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MSK > wrist > Flashcards

wrist Flashcards

1
Q

What is the wrist joint comprised of?

A

distal radius, ulna and carpal bones

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2
Q

What are the 3 joints that make up the wrist?

A

radiocarpal joint: distal radius and scaphoid & lunate bones
ulnocarpal joint: distal ulna and lunate & triquetral bones via articular disk
radioulnar joint

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3
Q

What is the name for the distal radial tubercle?

A

Lister’s tubercle

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4
Q

What is the ulnar styloid process the attachment site for?

A

UCL

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5
Q

Which carpal bone is embedded in a tendon and is not involved in wrist movement?

A

the Pisiform bone

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6
Q

Where is the triangular fibrocartilage

A

between the ulna and triquetral and lunate bones
allows forearm rotation

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7
Q

what mechanism is the dorsal wrist responsible for?

A

extensor mechanism for wrist, digits and thumb

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8
Q

What compartments is the snuff box made of?

A

compartment 1 and 3
(extensor pollicis brevis and extensor pollicus longus)

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9
Q

What 2 tendons are associated with De Quervain’s? (what is the compartment)

A

extensor pollicis brevis and abductor pollicis longus, compartment 1

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10
Q

what does compartment 2 contain?

A

extensor carpi radialis longus and brevis

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11
Q

what separates compartment 2 and 3?
what does compartment 3 contain?

A

Lister’s tubercle

extensor pollicis longus

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12
Q

When does the extensor pollicis longus commonly rupture?

A

in patients with rh arthritis due to the sharp radial deviation over Lister’s tubercle

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13
Q

what is contained within compartment 4 and 5?

A

4: extensor digitorum (superficial) and extensor indices (deep)
5: extensor digit minimi

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14
Q

what is contained within compartment 6?

A

extensor carpi ulnaris

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15
Q

what compartments are most commonly affected by tenosynovitis?

A

5th and 6th

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16
Q

what does the palmar wrist contain?
what tunnels does it contain?

A

flexor tendons, ulnar, median and radial nerve

contains the carpal tunnel and Guyon’s tunnel

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17
Q

What is contained within the carpal tunnel?

A

median nerve, flexor pollicis longus and eight flexor digitorum tendons (4 deep 4 superficial)

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18
Q

what forms the roof of the carpal tunnel?

A

flexor retinaculum?

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19
Q

what are the bony landmarks for the proximal carpal tunnel?

A

scaphoid on the radial side, and the pisiform on the ulnar side

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20
Q

what are the bony landmarks for the distal carpal tunnel?

A

trapezium on the radial size and hook of the hamate on the ulnar side

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21
Q

what is the Guyon’s tunnel and where is it?

A

on the ulnar side formed by the pisiform and hook of the hamate
contains the ulnar nerve and artery (nerve splits into superficial and deep branches)

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22
Q

what can cause most wrist pathologies?

A

tendon overuse or nerve compression

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23
Q

what systemic diseases can also cause wrist pathology?

A

rh arthritis
diabetes
lupus
osteoarthritis
psoriatic arthritis

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24
Q

what occurs with median nerve compression?

A

nerve paresthesia that causes burning/prickling sensation or numbness of the first 3 fingers

also called carpal tunnel syndrome

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25
Q

what is the most common entrapment syndrome of the upper limb?

A

CTS

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26
Q

what is the most common cause of CTS?

A

tenosynovitis of the flexor tendons

also ganglions, masses, thrombosed median artery, or accessory muscles

27
Q

what is the appearance of CTS?

A

3x bigger in one axis compared to the other
loss of honeycomb appearance
abrupt contour changes

28
Q

What can happen to the flexor retinaculum from CTS?

A

it may bulge outward due to intracanal pressure, best seen distally

if it extends more than 4mm above an imaginary line between the pisiform and scaphoid bone it is abnormal

29
Q

what is the measurement for the carpal tunnel?

A

(CSA @ PQ) - (CSA @ CP) >2mm

30
Q

what is a bifid median nerve associated with?

A

persistent median artery (important for sx) and with an increased association of CTS

31
Q

what are the symptoms of ulnar nerve compression?
how can you recreate these symptoms?

A

paresthesia in last 2 windows

reproduced with probe pressure over hook of hamate (Guyons tunnel syndrome)

32
Q

what is the most common cause of ulnar nerve compression in the wrist?

A

trauma

also chronic compression from long distance cycling or mass lesions

33
Q

how does Guyon’s tunnel syndrome appear?

