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Musculoskeletal 1 > Upper Extremity Injuries - Wrist > Flashcards

Upper Extremity Injuries - Wrist Flashcards

1
Q

what is the MC fx site of the upper extremity?

A

-distal radius fx

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2
Q

other names for distal radius fx

A
  • Colles fx
  • dinner fork deformity
  • smith fx
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3
Q

what population is a distal radius fx most common in ?

A
  • young athletes

- elder geriatric population

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4
Q

MC mechanism of injury for distal radius fx

A

FOOSH w/ wrist in extension

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5
Q

PE of distal radius fx

A
  • swelling, pain, decreased ROM
  • must assess neurovascular status
  • dinner fork deformity is common
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6
Q

radiology of distal radius fx

A

-3 view XR of wrist

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7
Q

radiology specific to colles fx

A

-transverse extraarticular fx of distal radius w/ DORSAL displacement of distal fx segment

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8
Q

radiology specific to Smith fx

A
  • transverse fx of distal radius w/ VOLAR displacement of distal fx segment
  • garden spade deformity
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9
Q

chauggeur fx (hutchnison fx)

A

intraarticular fx of the base of the radial styloid process

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10
Q

tx of a displaced distal radius fx

A
  • closed reduction prior to ortho referral
  • finger traps and traction/counter traction
  • after reduction, splin w/ sugar-tong and refer
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11
Q

parameters for closed reduction of distal radius fx

A
  • greater than 20 deg of dorsal angulation

- fx displacement greater than 2/3 width of radial shaft

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12
Q

criteria for adequate reduction of distal radial fx

A
  • no dorsal tilt
  • <5mm of radial shortening
  • <2cc of displacement of fx segments
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13
Q

tx of non-displaced distal radius fx

A

can be splinted in ER w/ sugar-tong and referred to ortho

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14
Q

distal ulnar fx

A
  • not as common as radius fx
  • same mechanism as radial fx
  • on XR: look at ulnar syloid
  • tx sugar tong splint w/ ortho referral
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15
Q

what is the MC carpal bone fx?

A

scaphoid

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16
Q

main blood supply to scaphoid bone

A
  • 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
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17
Q

mechanism of injury of scaphoid fx

A

-direct axial compression or hyperextension of wrist secondary to fall

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18
Q

PE of scaphoid fx

A
  • swelling, pain, decreased ROM

- pain to palpation at anatomical snuff box*****

19
Q

radiology of scaphoid fx

A
  • 3 view XR wrist and scaphoid views

- MC fx sites: waist, then proximal pole and tubercle

20
Q

what increases the risk of avascular necrosis in scaphoid fx

A

the more proximal the fx line is, the greater incidence of avascualr necrosis

21
Q

what to do if XR is negative but suspicious of scaphoid fx?

A

MRI

22
Q

tx of scaphoid fx

A
  • initial tx for any wrist injury w/ anatomical snuff box tenderness = placement of a THUMB SPICA SPLINT**
  • refer to ortho
  • if displaced, ORIF
23
Q

what is the second MC carpal bone fx?

A

triquetrum

24
Q

mechanism of injury of triquetrum fx

A

-FOOSH w/ wrist in extension and ulnar deviation

25
Q

PE of triquetrum fx

A

usually point tenderness dorsally, or along the ulnar border of wrist, 1-2 cm distal to distal aspect of unla

26
Q

radiology for triquetrum fx

A
  • 3 view of wrist
  • usually dorsal surface
  • if fx segment is present, best visualed in lateral or pronated oblique positions
27
Q

tx of triquetrum fx

A

-immobilization w/ volar splint w/ wrist in slight extension

28
Q

what is the MC dislocation of carpal bones?

A

lunate dislocation

29
Q

radiology of lunate dislocation

A
  • 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
30
Q

carpal tunnel syndrome

A

-complex s/s brought on by compression of MEDIAN n. as it goes through carpal tunnel

31
Q

risk factors of carpal tunnel syndrom

A
  • 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
32
Q

what is the hallmark on PE for carpal tunnel syndrome

A

pain/paresthesia in the distribution of the median nerve w/ varying degrees

33
Q

special tests for carpal tunnel syndrome

A
  • phalens (reverse prayer)
  • tinel (tapping)
  • hand elevation test (1 min)
34
Q

when is radiology indicated for carpal tunnel syndrome?

A

-if worried about tumore, deformity or joint dz

35
Q

non-surgical tx of carpal tunnel syndrome

A
  • wrist splinting to maintain wrist in neutral position
  • worn at night or day and night
  • steroid injections
  • NSAIDs
36
Q

surgical decompression for carpal tunnel sydrome

A

carpal tunnel release involves cutting the transverse carpal ligment

37
Q

ulnar tunnel syndrome

A

-compression of the ULNAR n. at the Guyon canal

38
Q

what is the MC cause of ulnar tunnel syndrome?

A

ganglion cyst

39
Q

tx of ulnar tunnel syndrome

A

same as for carpal tunnel

40
Q

cubital tunnel syndrome

A

-pressure on the ulnar n. at the elbow

41
Q

ganlgion cyst

A
  • one of the MC soft tissue swellings in that hand and wrist
  • benign
  • fluid filled swelling over joint or tendon sheath
42
Q

MC site of ganglion cyst

A

dorsal side of wrist

43
Q

non-surgical tx of ganglion cyst

A
  • reassurance and observation

- cyst aspiration (will likely come back)

44
Q

surgical tx of ganglion cyst

A

-cyst removal including the stalk (or will come back)

Musculoskeletal 1 (14 decks)

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