The Wrist & Hand Flashcards
1
Q
Introduction
Why are the wrist and hand vulnerable?
A
The wrist and hand are vulnerable to injury because of the intricate movements they require
2
Q
Introduction
How many bones?
A
There are 28 bones, and numerous articulations in the thumb, carpal, metacarpal and phalangeal regions
3
Q
Introduction
Injuries to wrist and hand are common in?
A
Injuries to the wrist and hand are common in sports such as:
* Basketball
* Volleyball
* Hockey
* Skiing
* Baseball
* Martial Arts
4
Q
Introduction
Injuries that can occur in this region?
A
Injuries are classified as:
* Traumatic
* Overuse
* Neurological
* Vascular
5
Q
Introduction
Traumatic Injuries?
A
- Sprains - carpal, thumb, MCP/PIP, DIP ligaments
- Strains - dorsal/palmar musculature
- Fractures
- Dislocations, volar plate injury
6
Q
Introduction
Overuse injuries?
A
- Tendonitis
- Tenosynovitis
- Synovitis
7
Q
Introduction
Vascular injuries?
A
Avascular necrosis - scaphoid/lunate
8
Q
Anatomy
Bones of wrist - regions?
A
The bones of the wrist can be broken down into three bony regions:
* Carpals
* Metacarpals
* Phalanges
9
Q
Anatomy
Two rows of carpal bones?
A
There are two rows of carpal bones which articulate as synovial joints
10
Q
Anatomy
Sesamoid bones?
A
There are two sesamoid bones in the thumb and the pisiform is also considered a sesamoid bone
11
Q
Anatomy
Proximal row of carpal bones includes?
A
The proximal row of carpal bones includes the:
* Scaphoid
* Lunate
* Triquetrum
* Pisiform
12
Q
Anatomy
Distal row of carpal bones includes?
A
The distal row of carpal bones includes the:
* Trapezium
* Trapezoid
* Capitate
* Hamate
13
Q
Scaphoid Bone
Found in?
A
The scaphoid bone is found in the anatomical “Snuff Box”
14
Q
Scaphoid Bone
Recipient of?
A
It is the recipient of forces which are transferred through the radius which makes it one of the most commonly fractured carpal bones
15
Q
Scaphoid Bone
Major concern with fracture?
A
The major concern with a fracture in this area is an “Avascular Necrosis”
16
Q
Scaphoid Bone
What indicates a fracture?
A
Tenderness and swelling in the anatomical snuff box may indicate a fracture of the scaphoid bone
17
Q
Scaphoid Bone
Where do most fractures occur? Blood supply?
A
Most fractures occur in the mid portion of this bone and a large segment of the population only has blood supply to one end of this bone
18
Q
Scaphoid Bone
Blood supply complications?
A
This may lead to an avascular necrosis of the scaphoid bone known as “Preiser Disease”
19
Q
Lunate Bone
Where is it found?
A
The lunate is found in the proximal row, sitting next to the scaphoid
20
Q
Lunate Bone
Why is it the most commonly dislocated of all the carpal bones?
A
Due to its location and shape, the lunate is the most commonly dislocated of all the carpal bones
21
Q
Lunate Bone
What is the mechanism of injury?
A
The mechanism of injury is forced wrist extension
22
Q
Lunate Bone
What happens with lunate dislocation?
A
With a lunate dislocation, this bone will migrate into the carpal tunnel, compressing the medial nerve
23
Q
Lunate Bone
What can this dislocation cause?
A
This is one of the potential causes of Carpal Tunnel Syndrome
24
Q
Lunate Bone
What is Murphy’s Sign
A
With a lunate dislocation, observations will reveal swelling on the dorsum of the wrist and a depressed second “knuckle” joint
25
# Lunate Bone
Bone may also be? What does this lead to?
The lunate may also be fractured, leading to an avascular necrosis known as Keinbock's Disease
26
# The Pisiform
What is it?
