Week 6 Masterclass Flashcards
Where is the TFCC located?
On the distal radioulnar joint (between the lunate, triquetrum, and ulnar head)
What direction is radial deviation
Moving the hand towards the radius
What direction is ulnar deviation
Moving the hand towards the ulnar
What 4 ligaments make up the TFCC
Ulnotriquetral Ligament
Ulnolunate Ligament
Plamar Radioulnar Ligament
Dorsal Radioulnar Ligament
What movement creates a TFCC injury
Forceful ulnar deviation (e.g hitting golf club into the turf, hitting a ball in tennis, Goalkeepers saving a powerful shot, Tricep dips)
Where is pain most common in TFCC injuries
ulnar side
What ADL is often painful in TFCC injuries
Turning a door key
What movements cause pain in TFCC injuries
Ulnar deviation or
Supination + TFCC compression (supinating with force)
What profession often gets TFCC injuries from overuse
Waiters due to the position of their hand when they’re carrying shit out
What ligament often tears in TFCC
radioulnar
What is positive ulnar variance
Ulnar is longer than the radius creating more compression through the TFCC
Why does positive ulnar variance lead to increased liklihood of TFCC injury
More compression through the TFCC as more load shifts over to the ulnar side
Special test for TFCC injury
Ulnar Fovea Sign
Scapholunate ligament injury position
Wrist positioned in ext, ulnar dev and sup. Usually from a fall or MVA
Is Scapholunate ligament injury diffused or localised pain
Diffused throughout the whole hand
Clinical features of Scapholunate ligament injury
Pain in mechanical loading
Decreased grip strength
Localised scapolunate tenderness
Initial management of Scapholunate ligament injury
Splinting and casting for 4 weeks
Is an MRI needed with a suspected Scapholunate ligament injury
No. but after splinting/casting for 4 weeks and there are still persistent symptoms, then MRI should be conducted
What does a scapholunate reconstruction entail
Tendon graft is threaded through scaphoid and lunate and a knot is tied. Similar to achilles rupture
Is scapholunate ligament injury on the ulnar or radial side
Radial
Differentiate between scapholunate ligament and TFCC injury based on pain location
TFCC - ulnar side
Scapholunate - Radial side
What can be observed in scapholunate ligament injury
Swelling of anatomical snuffbox
What sort of scaphoid fracture heals quickly
Distal pole fracture due to greater blood supply
What should happen if a scaphoid fracture is suspected but there is nothing evident in imaging
Put thumb in cast for 2 weeks and then go for another x-ray. This is due to bone reabsorption along the fracture line making the injury more visible after 2 weeks
Why is a proximal pole scaphoid fracture considered to be ‘scary’
It has poor blood supply leading to longer rehab time and possible avascular necrosis of the scaphoid bone
What 3 tendons are in the anatomical snuffbox
Abd Pollicis Longus (Thena)
EPB
EPL (Hypothena)
How to find the anatomical snuffbox
Make a starfish. Snuffbox appears at distal wrist
What injuries are found in the anatomical snuffbox
De Quervians synovitis
Scaphoid fracture
What movement is a bony avulsion (finger) pt unable to do
flex distal phalanx
If your hand is relaxed, what position will your fingers be in? How is this different to Jersey finger
Relaxed - fingers are in flexion
Jersey finger will be in ext when relaxed
What causes a bony avulsion in fingers
hyperextension. Common in footy when your finger gets caught in someones jersey bending it backwards
What is mallet finger
Disruption of the common extensor tendon on distal interphalangeal joint
What causes mallet finger
Forced flexion to then IP joint
What is the immediate treatment for mallet finger
Splint
What is a common observation in mallet finger pt
Unable to extend distal IP joint
What direction does a dorsal proximal dislocation move
Middle phalanx dislocates dorsal
What are other names for ulnar collateral ligament sprains (finger)?
skiers thumb or gatekeepers thumb
What finger is affected in ulnar collateral ligament sprain?
thumb
What observations can be made for skiers thumb
Weak pinch grip
Joint instability
Excessive thumb abduction due to lack of ligament
How to first line management of a partial UCL tear (thumb)?
Splint for 3-6 weeks
How to first line management of a full UCL tear (thumb)?
Surgery
After immobilisation, what exercises should UCL (finger) focus on
Pinching
What sort of fracture is common in adolescents in the arm
Distal radial fracture due to ongoing growth plate maturation
What are the nine tendons that run through the carpal tunnel
Flexor digitorum superficialis (4)
Flexor digitorum profundus (4)
Flexor carpi radialis (1)
Management of carpal tunnel syndrome
Education
Activity modification
Night splint
Nerve gliding exercises
What is De Quervain’s Tenosynovitis
Inflammation and increase of fluid in the synovial sheath in abductor policis longus and extensor pollicis brevis at the radial styloid
Is De Quervain’s Tenosynovitis a tendinopathy
No
Are the tendons in De Quervain’s Tenosynovitis healthy
Yes
What movement aggravates De Quervain’s Tenosynovitis
Ulnar deviation
What is De Quervain’s Tenosynovitis often known as
Mothers thumb due to picking up newborns constantly
Management of De Quervain’s Tenosynovitis
Prevent thumb flexion by putting them in a brace/splint for 2-4 weeks
What does TFCC stand for?
Triangular Fibrocartilage Complex
What is a TFCC injury
a tear or damage to the cartilage and ligaments on the ulnar side of the wrist, which helps stabilize the joint.
