress test and imaging would be plain x-ray and treat with 30-35 degree RD
what is a stenner lesion
aponeuosis and UCL is entrapped
structures that provide ulnar stability of the thumb
adductor aponeurosis, Adductor pollicus, UCL, volar plate
UCL is splinted how
in arm spice cast with IP free
how long to splint UCL if on contact situations
2 months
when can you start A/PROM and gripping in UCL
ROM at 3-4 weeks gripping at 6 weeks
after a thumb UCL repair, when ca you start PROM of thumb
6 weeks
when to d/c splint with UCL-R/r
8 weeks
UCL thumb repair RTS
3-4 months
CTS cause, exam and treatment
cause: inflammation of tendons and synovial sheaths in the wrist with repeated flexion
exam: phalen, tinel, medial compression test, sensory changes and paresthesia
treatment: non op: wrist splint in neutral, op: release
CT release timeline for ROM/ADL/strengthening/gripping and RTW/RTP
ROM at 2 weeks
ADLs 7d-14d
pinch/grip 2-4 weeks
RTP/RTW 2-4 week
bowler’s thumb
digital nerve compression from bowling ball
hamate fracture
cause exam and treatment
cause: contact while athlete is holding sport club/rqchuet into ulnar side of hand
wrist will be painful and weak
casting and immob for 6-8 weeks
scaphoid fracture
cause, exam and treatment
hypertext and RD wrist
TTP snuffbox, tubercle tenderness, compression pain
imaging with posterolateral, oblique and ulnar flex, PA, MRI
treatment varies
stable scaphoid fracture treatment
6 week sugar tong/long arm thumb splica by 6 weeks short arm thumb splica
minimally displaced scaphoid fracture
percutaneous fixation with scres
displaced scaphoid fx treatment `
ORIF
RTS after scaphoid fracture
18 weeks
colles fracture
radius, dirsal angulation of distal part
smith fracture
distal radius is palmarly displace
silver fork
hand dorsally displaces
how to treat a radius fracture
braced 4-6 weeks
DeQuervain’s cause, exam, treatment
cause: grasp with UD (tennis)
exam: pain at radial ascpect wrist, finkelstein’s pain with turning
immobilize with a radial thumb splica
TFCC cause, exam, treatment
FOOSH, rotational injury, repeated axial loading
exam: ulnar wrist pain, crepitus, pain with gripping and RD, shuck/shear/grind/press test
imaging: PA/lateral oblique with sho ABDwrist brace 4-6 weeks, RTS 3 months
RTS for TFCC issues
3 months
Keinboch’s disease
AVN lunate, maybe fall, pain like a sprained wrist, stiff, decreased grip strength, pain with turning hand upwards,
immobilized in cast early on!
