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Musculoskeletal > The Forearm/Wrist/Hand > Flashcards

The Forearm/Wrist/Hand Flashcards

1
Q

Which three muscles are responsible for thumb extension?

A

EPL
EPB
APL

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2
Q

Which two muscles are responsible for thumb flexion?

A

FPL

FPB

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3
Q

Which two muscles are responsible for thumb abduction?

A

AbPL

AbPB

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4
Q

Which two muscles are responsible for thumb adduction?

A

Ad P

1st dorsal interosseous

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5
Q

Which muscles compose the thenar eminence of the hand?

A

OpP
AbPB
FPB
AdP

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6
Q

Which muscles compose the hypothenar eminence of the hand?

A

AbDM
FDMB
Opponens digiti

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7
Q

Which muscles of the hand does the median nerve innervate?

A

LLOAF

First two lateral lumbricals
Opponens Pollicis
AbPB
FPB

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8
Q

What is the sensory distribution of the median nerve in the hand?

A

Lateral 3.5 fingers palmar aspect

Tips of 3.5 fingers dorsal aspect

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9
Q

Which muscles of the hand does the ulnar nerve innervate?

A

All intrinsic muscles (except LLOAF)

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10
Q

What is the sensory distribution of the ulnar nerve in the hand?

A

Palmar and dorsal aspects of 1.5 medial digits

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11
Q

Describe the key landmarks of the anatomical snuffbox.

A

Anterior boundary: Tendons of APL and EPB

Posterior boundary: Tendon of EPL

Floor: Radial artery, scaphoid, trapezium

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12
Q

Which muscles are involved in wrist flexion?

A

FCR
FCU
Assisted by: flexors of fingers and thumb, palmaris longus, APL

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13
Q

Which muscles are involved in wrist extension?

A

ECRL
ECRB
ECU
Assisted by: extensors of fingers and thumb

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14
Q

Which muscles are involved in wrist abduction?

A

APL
FCR
ECRL
ECRB

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15
Q

Which muscles are involved in wrist adduction?

A

ECU

FCU

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16
Q

What are the contents of the carpal tunnel?

A

FDP (x4 tendons)
FDS (x4 tendons)
FPL (x1 tendon)

Median nerve

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17
Q

What is mallet finger and how does it occur?

A

DIP joint forced into extreme flexion (hyperflexion) - can occur from either extensor tendon rupture at base of distal phalanx (no bony involvement) or avulsion injury

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18
Q

What is involved in the management of mallet finger? (2)

A
  1. Closed injuries treated with immobilisation splint with DIP joint in extension or hyperextension FULL TIME for 8 weeks, can be graded to night splinting if appropriate thereafter. Important to keep finger in extension in between/during splint changes, and watch out for skin breakdown.
  2. Surgery reserved for severe injury (e.g. volar subluxation of distal phalanx, injuries failing conservative management etc.)
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19
Q

What is trigger finger and what can it be caused by? (4)

A

aka stenosing tenosynovitis

Inflammation of flexor tendon sheath of finger/thumb causing pain and swelling to occur proximally at MCP joint (+/- nodule formation) and prevents smooth gliding under A1 pulley = locking of thumb or finger in flexion primarily

Aetiology: idiopathic or assoc. w/ RA, diabetes, hypothyroidism and gout

20
Q

How is trigger finger diagnosed?

A

Primarily clinical diagnosis

21
Q

How is trigger finger managed? (2)

A
  • reduce swelling and inflammation by immobilisation for 4-6 weeks (+/- glucocorticoid injection if refractory) OR local glucocorticoid injection straight up if locking is severe
  • avoid gripping, grasping etc.
  • panadol and ice for pain
  • on resolution of acute symptoms, gentle stretching exercises (extension)
  1. Surgical release of A1 pulley when locking and tenosynovitis persist despite two consecutive local glucocorticoid injection
22
Q

What is carpal tunnel syndrome?

A

Median nerve compression at the level of the flexor retinaculum

23
Q

What is the aetiology of carpal tunnel syndrome

A 
Myxoedema
Oedema
Diabetes
Idiopathic
Acromegaly
Neoplasm
Trauma
Rheumatoid arthritis
Amyloidosis
Pregnancy
24
Q

List 6 clinical features of carpal tunnel syndrome

A
  1. Sensory loss in median nerve distribution i.e. radial 3.5 digits
  2. Classically, patient awakened at night with numb/painful hand, relieved by shaking, dangling, rubbing
  3. Discriminative touch often lost first, with decreased light touch and 2-point discrimination
  4. Advanced cases: thenar wasting, weakness
  5. +/- Tinel’s sign (tingling sensation on percussion of nerve)
  6. +/- Phalen’s sign (wrist flexion induces symptoms)
25
Q

How is carpal tunnel diagnosed?

