Wrist and Hand

Question 1

MOI of forearm fracture:

Answer 1

falls (FOOSH) and direct blows

Question 2

Signs and symptoms of forearm fracture:

Answer 2

-audible pop crack followed by moderate to severe pain, swelling and disability.
-edema and ecchymosis with possible crepitus

Question 3

3 forearm fracture management:

Answer 3

1.POLICE (followed by splinting)
2. Check PMS
3. Long-term splinting followed by rehabilitation plan

Question 4

Where does Colle’s fracture occur?

Answer 4

lower end of radius or ulna

Question 5

Whats the MOI of Colle’s fracture?

Answer 5

-FOOSH forcing distal radius and ulna into posterior displacement

Question 6

whats the less common/reverse of colle’s fracture?

Answer 6

Smith fracture (anterior displacement of distal fragment)

Question 7

Colle’s fracture sign and symptoms? 3 things

Answer 7

1. Visible deformity (dinner fork)
   2.Misdiagnosed with bad sprain (when no deformity present)
   3.may include median nerve damage

Question 8

Colles fracture managment:

Answer 8

-acute management splint, refer to physisan
-xray and immobilization

Question 9

what should severe sprain be treated as?

Answer 9

fractures

Question 10

In children colles fracture may cause

Answer 10

lower epiphyseal seperation

Question 11

What’s different for observations for wrist and hand?

Answer 11

thumb to finger touching
color of nail beds/cap refill

Question 12

Wrist sprains MOI

Answer 12

-any forced movement
(often unexpected or uncontrollable)

Question 13

signs and symptoms of wrist sprain:

Answer 13

pain,swelling and difficulty with movement

Question 14

Management of wrist sprain: 4 things

Answer 14

1. refer to physisan for xray (if severe)
   2.POLICE, splint
   3.Active rehad as soon as symptoms allow
2. Tape for support to prevent further injury

Question 15

MOI of Triangular fibrocartilage complex (TFCC):

Answer 15

twist or torque of wrist

Question 16

addition of _______ may increase severity inTriangular fibrocartilage complex (TFCC):

Answer 16

Ulnar deviation

Question 17

what is Triangular fibrocartilage complex often associated with?

Answer 17

Sprain of UCL

Question 18

Signs and symptoms of Triangular fibrocartilage complex: 2 things

Answer 18

• pain along ulnar side of wrist, clicking, pain with ulnar deviation
  -patient may not report injury immediately (symptoms may increase gradually)

Question 19

Management of Triangular fibrocartilage complex (TFCC):

Answer 19

-refer to physican for initial management
-conservative treatment initially
—–> immobilize for 4 weeks

Question 20

surgical intervention may be needed for TFCC if

Answer 20

conservative treatments fail

Question 21

is tape effective in managing symptoms for TFCC?

Answer 21

yes very effective

Question 22

deQuervains syndrome what is it?

Answer 22

tendinopathy in thumb (extensor pollicis brevis and abductor pollicis longus)

Question 23

MOI of deQuervains syndrome

Answer 23

-constant wrist movement
-common in those training with a barbell frequently

Question 24

Signs and symptoms of deQuervains syndrome:

Answer 24

-aching pain that may radiate into hand and forearm
-point tenderness and weakness during thumb extension ab duction (loaded eccentric strain)

Question 25

positive _____ test for deQuervains syndrome

Answer 25

Finkelstein's

Question 26

Finkelstein's test:

Answer 26

-athlete makes a fist with thumb tucked inside -wrist ulnarly deviated -positive pain along EPB/APL

Question 27

Management of deQuervains syndrome:

Answer 27

immobilization,rest,cryotherapy

Question 28

manual therapy at the site of pain to reduce ________ for deQuervains syndrome

Answer 28

excessive fibrosis

Question 29

Dislocation/sublaxation of lunate bone MOI:

