Wrist

Question 1

What is the Finkelstein test?

Answer 1

De Quervain syndrom – flex the thum into the palm and close the fingers, ulnar deviate – positive if produces pain in the first dorsal compartment

Question 2

CPR for De Quervain syndrome 5 of 7

Answer 2

Finkelstein, tenderness over APL and EPB tendons, pain over the radial styloid, swelling, thickening, pain on the resisted thumb ext, and pain in the first extensor compartment with wrist movement (tendinosis of the tendon sheath)

Question 3

Describe the first CMC grind test

Answer 3

OA of the first CMC first metacarpal into the trapezium using an axial load and rotate the metacarpal – positive if it reproduces pain

Question 4

An athlete jams his finger and has immediate pain along with being unable to extend his DIP joint. He has full flexion and skin intact. What is his likley Dx? A) boxer’s fx B) Flexor digitroum profundus tendon avulsion (jersey finger) C) mallet finger D) neurotmesis

Answer 4

C – mallet finger

Question 5

Tx for a mallet finger for direct access?

Answer 5

splint joint in hyperext and refer him to MD for an x-ray for possible avulsion

Question 6

If x-rays are negative then tx of mallet finger includes:

Answer 6

splinting the distal interphalengeal joint in slight hyperext for 6-8 wks

Question 7

For mallet finger what is the primary criterion for exercise progression after 8 wks of immobilization?

Answer 7

no ext lag

Question 8

A fall onto the wrist causing hyperext and ulnar deviation may cause injure to what?

Answer 8

scapholunate ligament, may pain with lifting and dorsal side pain, pain with WB’ign

Question 9

What landmark is useful to palpate scapholunate?

Answer 9

anatomical snuff box

Question 10

What is the scaphoid shift or Watson test?

Answer 10

tests for scapholunate dissociation, by shifting the scaphoid ant and then post

Question 11

A scapholunate dissociation on x-ray whill likley reveal?

Answer 11

Dorsal intercalated segemental instability (DISI deformity)

Question 12

On x-ray what might a TFCC disorder present with?

Answer 12

Positive ulnar variance

Question 13

Scapholunate dissociation can result in what if not caught early?

Answer 13

degenerative changes in the wrist leaving few Tx options

Question 14

When seeing a patient for carpal tunnel what else should be rule out?

Answer 14

C7 nerve root involvement

Question 15

Early on in carpal tunnel what type of splint is indicated?

Answer 15

Volar wrist cock up splint with the wrist positioned at 0 degrees ext/flex

Question 16

What tests are useful for Dx carpal tunnel?

Answer 16

Tinel test, phalen test, and Semmes-Weinstein monofilament, abductor pollicis atrophy

Question 17

What education should be provided to carpal tunnel patient regarding sleeping?

Answer 17

appropriate use of night splints to keep the wrist in a neutral position

Question 18

If carpal tunnel conservative tx is failing how quickly should surgical intervention be discussed?

Answer 18

After 3 months

Question 19

After a patient receives a nerve decompression for carpal tunnel what is should be performed at the first visit for Tx?

Answer 19

cScar management including compression and gentle mobilizaition, prolonged stretching and aggravating postures should be avoided early to allow the nerve to heal

Question 20

When is surgical fixation of the fifth metacarpal fracuture indicated?

Answer 20

Angulation > 50 degrees

Question 21

Post op postioning after 5th metacarpal fixation should hold the MCP joints in?

Answer 21

60-80 degrees flexion keeps the ligaments taut and maintains there length during healing

Question 22

When should tendon involvement be consider as restricting movement in the hand?

Answer 22

When passive motion exceeds active motion by more 20 degrees