upper extremity 2 Flashcards
Wrist: Kienbock Disease
general and common complaint
Pathophysiology: AVN/osteonecrosis of the lunate > leads to collapse
Causes: result of trauma/injury, abnormal vascular diseases OR by unequal radius and ulna lengths
Common symptoms/ complaints:
Pain
stiffness
Wrist: Kienbock Disease
PE/Tests
Physical Exam:
Pain with wrist motion, especially weighted (pushup type of activity)
Mild dorsal swelling
TTP over lunate
Tests:
X-rays
MRI
Wrist: Kienbock Disease
Tx
Treatment:
Surgery
IF there is no collapse/minimal bone inflammation, possibility to halt the progression by joint leveling (osteotomy)
Arthrodesis, proximal row carpectomy or joint replacement; no longer using implant to “hold position” after taking out the lunate
Dislocation of a digit
general
Pathophysiology: when the bones of the finger or thumb are forced out of their normal position
Causes involve trauma such as a direct blow or a fall. Can also occur if there is a problem with the ligaments
Previous injuries to the hand/fingers increase the risk of further injury
Symptoms include:
Pain/stiffness
deformity
Dislocation of a finger/thumb
PE/ Tests
Physical exam:
Obvious deformity
Pain
Inability to use the digit/joint
Testing: Xray will be needed, possible MRI
Dislocation of a digit
Tx
Treatment for a dislocated finger or thumb
Reduction
as soon as possible
The longer the joint or digit is dislocated the more difficult it is to reduce
Xray and Splinting after reduction
Avulsion fracture is typical
Surgery
Hand: Trigger Finger
general
Pathophysiology: tenosynovitis of flexor tendon sheath at A1 pulley, causes a knot or swollen area/difficulty sliding through the sheath
Causes are hand strain, repetitive motion, women w/DM
Common symptoms/ complaints:
Catching/locking of finger, usually in flexion
Pain during flexion/extension of the digit
trigger finger
PE/tests
Physical Exam:
TTP over the volar MCP joint (area of the knot)
Catching or locking at the A-1 pulley of the finger while flexing at the PIP joint
If locked-DO NOT FORCE UNLOCK
Tests: none needed
trigger finger
Tx
Treatment:
NSAIDs/splinting may provide relief if early
Steroid injection into the area
Surgical release of A1 pulley
Misc:
Typically related to diabetes if occurring in multiple fingers
Hand: Dupuytren Contracture
general
Pathophysiology: thickening and contracting of the fibrous tissue within the palmar fascia, especially at the 4th and 5th flexor tendons
Cause is unknown: hereditary
Common symptoms/ complaints:
Puckered skin
Flexion contracture of fingers
Dupuytren Contracture
PE/Test
Physical Exam:
Palpable cord in the palm and proximal end of finger
Skin puckering and nodules
Flexion contracture of finger(s)
Tests: none needed
Dupuytren Contracture
Tx
Treatment:
Can delay progression with PT/massage
Nothing until function is significantly decreased
Can try collagenase injection
Surgical removal of fascial cords
Misc: AKA palmar fascial fibromatosis
Northern European descent, is more common in males, and has a hereditary predisposition
May also be linked to liver disease, alcoholism
Hand: Deformities Mallet Finger/Boutonniere Finger/Swan neck
general
Pathophysiology:
Rupture of extensor tendon or avulsion of tendon insertion at bone
Cause: result of direct trauma
Common symptoms/ complaints:
Injury resulting in deformity and limited function
Hand: DeformitiesMallet Finger/Boutonniere/Swan neck
PE/Tests
Physical Exam:
Obvious where the injury or deformity lies
Pain
Inability to flex or extend at the affected joint (PIP/DIP)
Tests: x-ray and MRI to confirm/know extent of injury