The pisiform is the smallest carpal bone
27
# The Pisiform
Where is it?
It is in the proximal row of carpal bones, where the wrist joins the ulna
28
# The Pisiform
What type of bone?
The pisiform is a sesamoid bone, lying within flexor carpi ulnaris
29
# The Pisiform
Where are the attachments? What does it make up?
There are attachments from the pisiform to the hook of the hamate (Pisohamate Ligament). This makes up the Tunnel of Guyon
30
# The Pisiform
What does the Tunnel of Guyon contain?
The Tunnel of Guyon contains the ulnar nerve and artery
31
# The Pisiform
Pisiform Injury
* Handle bars - compression of the ulnar nerve
* Loss of sensation in half of 4th digit and 5th digit
32
# Hamate Bone
Why is it unique?
The hamate bone is unique as it has a hook on it
33
# Hamate Bone
What is it joined to? What does it form?
Is joined to the pisiform by the pisohamate ligament, forming the roof of the Tunnel of Guyon
34
# Hamate Bone
Region can be compressed by?
* This region can be compressed by fracture, swelling, or by compression by leaning on the ulnar portion of the wrist
* Handlebar/Cyclist's Palsy
35
# The Capitate
What is it? What does it articulate with?
* The capitate is the largest of the carpal bones
* Articulating with seven other bones
36
# The Capitate
What radiates from this bone?
Many ligaments in the wrist region radiate from this bone
37
# The Capitate
What is the most common injury?
Fractures are the most common injury
38
# The Triangular Fibrocartilage
Where is it located?
The Triangular Fibrocartilage Complex (TFCC) of the wrist is located between the distal ulna and first row of carpal bones
39
# The Triangular Fibrocartilage
How is this structure injured?
This structure is injured through a fall on the hand and wrist, with the wrist in a hyperextended position
40
# The Triangular Fibrocartilage
Injury symptoms?
There is pain and swelling on the ulnar aspect of the wrist and the motion of wrist extension is usually painful and limited
41
# The Triangular Fibrocartilage
Injury - when is there pain?
Pain is elicited with palpation as well as ulnar compression, which is the same premise as the meniscal tests in the knee
42
# Ligament Injury
What is a common occurrence in sport?
Ligament injury of the wrist, finger joints (MCP, PIP & DIP collateral ligaments) as well the thumb (UCL/RCL) are a common occurrence in sport
43
# Ligament Injury
How are these ligaments injured?
These ligaments are usually injured by a traumatic mechanism
44
# Ligament Injury
What are these ligaments tested for?
These ligaments are tested for pain, laxity and end feel
45
# Ligament Injury
How are the ligaments of the wrist assessed?
The ligaments of the wrist (carpal region) are assessed by stabilizing one bone and testing the surrounding ligaments to the adjacent bones
46
# Ligament Injury
How are the ligaments of the fingers and thumb tested?
The ligaments of the various joints of the fingers and thumb are tested by a valgus and varus stress
47
# Ligament Injury of the Thumb
What is ulnar collateral sprain of the thumb also known as?
The ulnar collateral sprain of the thumb is also known as "Skier's Thumb" or "Gamekeeper's Thumb"
48
# Ligament Injury of the Thumb
How does this injury occur?
This injury occurs because of a forced abduction, and/or hyperextension mechanism, tearing the medial ulnar collateral ligament
49
# Ligament Injury of the Thumb
Signs and symptoms?
There is swelling and ecchymosis, pain upon movement and palpation as well as laxity with the "Abduction Test"
50
# Ligament Injury of the Thumb
How is this injury classified?
This injury is classified as 1st - 3rd degree
51
# Range of Motion
Range of motion for the wrist?
Range of motion for the wrist occurs at the midcarpal (flexion) and radiocarpal (extension) joints and radial and ulnar deviation
52
# Range of Motion
Movements at the fingers?