A

loss of honeycomb appearance
caliber change as it enters the tunnel

34
Q

where is the radial nerve often compressed and assessed?

what is it called?

A

level of mid forearm where the nerve passes between the forearm muscles during pronation

Wartenburgs syndrome

35
Q

how does joint fluid appear in the wrist?

A

anechoic distention of joint space representing simple fluid
collapses with pressure or movement, no internal flow**

36
Q

how does synovial hypertrophy appear? (compared to joint fluid distention)

A

distention of the sheath around the tendon
will not collapse, has some flow with power doppler

37
Q

what is rheumatoid tenosynovitis?

A

the immune system attacks the tendon sheaths in the wrists that causes inflammation of the synovium

38
Q

what is the appearance of rheumatoid tenosynovitis?

A

hypoechoic pannus with fluid in the sheath
hypervascularity with power doppler of the pannus
thickened and heterogenous tendon with jagged edges (if involved)

39
Q

what is the most affected tendon from rheumatoid tenosynovitis?

A

extensor carpi ulnaris

40
Q

what causes general tenosynovitis of the wrist tendons?

what is seen?

A

overuse and friction
large amounts of fluid is seen around the tendons, increased CD signal if infected

41
Q

What is the most common tendinopathy of the wrist? (what else is it called?)

A

De Quervain’s tenosynovitis (stenosing tenosynovitis) involving tendons in compartment 1

42
Q

what setting is useful in identifying the inflammatory process of De Quervain’s?

A

colour doppler

43
Q

what is the appearance of De Quervains?

A

swollen synovium with trace fluid around tendons and sheath, with restricted movement
colour doppler signals
bulge of the extensor retinaculum

44
Q

What is intersection syndrome?

A

is a form of tenosynovitis involving where the 1st compartment tendons pass over the 2nd compartment tendons

45
Q

how does intersection syndrome appear?

A

inflammation of the synovial sheath of the 2nd compartment

46
Q

what is the triangular fibrocartilage complex?

A

dense connective tissue between the lunate and triquetrum carpal bones and ulnar head

47
Q

how does a tear of the TFCC present?

(symptoms)

A

ulnar sided wrist pain, clicking with wrist movement and point tenderness

48
Q

how does a TFCC tear appear?

A

hypoechoic, thinned or absent

49
Q

what is the most common tendon in the wrist/hand to tear?

A

flexor digitorum longus

50
Q

what causes tears of the extensor tendons?

A

usually from rheumatoid tenosynovitis
most commonly extensor pollicis longus and extensor digit minimi

51
Q

what can cause a retinaculum tear?

A

after traction injuries
leads to instability

52
Q

what causes a tear of the extensor retinaculum specifically?

A

occurs after a punch or from chronic inflammation

53
Q

which tendon is prone to subluxation in the elbow?

A

extensor carpi ulnaris
diagnosed if >50% of the tendon moves out of the ulnar groove

54
Q

how do rheumatoid nodules appear?

A

palpable, compressible masses on the fingers with NO vascularity
small, oval, well defined and hypoechoic

55
Q

what is the most common expansible lesion of the wrist?

A

ganglion cyst

filled with gelatinous, mucoid thick fluid that may have septations and is non-compressible
communicates with the tendon sheath

56
Q

where is the most common site for a ganglion?

A

dorsal wrist, from the scapholunate ligament and radiocarpal joint

57
Q

what is a “dorsal occult ganglion”?

A

occurring dorsally to the lunate bone, very small (prevents detection), causes pain from compression on radial nerve

58
Q

where does a palmar ganlgia arise from?

A

radioscaphoid joint, usually between radial artery and flexor carpi radialis

59
Q

how does a palmar ganglion appear?

A

usually large, painless and can have transmitted pulsatility from radial artery

60
Q

what can a palmar ganglion be mistaken for?

A

pseudoaneurysm

61
Q

what is the 2nd most common mass of the wrist/hand?

A

giant cell tumor from the tendon sheaths

progessively enlarge and are benign

62
Q

how do giant cell tumors appear?

A

solid hypoechoic masses WITH internal flow
cause pressure of bone and tendon displacement

63
Q

what causes a pseudoaneurysm?

A

traumatic injury to blood vessel wall that can become thrombosed

64
Q

how does a pseudoaneurysm appear?

A

anechoic mass with internal echoes, ying yang flow pattern on colour doppler that is continuous with vessel

MSK (9 decks)

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