A

CLINICALLY

NCV and EMG may confirm, but do not exclude, the diagnosis

26
Q

How is carpal tunnel syndrome managed? (3)

A
  1. Wrist splinting in neutral position - usually at night but can be worn continuously esp. when repetitive wrist motion required
  2. Medical: NSAIDs, local corticosteroids, oral corticosteroids
  3. Surgical decompression - indicate if symptoms are intolerable and/or unresponsive to conservative measures
27
Q

What is the most common carpal bone injured?

A

Scaphoid

28
Q

Describe the type of injury seen in a scaphoid fracture.

A

Most commonly a transverse fracture through the waist of scaphoid, but can be distal or proximal fracture also

A larger percentage of proximal fractures result in non-union or AVN due to distribution of blood supply

29
Q

Which clinical feature is most sensitive for scaphoid injury?

A

Tenderness over anatomical snuffbox

30
Q

How is a suspected scaphoid fracture investigated?

A
  1. X-rays: AP, lateral ,scaphoid view *wrist extension and ulnar deviation)
  2. If X-ray negative but clinical features present, splint or plaster should be applied For two weeks
  3. After two weeks, a second X-ray is taken. If still no abnormalities, MRI or CT scan.
31
Q

How is an undisplaced scaphoid fracture managed? (3)

A
  1. No reduction required
  2. Cast: upper foreatm to just short of MCPs of fingers, incorporation proximal phalanx of thumb (‘holding glass’ position) for 8 weeks
  3. After 8 weeks,remove plaster and examine wrist clinically and radiologically - if all good, wrist left free
32
Q

How is a displaced scaphoid fracture managed?

A

ORIF (with compression screw)

33
Q

List 3 complications of scaphoid fractures.

A
  1. AVN due to distal to proximal supply
  2. Non-union
  3. OA secondary to AVN or non-union
34
Q

What is a nightstick fracture and how does it occur?

A

Isolated fracture of ulna without dislocation of radial head - from direct blow to forearm (e.g. holding arm up to protect face)

35
Q

How is a nightstick fracture managed? (2)

A
  1. Non-displaced - below elbow cast (x10 d) followed by forearm brace (~8 weeks)
  2. Displaced - ORIF if more than 50% displaced
36
Q

What is a Galeazzi fracture and how does it occur?

A

Fracture of the distal radial shaft with disruption of the distal radio-ulnar joint and associated ulnar dislocation.

FOOSH with some rotational force

37
Q

What is the piano-key sign?

A

Seen in a Galeazzi fracture - unstable ulna can be ballotted by holding patient’s forearm pronated and pushing sharply on prominent head of ulna

38
Q

How is a Galeazzi fracture managed? (3)

A
  1. ORIF of radius
  2. If DRUJ is stable and reducible, splint for 48h with early ROM encouraged
  3. If DRUJ is unstable, ORIF or percutaneous pinning with long arm cast in supination x 6 weeks
39
Q

What is a Colles’ fracture and in whom does it usually occur?

A

Transverse distal radius fracture with dorsal displacement +/- ulnar styloid fracture

Most common fracture in those >40 years especially women due to post-menopausal osteoporosis - mechanism = FOOSH

40
Q

What is the typical clinical feature seen in a Colles’ fracture?

A

‘Dinner fork deformity’ - prominence of back of wrist and depression in front

41
Q

How is an undisplaced Colles’ fracture managed? (3)

A
  1. Dorsal splint for a few days until swelling resolves, then cast is completed
  2. X-rays at 2 weeks - surgery if fracture has slipped
  3. If not, cast removed at 4 weeks to allow mobilisation
42
Q

How is a displaced Colles’ fracture managed? (3)

A
  1. Closed reduction under anaesthesia (Haematoma, Bier’s or axillary block)
  2. Position checked by X-ray and dorsal plaster slab applied
  3. X-rays retaken at 7-10 days - if re-displaced - re-manipulation/internal fixation in patients with high functional demands
    - in older people - modest degrees of displacement accepted
43
Q

What is a Smith’s fracture and how does it occur?

A

Volar displacement of the distal radius (i.e. distal fragment displaced anteriorly) aka reverse Colles’ fracture

Can occur after fall onto the back of the flexed hand causing ‘garden spade’ deformity

44
Q

How is a Smith’s fracture managed?

A

Usually unstable and needs ORIF - closed reduction under block then long-arm cast in supination x 6 weeks

45
Q

List some complications of wrist fractures. (3 early vs 5 late)

A

Early

  1. Compartment syndrome
  2. EPL tendon rupture
  3. Acute carpal tunnel syndrome

Late

  1. Malunion, radial shortening
  2. Post-traumatic arthritis
  3. Carpal tunnel syndrome
  4. CRPS/RSD
  5. ‘Shoulder-hand syndrome’ - trophic/vasomotor changes/ reflex sympathetic dystrophic characterised by pain and stiffness in shoulder followed by swelling/stiffening of hand and fingers

Musculoskeletal (9 decks)

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