Answer 29

-forceful hyperextension or fall on outstretched hand

Question 30

signs and symptoms of Dislocation/sublaxation of lunate bone: 3 things

Answer 30

1. pain 2. swelling 3. difficulty executing wrist flexion

Question 31

management of Dislocation/sublaxation of lunate bone:

Answer 31

-refer to physician -can lead to hypermobile lunate or unstable scapho lunate complex

Question 32

MOI of scaphoid fracture:

Answer 32

-force on outstretched hand -compressing scaphoid between radius and second row of carpal bones

Question 33

scaphoid fractures often fail to _______ due to _______ :

Answer 33

heal due to poor blood supply

Question 34

signs and symptoms of scaphoid fracture:

Answer 34

-swelling and severe pain in anatomical snuff box -pain with radial flexion

Question 35

what do scaphoid fracture present as?

Answer 35

wrist sprain

Question 36

management of scaphoid fracture:

Answer 36

-must be splinted and referred for X ray

Question 37

immobilization of scaphoid fracture lasts:

Answer 37

6 weeks

Question 38

wrist requires protection against _______ for ________ months (scaphoid fracture)

Answer 38

against impact loading for additional 3 months

Question 39

Unstable fractures extending through the scaphoid will need

Answer 39

surgical stabilization

Question 40

scaphoid fracture may become

Answer 40

non-union fracture, extending the time for healing = risk for avascular necrosis

Question 41

extensor tendon alvusion (mallet finger) MOI:

Answer 41

-blow to tip of finger avulsing extensor tendon from insertion

Question 42

signs and symptoms of extensor tendon alvusion (mallet finger):

Answer 42

-Pain at DIP joint -unable to extend distal end of finger (carrying at 30 degree angle) -point tenderness

Question 43

management of extensor tendon alvusion (mallet finger):

Answer 43

POLICE and splinting for 6-8 weeks

Question 44

flexor digitorum profundus rupture (jersey finger) is the rupture of

Answer 44

flexor digitorum profundus tendon from insertion on distal phalanx

Question 45

flexor digitorum profundus rupture (jersey finger) MOI:

Answer 45

occurs ring finger when athlete tries to grab a jersey

Question 46

signs and symptoms flexor digitorum profundus rupture (jersey finger):

Answer 46

-distal phalanx cannot be flexed.... finger remains extended -pain and point tenderness over distal phalanx

Question 47

managment of flexor digitorum profundus rupture (jersey finger):

Answer 47

-must be surgically repaired -extensive rehab

Question 48

does a flexor digitorum profundus rupture (jersey finger) often return to full function?

Answer 48

NO

Question 49

gamekeepers thumb is a sprain of the

Answer 49

sprain of UCL and MCP joint of thumb

Question 50

MOI of gamekeepers thumb

Answer 50

forceful ab duction of proximal phalanx, occasionally combined with hyper extension

Question 51

signs and symptoms of gamekeepers thumb:

Answer 51

pain over UCL in addition to weak and painful pinch

Question 52

management of gamekeepers thumb: if UNSTABLE

Answer 52

athlete should be referred to orthopedist

Question 53

management of gamekeepers thumb: if STABLE

Answer 53

x-ray should be performed to rule out fracture

Question 54

thumb splint should be applied for protection for

Answer 54

three weeks or until pain free

Question 55

the splint should extend from ________ to _________ in a _________ position

Answer 55

wrist, end of thumb, in a neutral position

Question 56

thumb spica should be used

Answer 56

following a splint for support

Question 57

Dislocation of phalange MOI

Answer 57

hyperextension or twisting in semi flexed

Question 58

signs and symptoms of phalange dislocation:

Answer 58

- pain and swelling over PIP -obvious deformity,disability, and possible avulsion

Question 59

finger dislocation management: (if angulated or unstable)

Answer 59

-splint on field and transport secure

Question 60

how long does it take to recover finger dislocation?

Answer 60

-6 to 8 weeks