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Ortho LE and UE > the wrist and hand > Flashcards

the wrist and hand Flashcards

1
Q

what capsule is tight in the radio-ulnar ligament in supination

A

anterior capsule

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2
Q

what capsule is tight in the radio-ulnar ligament in pronation

A

posterior capsule

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3
Q

radio collateral attachments

A

styloid and scaphoid

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4
Q

ulnar collateral ligament attachments

A

styloid to pisiform and triqutral

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5
Q

what does the carpal tunnel attach to

A

scaphoid, trapezium, capitate, hook of the hammate, pisiform

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6
Q

open pack of the distal radio ulnar joint

A

10 degrees of supination

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7
Q

closed pack of the distal radio ulnar joint

A

full extension and radio deviation

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8
Q

degree of freedom of the distal radio ulnar joint

A

1 (pronation and supination) concave radius on convex ulnar and TFCC

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9
Q

open packed of the radio carpal joint

A

nautral and slight ulnar deviation

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10
Q

closed packed of the radio carpal joint

A

full extension with radio deviation

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11
Q

degrees of freedom of the radio carpal joint

A

2 (sagittal and frontal) convex distally concave proximally

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12
Q

radial pain

A
  • traumatic suggest scaphoid fx
  • non traumatic suggest de quervain tenosynovitis
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13
Q

posterior pain

A
  • generalized might be associated with arthritis
  • defined mass indicate a ganglion cyst
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14
Q

ulnar pain

A

traumatic can suggest a tear of the fibrocartilage complex (TFCC)

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15
Q

anterior pain

A

think carpal tunnel, ganglion cyst formation and tenosynovitis

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16
Q

law of repetitive motion

A

I=NF/AR

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17
Q

what is carpal tunnel syndrome

A

compression neuropathy of the median nerve that occurs under the transverse carpal ligament of the wrist

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18
Q

subjective of carpal tunnel syndrome

A
  • numbness and tingling of the median nerve
  • pain in forearm and wrist
  • pain awake the pt at night
  • pain with activities involving wrist flexion
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19
Q

objective of carpal tunnel

A
  • thenar atrophy in late stage
  • positive phalen, tinel, carpal compression
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20
Q

intervention for carpal tunnel

A

splinting

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21
Q

what is de quervains tenosynovitis

A

inflammation of the extensor and abductor pollicis caused by repeative use of the thumb

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22
Q

subjective of de quevains tenosynovitis

A
  • pain on the radial side of the hand
  • difficulty with grasping or gripping
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23
Q

objective of de quervains tenosynovitis

A
  • swelling at radio styloid process
  • palpation elicits pain at the site of the retinaculum at the radial styloid process
  • positive finkelsteins, WHAT, and eichoffs
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24
Q

prognosis for de quervains tenosynovitis

A

good if seek treatment within first 6 mo of symptoms

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25
Q

what is duprytrens

A

fibroproliferation disease of the palmar fascia that is genetic and environmental - refer out for CCH injections

26
Q

what is the most common wrist injury for all age groups

A

fx of the distal radius

27
Q

colles fx

A

distal radius tilted upward (dorsally); typical foosh

28
Q

smith fx

A

distal radius tilted palmerly; foosh with wrist in extension

29
Q

barton fx

A

intra articular fx associated with subluxation of the carpus (dorsally or volarly) along the displaced articular fragment of the radius

30
Q

chauffeurs fx

A

oblique fx through the base of the radial styloid

31
Q

Die-punch fx

A

depressed fx of the articular surface opposite the lunate or the scaphoid boone

32
Q

subjective of the distal radius fx

A

acute pain, tenderness, swelling, and deformity of the wrist, FOOSH

33
Q

objective of the distal radius fx

A
  • swelling deformity and discoloration around the wrsit and distal radius
  • may have associated skin injury and bleeding
  • may have decreased sensation of the median, radial, or ulnar nerve distribution
  • may have decreased circulation in the hand
34
Q

what motions are going to be limited post immobilization of a fx of the distal radius

