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OCS > The Wrist & Hand > Flashcards

The Wrist & Hand Flashcards

1
Q

Causes of wrist/hand pain that fall into that are considered “serious diagnoses” are divided into what 2 categories?

A
  1. Traumatic or insidious
  2. Post-operative
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2
Q

List 4 traumatic/insidious diagnoses that can cause wrist/hand pain.

A
  1. fracture (scaphoid)
  2. instability
  3. nerve injury
  4. inflammatory arthritides
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3
Q

What are the top 5 physical findings which are most useful in screening for wrist fracture? Which 3 are the most sensitive? What is the bottom line with regards to referring the patient for x-rays?

A
  1. localized tenderness (Sn 94%)
  2. pain on active motion (Sn 97%)
  3. pain on passive motion (Sn 94%)
  4. pain with grip (Sn 71%)
  5. pain with supination (Sn 68%)

Bottom Line: any one of these findings + h/o trauma should get radiographs

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4
Q

Fractures of the metacarpals accounts for roughly what percentage of all hand fractures?

A

over 50% of hand fractures occur in the metacarpals

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5
Q

What is a mallet fracture and what is the most common cause in sports?

A

base of distal phalanx; most common MOI is a ball hitting the extended finger

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6
Q

What is a distal phalanx fracture called?

A

Mallet fracture

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7
Q

What are the 2 most common mechanisms of injury of a metatarsal shaft fracture?

A

direct trauma or repetitive stress

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8
Q

What is a Boxer’s fracture, and what is the most common MOI?

A

fracture of distal shaft of 5th metatarsal; most common MOI is direct trauma or repetitive stress

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9
Q

What is the most common MOI for Hamate fractures in sports

A

direct trauma or repetitive stress while holding a racquet

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10
Q

What is the most common MOI for a scaphoid fracture?

A

FOOSH (fall on outstretched hand)

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11
Q

What is a Smith’s fracture and what is the most common MOI?

A

distal radius fracture from a FOOSH in wrist flexion

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12
Q

What is a Colles’ fracture, and what is the most common MOI?

A

distal radius fracture from a FOOSH in wrist extension

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13
Q

Describe the longitudinal compression test for scaphoid fracture. What are the general specificity/sensitivity?

A
  • axial loading of thumb
  • passively abduct & extend thumb at the MCP
  • apply compressive load through the metacarpal bone
  • (+) if painful
  • sensitivity and specificity are both excellent (both 98%)
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14
Q

What are 3 ways to test for scaphoid fracture. What are the general specificity/sensitivity?

A
  1. snuffbox tenderness
  2. resisted supination
  3. longitudinal/axial compression

sensitivity and specificity are both excellent for all three tests (98%-100%)

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15
Q

Dx: vague wrist pain with the sensation of “clicks” or “clunks”

A

scapholunate instability

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16
Q

What is the most common MOI for scapholunate instability pain?

A

FOOSH in ulnar deviation

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17
Q

How will a patient with scapholunate instability present during grip testing?

A

weak grip with minimal pain

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18
Q

Describe the purpose & performance of the Scaphoid Shift test. What is the general sensitivity?

A
  • test to rule out scapholunate instability
  • place wrist in ulnar deviation
  • palpate scaphoid tubercle with thumb & grasp with index finger on the dorsal side
  • maintain firm pressure on scaphoid with thumb while passively moving wrist into radial deviation
  • (+) if “clunk” occurs and/or pain is recreated
  • (release may cause a click as the scaphoid reduces)

sensitivity is okay, but not great (69%)

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19
Q

Dislocation of which carpal bone can commonly cause volar swelling of the median nerve? What neurologic test might be abnormal in this case?

A

lunate bone; decreased 2-point discrimination in median nerve distribution

20
Q

Patients with which wrist condition tend to hold their fingers in partial flexion? Why?

A

lunate dislocation; they tend to have pain with active/passive wrist/finger extension

21
Q

Describe the purpose & performance of the Ballottement test for the wrist.

A
  • (+) test is suggestive of a wrist/carpal dislocation
  • grasp the lunate between the index finger & thumb
  • with other hand, grasp triquetrum (medial/ulnar side of lunate)
  • move volarly/dorsally (back & forth)
  • (+) test is pain, laxity, and/or crepitus
22
Q

Which wrist/carpal dislocation can produce considerable swelling? Which dislocation usually presents with minimal swelling?

A
  • perilunate dislocation = lots of swelling (deformity is often present due to fracture fragments on dorsal side)
  • scapholunate dislocation = usually minimal swelling
23
Q

Describe the performance of the Finger Extension test. What are the general specificity/sensitivity?

A
  • put patient’s wrist in flexion
  • resist extension of fingers 2-5
  • excellent sensitivity (96%) and good specificity (88%) for carpal instability or wrist ganglion cyst
24
Q

List 4 conditions which might result in a (+) Finger Extension test.

A
  1. radiocarpal instability
  2. midcarpal instability
  3. scaphoid instability
  4. occult wrist ganglion cyst
25
Q

Which soft tissue injury is often present with radial bone fractures?

A

Triangular Fibrocartilage Complex (TFCC) injury

26
Q

List the 3 most common mechanisms of Triangular Fibrocartilage Complex (TFCC) injury.

A
  1. fall on hyperextended wrist
  2. distraction
  3. drill use/gripping
27
Q

Which soft tissue injury often presents with ulnar variance / radial shortening on radiographs?

