Wrist and Hand

Question 1

Best physical exam test for carpal tunnel syndrome

Answer 1

Durkan’s
- firm pressure over carpal tunnel with thumbs for 30 seconds

Question 2

Cause of ganglion cysts

Answer 2

Degeneration/liquefication of collagen and fibrocytes into a thick, clear liquid

Question 3

Diagnostic tests used in carpal tunnel syndrome (not physical exam)

Answer 3

• EMG (electromyography)
• NCV (nerve conduction velocity)

(can also MRI and x-ray)

Question 4

Most common location of a ganglion cyst

Answer 4

Dorsal: scapho-lunate joint

Question 5

Carpal tunnel syndrome symptoms

Answer 5

• Vague aching in palmar hand occasionally radiating to forearm
• Numbness/tingling in median nerve (palmar digits 1-4)
• Night symptoms
• Dropping items

Question 6

Are scaphoid fractures more common in children or adults?

Answer 6

Adults

Question 7

Mallet finger treatment

Answer 7

Continuous splinting of DIP joint in extension

Question 8

Trigger finger treatments

Answer 8

• Injection is first line
• Surgery: A1 release/cut

Question 9

Most common fracture in adults

Answer 9

Distal radius fracture

Question 10

Describe a Monteggia fracture

Answer 10

• Displaced proximal ulna fracture
• Proximal radius dislocation

Question 11

Physical exam test for De Quervain’s tenosynovitis

Answer 11

Finklestein

Question 12

Best imaging for scaphoid fractures

Answer 12

MRI best for microscopic fractures

(may be hard to see on x-ray)

Question 13

De Quervain’s tenosynovitis involves the entrapment of these tendons

Answer 13

• Abductor pollicis longus
• Extensor pollicis brevis

Question 14

Treatment for De Quervain’s tenosynovitis

Answer 14

• Thumb spica splint
• NSAIDs
• Steroid injection (50% cure first time, 2nd 40-45%)

Question 15

Mallet finger symptoms

Answer 15

Decreased ability to extend distal finger

Question 16

Symptoms of a scaphoid fracture

Answer 16

• History of dorsiflexion wrist injury
• Pain near anatomical snuffbox
• Pain with motion and gripping

Question 17

After diagnosing a wrist fracture, which other joint should be examined?

Answer 17

Elbow

Question 18

Who is Dupuytren’s contracture most common in?

Answer 18

Northern European men aged 50+

Question 19

Carpal tunnel syndrome is associated with the wasting of these muscles

Answer 19

LOAF muscles
- lumbricals
- opponens pollicis
- abductor pollicis brevis
- flexor pollicis brevis

Question 20

Distal radial fragment displacement direction in a Colles fracture

Answer 20

Dorsal

Question 21

Pathophysiology of Dupuytren’s contracture

Answer 21

Nodular thickening and contracture of palmar fascia, leading to digital contractures
Associated causes:
- Decompensated liver cirrhosis
- Diabetes
- Alcohol/smoking
- Past/repeated trauma

Question 22

Symptoms of trigger finger

Answer 22

• Pain/snapping with digit flexion/extension
• Digit may lock

Question 23

Two conditions treated with a spica thumb splint

Answer 23

• De Quervain’s tenosynovitis
• Scaphoid fracture

Question 24

Treatments for Dupuytren’s contracture

Answer 24

• PT early
• Steroid injections early
• Surgery if late (contracted more than 30 degrees)

Question 25

Treatment for ganglion cysts

Answer 25

Surgical excision much more effective than aspiration (do not aspirate volar ganglion cysts)

Question 26

Risks associated with scaphoid fractures

Answer 26

High incidences of malunion and osteonecrosis due to limited blood supply

Question 27

Carpal tunnel syndrome is caused by the entrapment of this nerve

Answer 27

Median nerve

Question 28

A patient presents with these symptoms: - Pain and swelling over radial styloid - Pain with movement of thumb or making a fist - Noticeable creaking as tendon moves What does she have?

Answer 28

De Quervain's tenosynovitis

Question 29

Pathophysiology of trigger finger

Answer 29

Nodule on flexor tendon which can get trapped under pulley (A-1) limiting range of motion

Question 30

Flexion force impact on an extended DIP can lead to this condition

Answer 30

Mallet finger

Question 31

Scaphoid fracture treatment

Answer 31

Thumb spica splint, even if x-rays are normal

Question 32

What is the most commonly fractured carpal bone?

Answer 32

Scaphoid

Question 33

Describe a Galeazzi fracture

Answer 33

- Displaced distal radius fracture - Distal ulna dislocation

Question 34

Dupuytren's contracture and tigger finger are most common in these digits

Answer 34

Both in ring finger most often

Question 35

Treatment for carpal tunnel syndrome

Answer 35

- PT - Night splint for 3 weeks - Surgery: carpal tunnel release/cut (oral meds don't work and injections dangerous)

Question 36

Carpal tunnel syndrome is more common in this gender and this age

Answer 36

Women aged 45-60

Question 37

Physical exam test for scaphoid fracture

Answer 37

Very tender to palpation over anatomical snuffbox