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
Hand: Mallet/Boutonniere/SwanNeck Deformities
Tx
Treatment:
Splinting/stack splint
Can try splint and hope that it heals without surgery
surgical repair
Misc:
Avulsion tends to have better prognosis but all types of repairs have high chance of not returning to full ROM
Gamekeeper Thumb/ Ligament Tear
general
Pathophysiology:
Traumatic rupture of UCL of thumb
Can be acute, single injury or repetitive trauma that finally ruptures
Common symptoms/ complaints:
Laxity, instability at MCP joint of thumb
Difficulty with pinching
Misc: AKA Skier or Gamekeeper thumb
Hand:Gamekeeper Thumb/ Ligament Tear
PE/Tests
Physical Exam:
Instability of 1st MCP UCL
Poor grip/ pinch strength with thumb
Might have some discomfort and swelling over UCL
Tests: x-rays and MRI to confirm injury and look for avulsion fx
Hand: Gamekeeper Thumb/ Ligament Tear
Tx
Treatment:
Might be able to use thumb spica brace/ splint/ cast for partial tears
Surgical repair with immobilization after surgery for complete rupture
Hand: CMC Osteoarthritis
general
Pathophysiology: Mechanical and/or degenerative loss of articular cartilage of joint(s) hand; can happen at any joint but is most often seen (in the hand) at the 1st CMC
Causes: result from trauma or wear and tear
If at CMC, most likely in other joints MCP/PIP/DIP
Common symptoms/ complaints:
Joint pain/pain with activity
Grinding/crepitus
Swelling
Stiffness
CMC Osteoarthritis
PE/Tests
Physical Exam:
Pain/stiffness at CMC
Swelling/erythema at site
Grind test—increased pain/crepitus
Tests: x-rays will confirm OA; can do specific CMC series
Joint space narrowing, sclerosis, osteophyte formation, subchondral cysts, misalignment/ malalignment
Hand: Osteoarthritis
Tx
Treatment:
Topical creams, NSAIDs, Tylenol
Bracing???
Gentle exercise/PT
Steroid injection
Surgery
Misc:
Surgical repair has 2 options:
Arthrodesis
Joint replacement
Hand: Raynaud’s Disease
general
Pathophysiology:
Reversible ischemia to fingers due to peripheral arteriole constriction related to cold or emotional stress
Causes: idiopathic primary, there is a secondary type that is more serious and are result of other health conditions
Common symptoms/ complaints:
Cold sensitivity
Red, white and blue discoloration
Hand: Raynaud’s Disease
PE/Tests
Physical Exam:
Sharply demarcated color change when exposed to cold
This is visible-white, blue and red
Cold sensitivity/temperature change
Pain associated with it
Tests: not necessary
Hand: Raynaud’s Disease
Tx
Treatment:
Stay warm!
Don’t smoke
Misc:
More common in women
Hand: Buerger’s Disease
general
Pathophysiology:
Digital ischemia caused by thrombosis and vasculitis of medium sized blood vessels (arteries and veins)
Causes are unknown, tobacco use is associated with disease, genetics?
Common symptoms/ complaints:
Discoloration
Pain and/ or numbness
Skin changes (gangrene)
Hand: Buerger’s Disease
PE/Tests
Physical Exam:
Pain/discoloration
When dealing with hand disease, they often present when it is too late ie:gangrene already setting in
Tests:
Angiography
Labs
Hand:Buerger’s Disease
Tx
Treatment:
STOP SMOKING!!!!!!
Surgical amputation
Misc:
AKA thromboangiitis obliterans
More common in men and smokers
- scaphoid Fx
- buckle/torus fx
- ulnar styloid fx
