Wrist

Question 1

Carpal Bones

Answer 1

Proximal Row:
scaphoid, lunate, triquetrum, pisiform

Distal row:
Trapezium, Trapezoid, Capitate, Hamate

Question 2

Articulation of the wrist and hand

Answer 2

Distal Radioulnar joint

Radiocarpal joint (radius, scaphoid, lunate, and triquetrum)

Intercarpal joints

Midcarpal joints (between distal and prox)

Carpometacarpal Joint (CMC)

Intermetacarpal Joints (IM)

Metacarpophalangeal joint (MCP)

Interphalangeal Joint (IP)

Question 3

Gamekeeper’s Thumb

Answer 3

E: tear of UCL of the MCP joint
MOI: MCP extension and forceful abduction

S/S: palmar aspect pain and swelling, +ve abduction stress

M: Acute = spica cast (3-6 weeks)
Severe = surgical repair

Question 4

Metacarpal Fractures

Answer 4

MOI: direct trauma.
1. boxer’s fracture
2. Bennett’s fracture

S/S: pain, deformity, crepitus, selling + abnormal Mobility

M: PIER, splint + refer (4-6 weeks)

Question 5

Boxer’s fracture

Answer 5

E: unstable distal metaphysis or neck of fourth or fifth metacarpals

S/S: sudden pain, inability to grip, swelling, and deformity, point tenderness, crepitus. Increase pain w/ axial compression and percussion

M: acute = splint, referral

Question 6

Scaphoid Fracture

Answer 6

MOI: FOOSH

S/S: tenderness in snuff box, pain inward pressure along long axis, increase pain w/ wrist ext. and radial deviation

M: acute = splint; severe = referral

Concern: avascular necrosis

Question 7

Wrist Ganglion

Answer 7

rupture (herniation) of the tendon sheath or joint capsule
MOI: unknown, may be due to rep injuries

S/S: Jelly-like mass on dorsal aspect of hand, palpable and mobile

M: past = breaking w/out rupturing skin (heavy book)
Present = 50% go away by themselves. close rupture w/ multiple needle punctures, or surgery

Question 8

Special tests for the wrist

Answer 8

Tinel’s Sign (carpal tunnel syndrome) - tap the carpal tunnel

Radial pulse