A

extension and supination commonly limited and need to be mobilized

35
Q

fx of the scaphoid

A

dx is often delayed or missed
vulnerable to a FOOSH

36
Q

fx of scaphoid subjective

A
  • hx fo foosh
  • dorsal wrist pains and with grippind
  • tenderness over the anatomic snuff box
37
Q

objective findings for fx of scaphoid

A
  • tender anatomic snuff box
  • decrease AROM of the wrist (by 50%)
  • decrease grip strength
  • normal neuro exam
  • pain with axial compression of the thumb
38
Q

time line for fx of the scaphoid

A

after splint removal - initiate AROM
2 weeks PROM and gental stretching

39
Q

what is the discription of gamekeepers thumb or skier thumb

A

injury to the ulnar collateral ligament of the thumb leading to instability of the MCP joint

40
Q

subjective of gamekeepers thumb/ skiiers thumb

A
  • pain and swelling along the ulnar side of the MCP joint (acute)
  • complaints of pain, weakness or loss of stability (chronic)
40
Q

intervention for gamekeepers thumb both post op and non surgical

A

immobilization for 3 weeks, with additional splinting for 2 weeks
- AROM at 3 weeks
- strengthening at 8 weeks
- no abduction stress for first 2-6 weeks

40
Q

objective of gamekeepers thumb

A
  • local tenderness and swelling with palpation along the ulnar side of the MCP joint
  • pain or laxity with valgus stress testing
  • impaired MCP joint flexion and extension
  • decreased pinching strength and opposition
  • valgus at extension and 30 degrees of flexion
41
Q

OA of the thumb symptoms

A
  • pain with activities such as turning a key, opening a door, or snapping your fingers
  • swelling at the base of the thumb
  • aching discomfort after prolonged use
  • out of joint appearance
  • development of bony prominence
41
Q

how long do you have to wear a thumb cast with LRTI

A

4 weeks

41
Q

what are the different surgical options for thumb OA

A

1) ligament reconstruction-use wrist flexor tendon
2) ligament reconstruction and tendon interposition (LRTI)-remove trapezium
3) total joint replacement
4) fusion

42
Q

flexor digitorum profundus avulsion MOI

A

hypextension stress applied to a flexed finger most often misdx as a jammed finger most common in the ring finger

43
Q

subjective of flexor digitorum profundus alvulsion

A
  • hx of trauma involving the digit
44
Q

objective for flexor digitorum profundus alvulsion

A
  • testing of the isolated DIP joint flexion in all digits reveals effected digit
  • inability to flex the DIP
  • tenderness along the flexor tendon sheath or in the palm
45
Q

tx for flexor digitorum profundus avulsion

A

refer out for surgery

46
Q

trigger finger MOI

A

inflammation of the 2 flexor tendons of the tinger which become thickened and narrowed as the cross the MC head and palm causing painful snapping

47
Q

trigger finger subjective

A

complaints of painful finger loss of smooth motion (catching) with gripping or pinching
- painful nodule in the distal palm

48
Q

trigger finger objective

A
  • tenderness with palpation
  • crepitus or moving nodular mass
  • pain aggravated by stretching the tendon into extension or resisted flexion
  • clicking or locking
  • full flexion might not be possible
49
Q

trigger finger tx

A

reduce inflammation and steroid injections

50
Q

Mallet finger/ baseball finger

A

DIP is unable to extend/ is locked in flexion

51
Q

MOI of mallet finger/baseball finger

A

ball strikes the tip of the finger damaging the extensor

52
Q

tx for mallet finger

A

mallet splint for 6-8 weeks
extension block k-wire for 4 weeks
DO NOT LET THR FINGER BEND

53
Q

boutonniere deformity

A

injury to the PIP extensors. PIP locked in flexion

54
Q

MOI of boutonniere deformity

A

forceful blow to the top (dorsal) side of a bent (flexed) PIP, or cutting the top of the hand, or athritis

55
Q

how long to wear a splint for boutonniere deformity

A

6 weeks for young pt; 3 weeks for elderly pt

56
Q

swan neck deformity

A

PIP is extendend and DIP is flexed

57
Q

what is swan neck deformity caused by

A

weakness or tearing of the tigament and tendon

Ortho LE and UE (7 decks)

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