Movement at the fingers include:
* Flexion
* Extension
* Abduction
* Adduction
* Thumb also has opposition
53
# Range of Motion
What causes these movements?
There are numerous muscle groups which cause these movements
54
# Circulation
What terminates in the wrist and hand?
The ulnar and radial arteries terminate in the wrist and hand
55
# Circulation
What is used to assess circulation?
* Capillary refill
* The "Allen Test"
56
# Circulation
How is the "Allen Test" performed?
* The patient is asked to quickly open and close the hand several times and then squeeze it shut
* The examiner then places his/her thumb and index finger over the radial and ulnar arteries temporarily occluding blood flow
* The patient then opens their hand and the examiner can test each artery by releasing the pressure and seeing if the hand "flushes"
57
# Flexor Tendon Injury
Where do flexor tendons originate?
The flexor tendons originate on the medial epicondyle
58
# Flexor Tendon Injury
Where do they pass under?
The flexor tendons pass underneath the flexor retinaculum and into the hand
59
# Flexor Tendon Injury
What do these tendons do?
These tendons flex and pronate the wrist and elbow
60
# Flexor Tendon Injury
What are these tendons involved in?
The flexor tendons are involved in a number of injuries as they pass into the wrist and hand
61
# Flexor Tendon Injury
What do some of the injuries include?
* Tendonitis/strains
* Carpal tunnel syndrome
* Palmaris Longus (Dupuytren's Contracture)
* Flexor Tendon Injury (Sweater Finger)
* Swan Neck deformity
62
# Carpal Tunnel Syndrome
What is it?
Carpal Tunnel Syndrome is a compression of the median nerve as it passes beneath the flexor retinaculum at the wrist
63
# Carpal Tunnel Syndrome
What is the Carpal Tunnel?
The Carpal Tunnel is an enclosed space
64
# Carpal Tunnel Syndrome
What can space occupying lesion lead to?
Any space occupying lesion can lead to compression of the nine flexor tendons and median nerve
65
# Carpal Tunnel Syndrome
Where is it seen?
Carpal Tunnel Syndrome is seen in sports involved with wrist flexion, such as:
* Bowling
* Rock climbing
* Wheel chair sports
* Gripping and throwing sports mechanics
66
# Carpal Tunnel Syndrome
Why may it develop?
Carpal Tunnel Syndrome (CTS) mau develop due to:
* Overuse (tendonitis)
* Peripheral edema (pregnancy)
* Anatomical anomalies
* Trauma, such as a Colle's fracture or lunate dislocation
67
# Carpal Tunnel Syndrome
Tests?
Tests include:
* The Tinel's Tap Test
* Phallen's
* Carpal Compression Tests
68
# Palmaris Longus (Dupuytren's Contracture)
What is it?
The Palmaris Longus tendon is a flexor tendon
69
# Palmaris Longus (Dupuytren's Contracture)
Where does it insert?
The Palmaris Longus tendon inserts into the palmar fascia of the hand
70
# Palmaris Longus (Dupuytren's Contracture)
Dupuytren's Contracture - what is it?
Named after the French surgeon, Dupuytren's Contracture is a progressive and painless thickening of the subcutaneous tissue of the palm primarily affecting the ring and little fingers
71
# Palmaris Longus (Dupuytren's Contracture)
Cause?
Even though not everyone has a Palmaris Longus Tendon (only 14% of the population), the cause of this condition is still unknown
72
# Palmaris Longus (Dupuytren's Contracture)
Condition frequently seen in?
This condition is frequently seen in women between the ages of 50-70
73
# Jersey/Sweater Finger
What is it?
Sweater or Jersey finger is a tear or avulsion of the distal flexor digitorum profundus tendon
74
# Jersey/Sweater Finger
Occurs most frequently to?
This injury occurs most frequently to the ring finger
75
# Jersey/Sweater Finger
Commonly seen when?
Commonly seen when an athlete tries to grab an opponents sweater
76
# Jersey/Sweater Finger
What happens?
