Upper Extremity Injuries - Wrist Flashcards
what is the MC fx site of the upper extremity?
-distal radius fx
other names for distal radius fx
- Colles fx
- dinner fork deformity
- smith fx
what population is a distal radius fx most common in ?
- young athletes
- elder geriatric population
MC mechanism of injury for distal radius fx
FOOSH w/ wrist in extension
PE of distal radius fx
- swelling, pain, decreased ROM
- must assess neurovascular status
- dinner fork deformity is common
radiology of distal radius fx
-3 view XR of wrist
radiology specific to colles fx
-transverse extraarticular fx of distal radius w/ DORSAL displacement of distal fx segment
radiology specific to Smith fx
- transverse fx of distal radius w/ VOLAR displacement of distal fx segment
- garden spade deformity
chauggeur fx (hutchnison fx)
intraarticular fx of the base of the radial styloid process
tx of a displaced distal radius fx
- closed reduction prior to ortho referral
- finger traps and traction/counter traction
- after reduction, splin w/ sugar-tong and refer
parameters for closed reduction of distal radius fx
- greater than 20 deg of dorsal angulation
- fx displacement greater than 2/3 width of radial shaft
criteria for adequate reduction of distal radial fx
- no dorsal tilt
- <5mm of radial shortening
- <2cc of displacement of fx segments
tx of non-displaced distal radius fx
can be splinted in ER w/ sugar-tong and referred to ortho
distal ulnar fx
- not as common as radius fx
- same mechanism as radial fx
- on XR: look at ulnar syloid
- tx sugar tong splint w/ ortho referral
what is the MC carpal bone fx?
scaphoid
main blood supply to scaphoid bone
- dorsal branch of radial a.
- enters at dorsal rdige and flows in retrograde fashion toward proximal pole
- can be interupted by fx = necrosis and non union
mechanism of injury of scaphoid fx
-direct axial compression or hyperextension of wrist secondary to fall
PE of scaphoid fx
- swelling, pain, decreased ROM
- pain to palpation at anatomical snuff box*****
radiology of scaphoid fx
- 3 view XR wrist and scaphoid views
- MC fx sites: waist, then proximal pole and tubercle
what increases the risk of avascular necrosis in scaphoid fx
the more proximal the fx line is, the greater incidence of avascualr necrosis
what to do if XR is negative but suspicious of scaphoid fx?
MRI
tx of scaphoid fx
- initial tx for any wrist injury w/ anatomical snuff box tenderness = placement of a THUMB SPICA SPLINT**
- refer to ortho
- if displaced, ORIF
what is the second MC carpal bone fx?
triquetrum
mechanism of injury of triquetrum fx
-FOOSH w/ wrist in extension and ulnar deviation
PE of triquetrum fx
usually point tenderness dorsally, or along the ulnar border of wrist, 1-2 cm distal to distal aspect of unla
radiology for triquetrum fx
- 3 view of wrist
- usually dorsal surface
- if fx segment is present, best visualed in lateral or pronated oblique positions
tx of triquetrum fx
-immobilization w/ volar splint w/ wrist in slight extension
what is the MC dislocation of carpal bones?
lunate dislocation
radiology of lunate dislocation
- loss of congruity of the carpal arcs
- abnl triangular configuration of lunate
- lateral XR shows all other carpal bones posterior to lunate
- “spilled teacup” sign
carpal tunnel syndrome
-complex s/s brought on by compression of MEDIAN n. as it goes through carpal tunnel
risk factors of carpal tunnel syndrom
- obesity
- female
- DM
- RA
- connective tissue disorders
- sustained wrist/palm pressure
- prolonged wrist extension/flexion
- repetitive hand/wrist use (keyboard, drilling, etc)
- work with vibrating tools
what is the hallmark on PE for carpal tunnel syndrome
pain/paresthesia in the distribution of the median nerve w/ varying degrees
special tests for carpal tunnel syndrome
- phalens (reverse prayer)
- tinel (tapping)
- hand elevation test (1 min)
when is radiology indicated for carpal tunnel syndrome?
-if worried about tumore, deformity or joint dz
non-surgical tx of carpal tunnel syndrome
- wrist splinting to maintain wrist in neutral position
- worn at night or day and night
- steroid injections
- NSAIDs
surgical decompression for carpal tunnel sydrome
carpal tunnel release involves cutting the transverse carpal ligment
ulnar tunnel syndrome
-compression of the ULNAR n. at the Guyon canal
what is the MC cause of ulnar tunnel syndrome?
ganglion cyst
tx of ulnar tunnel syndrome
same as for carpal tunnel
cubital tunnel syndrome
-pressure on the ulnar n. at the elbow
ganlgion cyst
- one of the MC soft tissue swellings in that hand and wrist
- benign
- fluid filled swelling over joint or tendon sheath
MC site of ganglion cyst
dorsal side of wrist
non-surgical tx of ganglion cyst
- reassurance and observation
- cyst aspiration (will likely come back)
surgical tx of ganglion cyst
-cyst removal including the stalk (or will come back)
