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Wrist Flashcards

1
Q

Carpal bones form what

A

Volar concave arch aka carpal tunnel

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2
Q

Ulnar nerve artery and vein cross over retinaculum but sometimes covered by fibrous band called….

A

Ulnar tunnel aka guyon canal

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3
Q

Forces and how they’re transmitted through wrist

A

Capitate, lunate and scaphoid on to distal radius

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4
Q

Force on radial side of wrist Mc lead to what when wrist in 95-100 degrees of extension

A

Scaphoid fractures

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5
Q

Carpal tunnel syndrome

A

Any process that causes increase in volume of carpal tunnel or decrease capacity that compress median nerve and 9 digital flexor tendons

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6
Q

S/s of carpal tunnel syndrome

A

Pain over median nerve distribution

  • opposition of thumb disappears before sensory
  • hypoesthesia/anesthesia
  • motor nerves larger and damaged more than sensory
  • pain may reach forearm/shoulder
  • MC in Female
  • more prominent at night
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7
Q

Causes of CTS

A 
Repetitive hand movements
HTN
Thyroid dysfunction (retain fluids)
Pregnancy
Diabetes
RA
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8
Q

Ulnar tunnel syndrome

A

Ulnar nerve compressed as travels through pisohamate canal (aka guyon canal)

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9
Q

Pisohamate canal aka and nerve that is compressed here

A

Guyon canal

Ulnar nerve

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10
Q

What may cause ulnar tunnel syndrome

A 
Road cycling
Crutches
SOL
Vascular lesion
Fx of hook of hamate
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11
Q

Ulnar nerve gives off two sensory branches above wrist that supply what

A

Palmar and dorsal aspects of hand

Does not pass through guyon canal

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12
Q

If ulnar nerve compressed in canal what is affected

A

Only fingers show altered sensation

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13
Q

Fracture of pisiform/hamate may cause what

A

Ulnar tunnel syndrome

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14
Q

What covers the volar concave arch (aka carpal tunnel)

A

Flexor retinaculum

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15
Q

where does the median nerve lie at the wrist

A

Beneath fascia protected only my palmaris longus tendon

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16
Q

What is contained in carpal tunnel

A

Median nerve

Nine digital flexor tendons

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17
Q

What is median nerve compressed Mc by

A

Volar carpal ligament

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18
Q

Treatment for carpel tunnel syndrome

A 
Wrist splint (cock-up splint)
NSAIDS
Steroids
Surgery
Adjust
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19
Q

If ulnar nerve is compressed at the elbow what are the findings

A

Altered sensation of entire ulnar distribution

Palmar and dorsal aspects of HAND and fingers

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20
Q

Findings if ulnar nerve compressed at wrist? Elbow?

A

Wrist: altered sensation of palmar/dorsal aspects of fingers

Elbow: palmar/dorsal aspects of fingers and hand (recall 2 sensory branches branch before wrist that supply these)

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21
Q

What motor loss is seen with ulnar tunnel syndrome

A

Motor loss of hypothecate eminence (flexor digiti minimi, abductor digiti minimi, opponens digiti minimi)

Adductor pollicis
Interosseous
Medial 2 lumbricals
Palmaris brevis

22
Q

Aka for de Quervain disease

A

Hoffman disease

23
Q

What is de Quervain disease/Hoffman disease

A

Stenosing Tenosynovitis of tendon sheath of abductor pollicis longus and extensors pollicis brevis

24
Q

Dequervain/Hoffman affects who Mc

A

Women 30-60

25
What causes Hoffman/de Quervain
Repetitive thumb adduction or extension ulnar wrist deviation
26
What activities cause de Quervain/Hoffman
Keyboarding Filing Carpentry Assembly-line worker
27
S/s of de Quervain/Hoffman
Pain, tenderness, swelling over first dorsal compartment (increased with thumb movement) - swelling over styloid of radius - palpable crepitus - wrist use causes pain - bilateral-30%
28
Dx with pain, tenderness, swelling over first dorsal compartment that increased with thumb motion. Swelling over styloid of radius and palpable crepitus
Dequervian/Hoffman
29
Trigger finger
Finger gets stuck in bent position Inflammation narrows space within sheath surrounding tendon
30
S/s of trigger finger
Bent finger may bend/straighten with a snap
31
Swan neck deformity
Hyperextension of PIP Flexion of DIP RA Alt: ehlers-Danilo’s, poorly healed fx
32
Boutonnière deformity
Flexion-PIP Extension-DIP RA OA
33
Mallet finger
Rupture or avulsion of extensor tendon where it inserts into distal phalanx
34
Causes of mallet finger
Sports injuries Especially catching a ball
35
Jersey finger
Tear of flexor tendons in finger
36
Causes of jersey finger
Contact sports: football/rugby Gripping a jersey with fingers bent and opponent wrestles away causing forced extension. Avulsion injury
37
Wrist ROM
Flexion: 90 Extension: 70 Ulnar deviation: 55 Radial deviation: 20
38
Tinel sign at the wrist-where
Over carpal tunnel and guyon canal
39
Phalen sign: for and what?
Back of palms upsidown praying pose for one minute. += tingling along median nerve distribution CTS due to neural ischemia
40
Phalen sign indicates what
CTS due to neural ischemia
41
Reverse phalen sign: what? For?
Praying position one minute + tingling along median CTS by neural stretch and compression
42
Reverse phalen indicates what
CTS by neural stretch and compression
43
Carpal compression test: what? For?
Compress carpal tunnel with patients wrist flexed + Paresthesia in median nerve distribution CTS (if less than 15 seconds indicates more advanced)
44
Finkelstein test: what? For?
Fist with thumb inside and wrist ulnar deviated + over abductor pollicis longus and extensors pollicis brevis Stenosing Tenosynovitis in tendons
45
What does + Finkelstein test indicate
Stenosing Tenosynovitis of AbPL and EPB
46
Bracelet test: what? For?
Distal radius/ulna squeezed while patient makes fist + pain over forearm, wrist, hand = RA
47
What does bracelet test for?
RA
48
Bunnel- littler test: for? What?
Wrist extended and examiner extends MCP and flexes DIP/PIP. +decreased flexion = contracture of joint capsule or OA
49
+ bunnel-littler test?
Contracture of joint capsule | OA
50
Mannkopf sign
Pressure on pain and palpate heart rate + increase of 10BPM or more = pain is organic
51
S/s of scaphoid fracture
Pain on thumb side of wrist and within snuffbox
52
Tests for scaphoid fracture
``` Axial compression Percussion on extended thumb Forced dorsiflexion Resisted pronation Max. Ulnar deviation (w/ pain in snuffbox) ```

NMS (12 decks)

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