There is an inability to flex the distal (DIP) joint where the FDP attaches and the finger is stuck in an extended position
77
# Jersey/Sweater Finger
"Sweater Finger Sign" Evident when?
The "Sweater Finger Sign" is evident when the distal phalanx of the involved finger does not flex
78
# Jersey/Sweater Finger
Tendon can be assessed?
The tendon can be assessed for strength with a partial tear
79
# Swan Neck Deformity
Characterized by?
Swan Neck Deformity is charcaterized by hyperextension of the PIP joint and flexion of the DIP joint
80
# Swan Neck Deformity
Caused by?
It is caused by:
* Trauma/force
* Damage to the volar plate
* Rheumatoid arthritis which can damage the joint
81
# Swan Neck Deformity
Plates in human hand? Found in?
* The human hand has both palmar and volar plates (also called volar ligaments)
* These are found at the various joints where they serve to reinforce the joint capsules and limit hyperextension/flexion
82
# Swan Neck Deformity
Injury treated with?
This injury is usually treated with:
* Splinting
* Therapy
* Surgery is sometimes required
83
# Extensor Tendon Injury
Where do the extensor tendons originate?
The extensor tendons originate on the lateral epicondyle
84
# Extensor Tendon Injury
What is the function of the extensor tendons?
They extend and supinate the wrist and elbow
85
# Extensor Tendon Injury
Involved in?
These tendons are involved in a number of injuries as they pass into the wrist and hand
86
# Extensor Tendon Injury
Injuries include?
Some of these injuries include:
* Tendonitis/strains
* Dequervain's Disease
* Mallet/Frisbee Finger
* Boutonniere Deformity
87
# Extensor Tendon Injury
How many tunnels? Where do they cross?
There are six extensor tunnels which cross the dorsal region of the wrist
88
# Extensor Tendon Injury
Tunnels present with?
Each of the tunnels may present with certain pathology either alone, or in combination with other tunnels
89
# Extensor Tendon Injury
Tunnel 1
Abductor Pollicis Longus/Extensor Pollicis Brevis
90
# Extensor Tendon Injury
Tunnel 2
Extensor Carpi Radialis Longus and Brevis
91
# Extensor Tendon Injury
Tunnel 3
Extensor Pollicis Longus
92
# Extensor Tendon Injury
Tunnel 4
Extensor Digitorum Communis and Indicis
93
# Extensor Tendon Injury
Tunnel 5
Extensor Digiti Minimi
94
# Extensor Tendon Injury
Tunnel 6
Extensor Carpi Ulnaris
95
# Dequervain's Disease (Tunnels 1 and 3)
What do tunnels 1 and 3 make up?
Tunnels 1 and 3 make up the boundaries of the anatomical snuff box which is found on the radial aspect of the wrist
96
# Dequervain's Disease (Tunnels 1 and 3)
What can occur in this region?
A common tendonitis or Stenosing Tenosynovitis, can occur in this region known as "Dequervain's Disease"
97
# Dequervain's Disease (Tunnels 1 and 3)
What is it?
This is an overuse injury
98
# Dequervain's Disease (Tunnels 1 and 3)
How can it occur?
This condition can occur during pregnancy due to peripheral water retention
99
# Dequervain's Disease (Tunnels 1 and 3)
Assessed by?
This condition is assessed by:
* Palpating for pain and crepitus
* "Finkelstein Test"
100
# Dequervain's Disease (Tunnels 1 and 3)
What does it affect?
Dequervain's Disease affects dorsal tunnels 1 (abductor pollicis longus/extensor pollicis brevis) and 3 (extensor pollicis longus)
101
# Dequervain's Disease (Tunnels 1 and 3)
Finkelstein's Test
* Stretches the tendons of the first dorsal compartment
* (Fist closed, hand pulled down)
102
# Extensor Tunnels
What does tunnel 2 contain? What is it involved in?