A

Triangular Fibrocartilage Complex (TFCC) injury

28
Q

List 4 common physical exam findings in a patient with Triangular Fibrocartilage Complex (TFCC) injury.

A
  1. pain/clicking with wrist ROM
  2. wrist weakness
  3. increased mobility with distal radioulnar joint mob
  4. lunotriquetral ligament tenderness
29
Q

What are the 3 connective tissue structures that make up the Triangular Fibrocartilage Complex (TFCC) of the wrist?

A
  1. radioulnar ligament
  2. ulnar collateral ligament
  3. tendon sheath of extensor carpi ulnaris
30
Q

Describe the purpose & performance of the Ulna Fovea sign. What are the general specificity/sensitivity?

A
  • test for TFCC instability
  • press thumb into anterior interval between ulnar styloid process and flexor carpi ulnaris tendon (just distal to ulnar styloid)
  • excellent sensitivity (95%), moderately good specificity (86%)
31
Q

When trying to distinguish between osteoarthritis of the wrist/hand & rheumatoid arthritis, what can the location of symptoms tell you?

A

RA: MCP, PIP, and carpal/wrist pain
OA: DIP, PIP, 1st MCP joint pain

32
Q

What are the 2 most common serious conditions of the hand/wrist that can present post-operatively? What less common condition should also be considered if symptoms are persistent?

A
  1. infection
  2. iatrogenic injury

Chronic Regional Pain Syndrome

33
Q

Describe 4 nerve injuries of the wrist/hand & their respective nerves.

A
  1. Benediction hand (4th/5th finger flexion); median nerve
  2. Claw hand (MCP extension with PIP flexion); median or ulnar nerve
  3. Ape hand (inability to abduct the thumb); median nerve
  4. Wrist drop; radial nerve
34
Q

Generally, how reliable is radiography in detecting scaphoid fractures?

A

Always first line, but sometimes it can miss small fractures. Refer for MRI if a fracture is still suspected (snuffbox palpation & axial compression are +)

35
Q

How can reflex testing help to differentiate between Cervical Radiculopathy, Carpal Tunnel Syndrome, and Cervical Myelopathy?

A
  • C5-6 Radiculopathy: hyporeflexia
  • CTS: no reflex changes
  • Cervical Myelopathy: hyperreflexia; pathological reflexes (Babinski, Hoffman, clonus) may be present
36
Q

How can you use ROM and manual assessment to help differentiate between Cervical Radiculopathy, Carpal Tunnel Syndrome, and Cervical Myelopathy?

A
  • C5-6 Radiculopathy: cervical ROM or PAs should reproduce sx
  • CTS: ROM of wrist may aggravate sx & compression test might be (+); cervical spine is clear
  • Cervical Myelopathy: cervical ROM or PAs may reproduce sx & wrist ROM is painless
37
Q

How can manual muscle testing help to differentiate between Cervical Radiculopathy, Carpal Tunnel Syndrome, and Cervical Myelopathy?

A
  • C5-6 Radiculopathy: biceps or deltoid weakness
  • CTS: thenar muscle weakness
  • Cervical Myelopathy: general limb weakness
38
Q

Describe the purpose & performance of the Compression test of the wrist/hand.

A
  • carpal tunnel test
  • place wrist is flexion
  • use flat thumb to compress the carpal tunnel & hold 30 seconds
  • (+) test is reproduction of symptoms
    (+3.5 LR)
39
Q

According to Seddon, what are the 3 types of nerve injury?

A
  1. neurapraxia
  2. axonotmesis
  3. neurotmesis
40
Q

What is neurapraxia?

A
  • mildest form of traumatic peripheral nerve injury
  • local segmental demyelination without disruption of axon continuity or surrounding connective tissue
  • results in blockage of nerve conduction & transient weakness or paresthesia
    (greek “neur” [nerve] + “a” [not] + “praxis” [action])
41
Q

Which type of nerve injury is characterized by local segmental demyelination without disruption of axon continuity or surrounding connective tissue?

A

neurapraxia

42
Q

What is axonotmesis?

A
  • injury to the axon with no or only partial injury to the connective tissue framework
  • endoneurial sheath is intact, so regeneration can take place
  • (+) Tinel’s sign
  • axon & myelin degeneration distal to injury, causing complete denervation
43
Q

What type of nerve injury is characterized by damage to the axon and myelin with no or only partial injury to the connective tissue framework?

A

axonotmesis

44
Q

What is neurotmesis?

A
  • most severe type of peripheral nerve injury
  • complete disruption of the nerve
  • complete functional loss and no potential for recovery without surgery
45
Q

Describe the purpose & performance of the Thumb Ulnar Collateral Ligament Laxity Test. What are the general specificity and sensitivity?

A
  • to test for laxity of the UCL / 1st MCP joint (Skier’s Thumb)
  • passively bring thumb into extension and apply a valgus stress to the 1st MCP joint
  • (+) test is 30°-35° of valgus motion
  • test both with palm up & palm down

specificity is poor (12%) and sensitivity is moderate (87%)

46
Q

List the 3 items that are most closely associated with 1st CMC osteoarthritis.

A
  1. radial wrist pain
  2. older age
  3. 1st CMC grind test
47
Q

List the 3 items that are most closely associated with a thumb UCL injury.

A
  1. history of trauma (hyperabduction or traction)
  2. pain at MCP without pain at CMC or IPs)
  3. (+) UCL Laxity test

OCS (13 decks)

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