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Musculoskeletal 1 > Upper Extremity Injuries - Hand > Flashcards

Upper Extremity Injuries - Hand Flashcards

1
Q

common mechanisms of injury of metacarpal fxs

A
  • fall
  • high speech MVC
  • assault
  • crush
  • etc
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2
Q

PE of metacarpal fx

A
  • swelling, tenderness, possible deformity

- assess neurovascular status

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3
Q

Boxers fx

A
  • metacarpal fx of 4th or 5th metacarpal
  • angulation of distal fragment
  • d/t clinched fist striking object
  • assess for angulation, rotation, or displacement
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4
Q

bennetts fx

A
  • 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
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5
Q

rolandos fx

A
  • comminuted version of Bennett’s

- fragments may form “T” or “Y” pattern at base of metacarpal

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6
Q

tx of metacarpal fxs

A
  • splint above and below injury site

- ORIF if indicated

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7
Q

phalangeal fxs

A
  • more common than metacarpal fxs

- can occur in multiple locations (proximal, middle, distal phalanx)

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8
Q

Gamekeepers / skiers thumb

A
  • UCL injury
  • forced abduction and hyperextension of the MCP joint
  • MCP joint tenderness localized to ulnar aspect w/ swelling
  • loss of integrity of UCL
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9
Q

radiology for gamekeepers thumb

A

-XR of 1st MCP can show avulsion fxs at insertion site of UCL

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10
Q

tx of gamekeepers thumb

A
  • surgical referral
  • thumb spica
  • PT/OT
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11
Q

two common extensor tendon injuries

A
  • mallet finger

- boutonniere

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12
Q

MC tendon injury of the finger?

A

mallet figer

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13
Q

mallet finger

A
  • most often occurs in workplace or ball-handling sports

- damage to the terminal slip of extensor tendon at the DIP

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14
Q

mechanism of injury of mallet finger

A

direct blow to the tip of finger causing sudden forceful flexion of distal phalanx

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15
Q

PE of mallet finger

A
  • inability to fully extend DIP

- swelling, ecchymosis, deformity

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16
Q

radiology of mallet finger

A
  • XR to assess for fx of distal phalanx

- avulsion fx MC

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17
Q

non-surgical tx of mallet finger

A
  • full time DIP splinting w/ extension/hyper extension for 6 wks
  • then part-time splinting for 4-6 more weeks
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18
Q

surgical repair of mallet finger is indicated when?

A

complex tendon lacerations

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19
Q

boutonniere

A

flexion deformity of PIP joint w/ hyperextension of DIP

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20
Q

mechanism of injury of boutonniere

A

tear or avulsion of the middle slip of the extensor mechanism which allow PIP to flex and DIP to extend

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21
Q

PE of boutonniere

A
  • limited extension of PIP and DIP

- DIP stuck in flexion

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22
Q

tx of boutonniere

A

splint w/ full extension for 6 weeks

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23
Q

common flexor tendon injuries

A
  • jersey finger

- trigger finger

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24
Q

jersey finger

A

rupture of the flexor digitorum profundus tendon from its distal attachment

25
Q

mechanism of injury of jersey finger

A
  • when a flexed DIP joint is suddenly and forefully hyperextended
  • like grabbing a jersey
26
Q

PE of jersey finger

A
  • pain and swelling over DIP

- may be able to palpate part of retracted tendon

27
Q

what is the pathognomonic finding in jersey finger?

A

inability to actively flex DIP joint

28
Q

classifications of jersey finger

A
  • 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
29
Q

radiology of jersey finger

A

CR to r/o avulsion

30
Q

initial tx of jersey finger

A

splinting in slight flexion

31
Q

definitive tx of jersey finger

A

surgical repair of tendon

32
Q

stenosing tenosynovitis aka trigger finger

A
  • disparity of the flexor tendons and surrounding pulley systems at the A1 pulley (over MCP joint)
  • flexor tendon catches
  • most are idiopathic
33
Q

PE of trigger finger

A
  • painless snapping, catching, locking of one or more fingers during flexion
  • pain sometime present on volar aspect of MCP
  • sometimes can be completely stuck
34
Q

initial tx of trigger finger

A
  • splinting, activity restriction, NSAIDs

- steroid injections

35
Q

tx of trigger finger if conservative tx fails

A

surgery

36
Q

de quervain tenosynovitis

A

-tendinopathy affecting the abductor pollicis longus and extensor pollicis brevis tendons

37
Q

PE of de quervain tenosynovitis

A
  • pain on radial side of wrist exacerbated by movement

- postive finkelsteins test

38
Q

tx of de quervians tendosynovitis

A
  • splinting, NSAIDs, activity restriction

- steroid injections

39
Q

dupuytren contracture

A
  • progressive fibrosis of the palmar fascia
  • bengin and slow
  • most pts: white males > 50 yo
40
Q

PE of dupuytren contracture

A
  • complain of thickening or nodule in palm w/ loss of motion
  • difficultly extending 4th and 5th digits
41
Q

tx of dupuytren contracture

A

surgery w/ palmar fasciotomy and possible skin graft

42
Q

most common organisms causing infection d/t HUMAN bites

A
  • group A strep
  • staph
  • e. corrodens
43
Q

tx of human bite

A
  • debride and wash out
  • loose closure if necessary
  • augmentin
44
Q

most common organisms causing infection d/t ANIMAL bites

A
  • staph
  • strep
  • pasturella specis
45
Q

tx of animal bites

A
  • debride and wash out
  • loose closure if necessary
  • augmentin
46
Q

paronychia

A
  • inflammation and infection involving proximal fingernail folds
  • can develop subsequent superficial abscess
47
Q

tx of paronychia

A
  • warm compress
  • keflex
  • I&D
48
Q

infective tenosynovitis

A
  • infection and spread of inflammation along tendon sheaths of flexor tendons in hand
  • can result in compartment syndrome
49
Q

mechanism of injury of infective tenosynovitis

A
  • traumatic implantation (staph and strep are common)

- can be hematogenously spread from n. gonorrhea and mycobacteria

50
Q

PE of infective tenosynovitis

A
  • tenderness along flexor sheath
  • symmetric or fusiform enlargement of affected digit
  • slightly flexed finger at rest
  • PAIN W/ PASSIVE TENDON EXTENSION
51
Q

tx of infective tenosynovitis

A
  • surgical debridement
  • IV abx
  • vanc + cipro
52
Q

compartment syndrome

A
  • 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
53
Q

mechanism of injury of compartment syndrome

A
  • long bone fx
  • trauma w/o fx:
  • crush injury
  • burn
  • constrictive bandages
  • penetrating trauma
  • thrombosis
  • bleeding
  • nephrotic syndrome
  • animal bites
  • IV drug use
54
Q

2 MC long bone that can cause compartment syndrome when injured

A
  • tibia MC

- forarm bones 2nd MC – mainly supracondylar fx in children

55
Q

initial sx of compartment syndrome

A
  • pain out of proportion to injury
  • persistent deep ache or burning pain
  • paresthesias
56
Q

later sx of compartment syndrome

A
  • pain w/ passive muscle stretch
  • tense compartment w/ wood-like feeling
  • pallor
  • diminished sensation
  • muscle weakness
57
Q

lab finding in compartment syndrome

A

elevated CK

58
Q

at what pressure is capillary flow compromised in compartment syndrome?

A
  • 25-30 mmHg

- 0-8 mmHg is nl

59
Q

tx of compartment syndrome

A

decompressive fasciotomy performed by surgeon

Musculoskeletal 1 (14 decks)

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