* Tunnel 2 contains the extensor carpi radialis longus and brevis
* Both of which are involved in lateral epicondylitis
103
# Extensor Tunnels
Where do these tendons (extensor carpi radialis longus and brevis) insert?
These tendons insert onto the lateral dorsal surface of the base of the 3rd metacarpal bone with a few fibers inserting onto the second as well
104
# Extensor Tunnels
How can these tendons (extensor carpi radialis longus and brevis) be palpaed?
They can be palpated with a clenched fist
105
# Extensor Tunnels
What does tunnel 6 contain?
Tunnel 6 contains the extensor carpi ulnaris which is found on the ulnar aspect of the wrist
106
# Extensor Tunnels
What is tunnel 6 a common site for?
Tunnel 6 is a common site for tendonitis
107
# Extensor Tunnels
What facilitates palpation of the extensor carpi ulnaris?
Ulnar deviation of the wrist facilitates palpation of this tendon
108
# Mallet Finger
What is it?
| Injury to what?
A mallet (baseball, frisbee, or basketball) fingers is an injury to the terminal slip (DIP joint) of the extensor tendon
109
# Mallet Finger
Caused by?
It is caused by a sudden forceful flexion of the distal phalanx, such as catching the ball on the end of the finger-tip
110
# Mallet Finger
Extensor tendon can suffer from?
The extensor tendon can suffer a variety of injuries such as:
* Stretching the tendon
* Tearing the tendon
* Avulsion
* Epiphyseal fracture
111
# Mallet Finger
Injury evident upon?
This injury is evident upon observation by its appearance
112
# Mallet Finger
How is this injury treated? In some cases?
* This injury is treated non-operatively and requires immobilization (splinting)
* In some cases, a large flake of bone (avulsion fracture) may need to be surgically fixated
113
# Boutonniere Deformity
Caused by?
The Boutonniere or "button-hole" deformity is cuased by a rupture of the extensor tendon at the proximal inter-phalangeal joint (PIP)
114
# Boutonniere Deformity
Region known as?
This region is known as the central extensor hood, or slip
115
# Boutonniere Deformity
Mechanism of injury
The mechanism of this injury is trauma to the tip of the finger forcing the DIP joint into extension and the PIP into flexion, injuring the extensor tendon at the PIP joint and leading to the inability to extend the PIP joint
116
# Boutonniere Deformity
How is this injury treated?
This injury is often treated non-operatively and splinting/bracing is usually required
117
# Ganglion Cyst
What are they?
Ganglion cysts (also called "bible bumps") are the most common mass or lump in the hand
118
# Ganglion Cyst
Where do they occur?
Occur in various locations, mostly developing on the dorsum of the hand
119
# Ganglion Cyst
Harm?
They are not cancerous and, in msot cases are harmless
120
# Ganglion Cyst
How do they develop?
These fluid-filled cysts can quickly appear, disappear, and change size
121
# Ganglion Cyst
Treatment?
Many ganglion cysts do not require treatment, but if they are painful, or interfere with hand function, there is a surgical option
122
# Ganglion Cyst
What triggers the formation?
It is not known what triggers the formation of ganglion cyst
123
# Colle's Fracture
What is it?
Colle's fractures are one of the most common types of forearm fractures
124
# Colle's Fracture
Mechanism?
FOOSH - occurs from a fall on an outstretched extended hand
125
# Colle's Fracture
Also called a?
"Dinner or Silver Fork" deformity due to its appearance
126
# Colle's Fracture
Commonly seen in?
This is a common fracture seen in the elderly as well as athletes
127
# Colle's Fracture
What is involved?
The distal radius, and to a lesser degree the ulna are usually involved
128
# Smith's Fracture
What is it?
The opposite displacement of a Colle's fracture is known as a Smith's fracture
129
# Smith's Fracture
What causes it?
This fracture is caused by falling on a flexed wrist
