Upper Extremity Injuries - Hand Flashcards
common mechanisms of injury of metacarpal fxs
- fall
- high speech MVC
- assault
- crush
- etc
PE of metacarpal fx
- swelling, tenderness, possible deformity
- assess neurovascular status
Boxers fx
- metacarpal fx of 4th or 5th metacarpal
- angulation of distal fragment
- d/t clinched fist striking object
- assess for angulation, rotation, or displacement
bennetts fx
- fx or dislocation of the base of 1st metacarpal
- proximal fragment maintains ulnar attachement to trapezium
- distal aspect is supinated and dislocated radially by adductor pollicis
rolandos fx
- comminuted version of Bennett’s
- fragments may form “T” or “Y” pattern at base of metacarpal
tx of metacarpal fxs
- splint above and below injury site
- ORIF if indicated
phalangeal fxs
- more common than metacarpal fxs
- can occur in multiple locations (proximal, middle, distal phalanx)
Gamekeepers / skiers thumb
- UCL injury
- forced abduction and hyperextension of the MCP joint
- MCP joint tenderness localized to ulnar aspect w/ swelling
- loss of integrity of UCL
radiology for gamekeepers thumb
-XR of 1st MCP can show avulsion fxs at insertion site of UCL
tx of gamekeepers thumb
- surgical referral
- thumb spica
- PT/OT
two common extensor tendon injuries
- mallet finger
- boutonniere
MC tendon injury of the finger?
mallet figer
mallet finger
- most often occurs in workplace or ball-handling sports
- damage to the terminal slip of extensor tendon at the DIP
mechanism of injury of mallet finger
direct blow to the tip of finger causing sudden forceful flexion of distal phalanx
PE of mallet finger
- inability to fully extend DIP
- swelling, ecchymosis, deformity
radiology of mallet finger
- XR to assess for fx of distal phalanx
- avulsion fx MC
non-surgical tx of mallet finger
- full time DIP splinting w/ extension/hyper extension for 6 wks
- then part-time splinting for 4-6 more weeks
surgical repair of mallet finger is indicated when?
complex tendon lacerations
boutonniere
flexion deformity of PIP joint w/ hyperextension of DIP
mechanism of injury of boutonniere
tear or avulsion of the middle slip of the extensor mechanism which allow PIP to flex and DIP to extend
PE of boutonniere
- limited extension of PIP and DIP
- DIP stuck in flexion
tx of boutonniere
splint w/ full extension for 6 weeks
common flexor tendon injuries
- jersey finger
- trigger finger
jersey finger
rupture of the flexor digitorum profundus tendon from its distal attachment
mechanism of injury of jersey finger
- when a flexed DIP joint is suddenly and forefully hyperextended
- like grabbing a jersey
PE of jersey finger
- pain and swelling over DIP
- may be able to palpate part of retracted tendon
what is the pathognomonic finding in jersey finger?
inability to actively flex DIP joint
classifications of jersey finger
- type I: retraction of profundus tendon all the way to the palm
- type IV: avulsion of profundus tendon from the fx site
- both need surgical repair w/i 7 days
radiology of jersey finger
CR to r/o avulsion
initial tx of jersey finger
splinting in slight flexion
definitive tx of jersey finger
surgical repair of tendon
stenosing tenosynovitis aka trigger finger
- disparity of the flexor tendons and surrounding pulley systems at the A1 pulley (over MCP joint)
- flexor tendon catches
- most are idiopathic
PE of trigger finger
- painless snapping, catching, locking of one or more fingers during flexion
- pain sometime present on volar aspect of MCP
- sometimes can be completely stuck
initial tx of trigger finger
- splinting, activity restriction, NSAIDs
- steroid injections
tx of trigger finger if conservative tx fails
surgery
de quervain tenosynovitis
-tendinopathy affecting the abductor pollicis longus and extensor pollicis brevis tendons
PE of de quervain tenosynovitis
- pain on radial side of wrist exacerbated by movement
- postive finkelsteins test
tx of de quervians tendosynovitis
- splinting, NSAIDs, activity restriction
- steroid injections
dupuytren contracture
- progressive fibrosis of the palmar fascia
- bengin and slow
- most pts: white males > 50 yo
PE of dupuytren contracture
- complain of thickening or nodule in palm w/ loss of motion
- difficultly extending 4th and 5th digits
tx of dupuytren contracture
surgery w/ palmar fasciotomy and possible skin graft
most common organisms causing infection d/t HUMAN bites
- group A strep
- staph
- e. corrodens
tx of human bite
- debride and wash out
- loose closure if necessary
- augmentin
most common organisms causing infection d/t ANIMAL bites
- staph
- strep
- pasturella specis
tx of animal bites
- debride and wash out
- loose closure if necessary
- augmentin
paronychia
- inflammation and infection involving proximal fingernail folds
- can develop subsequent superficial abscess
tx of paronychia
- warm compress
- keflex
- I&D
infective tenosynovitis
- infection and spread of inflammation along tendon sheaths of flexor tendons in hand
- can result in compartment syndrome
mechanism of injury of infective tenosynovitis
- traumatic implantation (staph and strep are common)
- can be hematogenously spread from n. gonorrhea and mycobacteria
PE of infective tenosynovitis
- tenderness along flexor sheath
- symmetric or fusiform enlargement of affected digit
- slightly flexed finger at rest
- PAIN W/ PASSIVE TENDON EXTENSION
tx of infective tenosynovitis
- surgical debridement
- IV abx
- vanc + cipro
compartment syndrome
- occurs when increased pressure w/i a compartment compromises the circulation and function of tissues in that space
- cellular anoxia d/t poor perfusion is the result
mechanism of injury of compartment syndrome
- long bone fx
- trauma w/o fx:
- crush injury
- burn
- constrictive bandages
- penetrating trauma
- thrombosis
- bleeding
- nephrotic syndrome
- animal bites
- IV drug use
2 MC long bone that can cause compartment syndrome when injured
- tibia MC
- forarm bones 2nd MC – mainly supracondylar fx in children
initial sx of compartment syndrome
- pain out of proportion to injury
- persistent deep ache or burning pain
- paresthesias
later sx of compartment syndrome
- pain w/ passive muscle stretch
- tense compartment w/ wood-like feeling
- pallor
- diminished sensation
- muscle weakness
lab finding in compartment syndrome
elevated CK
at what pressure is capillary flow compromised in compartment syndrome?
- 25-30 mmHg
- 0-8 mmHg is nl
tx of compartment syndrome
decompressive fasciotomy performed by surgeon
