Week 7

Question 1

What are the acronyms to remember the wrist bones?

Answer 1

So Long To Pinky

Here Comes the Thumb

Question 2

What finger flexors and nerve run through the carpal tunnel?

Why does pregnancy cause an increase in carpal tunnel syndrome?

Answer 2

Muscles: 
Flexor Digitorum Superficialis 
Flexor Digitorum Profundus 
Flexor Pollicis Longus 
Median Nerve 

Increase during pregancy because there is a build up of fluid.

Question 3

What are signs and symptoms of tendonitis/ Tendonosis/ Tenosynovitis?

Answer 3

Inflammation 
Limited motion 
Pain 
Tenderness 
Crepitus- snapping/ clicking

Question 4

Describe the treatment method - IONTO.

Answer 4

That is the method of transferring medication below skin surface to the muscle through electricity. It is done for anti-inflammatory purposes.

Question 5

What are mechanisms for forearm fractures?

Why can you not always ice a fracture?

Answer 5

Fall on outstretched arm and direct blow. Can’t always ice because will cause shooting pain if too much pressure.

Question 6

What is the difference between a Colles vs. Smith Fracture? Which is more common?

Answer 6

Colles is when the radius is displaced dorsally while Smith is there is a volar angulation towards the palm. Colles is more common (90% of radial fractures).

Question 7

Scaphoid Fracture - mechanism, special tests- why is it problematic?

Answer 7

M- compression against radius and direct contact.

ST- palpation of the anatomical snuff box and scaphoid compression test.

Problematic - poor blood supply- harder to heal - inhibits the inflammatory process.

Question 8

What are some signs and symptoms of a hamate fracture?

Answer 8

Pain, Swelling - Tenderness on ulnar side: may feel pain along the flexor carpi ulnaris. May experience parasthesia as the ulnar nerve runs through this area.

Question 9

What is the mechanism of a wrist dislocation?

Answer 9

Axial Load - FOOSH

Question 10

What is the mechanism for a lunate dislocation? Is there any special tests (why or why not)?

Answer 10

Forced Hyperextension

There is no special tests because there are no muscles that attach onto the lunate.

Question 11

Describe the 2 special tests for carpal tunnel syndrome.

Answer 11

Phalen’s Test- bend arms at the elbow and touch the dorsal parts of both hands together. Positive- any tingling or numbness.

Tinel’s - touch area where median nerve runs down.

Question 12

What is unique about the mechanism for ligament sprains and muscle strains?

Answer 12

Can be caused by either hyperextension or hyper-flexion.

Question 13

Describe the valgus and varus special tests for a ligament sprain and a muscle strain of the wrist.

Answer 13

Valgus- radially deviating the wrist- testing the integrity of the ulnar collateral ligament.

Varus- ulnar deviation of the wrist- testing the integrity of the radial collateral ligament.

Question 14

What is the function of the Triangular Fibrocartilage Complex (TFCC)?

Answer 14

Functions like the meniscus in the knees.

• Gliding surface for distal area of radius and ulna.
• flexibility for lunate and triquetrium bones to rotate around ulnar axis.

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Question 15

What is the mechanism and signs and symptoms of a TFCC tear?

Answer 15

Mechanism- hyperextension and torque of the wrist.

Signs and symptoms - pain distal to the ulna- clicking sensation.

Question 16

How do you treat a ganglion cyst?

Answer 16

If it is not painful and doesn’t restrict movement- then do nothing.

Question 17

What is the role of Volar Plates in our hands?

Answer 17

Prevent hyperextension

Question 18

What is deQuervain’s syndrome?

Mechanism?

Answer 18

Tenosynovititis of the thumb and 2 of the tendons that run through the anatomical snuff box - extensor pollicis brevis and abductor pollicis longus.

Lots of repetitive wrist motion.

Question 19

What is Trigger Finger

Answer 19

Tenosynovitis of the tendon sheath at the base of the finger known as the A1 pulley.

When finger is then stuck in a bent position.

Question 20

What is different and simliar among boxer and bennett fractures?

Answer 20

Both can be caused by punching and an axial/compressive load. Tests can be compression or percussion tests.

Ben- injury to the palmar aspect of the base of the 1st metacarpal.

Box- injury to the neck of the fifth metacarpal.

Question 21

What is the mechanism for phalanx fracture?

Answer 21

Avulsion

Crushing, longitudinal compression or rotation.

Question 22

PIP and DIP dislocation/sprain or strain.
Varus and Valgus
Xray

Answer 22

Varus- testing integrity of the lateral collateral ligament,

Valgus- testing integrity of the medial collateral ligament.

X ray before reduction- need to ensure that nerve or artery is not pinched.

Question 23

What is Game Keeper’s Thumb? Why is it important to treat?

Answer 23

Spain of ulnar collateral ligament of the thumb.

Interferes with activities of daily living.

Question 24

What is a Boutonniere Deformity?

Difference between this and Pseudo Boutionniere deformity.

Answer 24

Forced flexion of the PIP- causing a deformity bump.

Pseudo- passive flexion of the DIP is possible, not possible in the other.

Question 25

What is a Swan Neck Deformity - compare and contrast to Boutonniere Deformity.

Answer 25

Same joint PIP but BD = forced flexion and DIP is hyperextension.

Question 26

What is the mechanism and signs and symptoms of mallet finger.

Answer 26

M- extended DIP forced into flexion.

S/S- unable to actively extend DIP and pain in distal phalanx.

Question 27

What is Jersey Finger?

Answer 27

Flexed finger that is forced into extension.

Rupture of the flexor digitorum profundus tendon from its insertion on the distal phalanx.