Wrist and Hand Flashcards by Larry Yan

Name 2 types of distal radius fractures

1) Colles fracture

2) Smith fracture

How well did you know this?

Not at all

Perfectly

Describe a Colles fracture

Fracture 1.5” proximal to distal end of radius

How well did you know this?

Not at all

Perfectly

With a Colles fracture, what can occur in more than 50% of cases?

Could include fracture into radiocarpal joint and/or avulsion fracture of the ulnar styloid in more than 50% of cases

How well did you know this?

Not at all

Perfectly

Distal Radius Fractures: Complications-Residual symptoms occur in what % of patients?

20% of patients

How well did you know this?

Not at all

Perfectly

Distal Radius Fractures: Complications-Significant functional impairments in what % of patients?

10% of patients

How well did you know this?

Not at all

Perfectly

Distal Radius Fractures: Complications-What are most of these complications due to?

Malalignment/malunion of fragments resulting in joint incongruity

How well did you know this?

Not at all

Perfectly

Distal Radius Fractures: Complications-Residual dorsal tilting of radius > how many degrees? Loss of inward tilt of the articular surface of > degrees? -> poor functional results

Residual dorsal tilting of radius > 5 degrees, loss of inward tilt of the articular surface of > 3 degrees -> poor functional results

How well did you know this?

Not at all

Perfectly

Distal Radius Fractures: Complications-Shortening the radius of __ mm and/or residual dorsal tilt of the articualr surface results in increased axial load to the __ shaft leading to DJD and pain in the ulnar aspect of the wrist

Shortening the radius of 2.5 mm and/or residual dorsal tilt of the articualr surface results in increased axial load to the ulnar shaft leading to DJD and pain in the ulnar aspect of the wrist

How well did you know this?

Not at all

Perfectly

Distal Radius Fractures: Complications-__ dysfunction

DRUJ dysfunction

How well did you know this?

Not at all

Perfectly

Distal Radius Fractures: Complications-__ arthritis

Radiocarpal arhritis

How well did you know this?

Not at all

Perfectly

Distal Radius Fractures: Complications-__ instabilities

Midcarpal instabilities

How well did you know this?

Not at all

Perfectly

Distal Radius Fractures: Complications-Loss of __ __ and __

Loss of grip strength and ROM

How well did you know this?

Not at all

Perfectly

Distal Radius Fractures: Complications-And this is always a complication!

Pain

How well did you know this?

Not at all

Perfectly

Distal Radius Fractures: Complications-__ contractures

Intrinsic contractures

How well did you know this?

Not at all

Perfectly

Distal Radius Fractures: Complications-Limited tendon __

excursion

How well did you know this?

Not at all

Perfectly

Distal Radius Fractures: Complications-Rupture of this muscle

Extensor Pollicus longus

How well did you know this?

Not at all

Perfectly

Distal Radius Fractures: Complications-Nerve compression and irritation of these 3 nerves

1) median nerve
2) Radial nerve
3) Ulnar nerve

How well did you know this?

Not at all

Perfectly

Distal Radius Fractures: Complications-Name 3 “diseases”

1) Reflex Sympathetic Dystrophy (RSD)
2) Complex Regional Pain Syndrome
3) Causalgia

How well did you know this?

Not at all

Perfectly

Clinical findings of RSD?

Burning pain -severe dyasesthesias (which means abnormal feeling)

How well did you know this?

Not at all

Perfectly

RSD-What will it look like?

1) Edema

2) Discoloration

How well did you know this?

Not at all

Perfectly

RSD-Name 2 types of changes

1) Vasomotor/trophic changes

2) Sudomotor changes (of, relating to, or being nerve fibers controlling the activity of sweat glands)

How well did you know this?

Not at all

Perfectly

RSD-What two other complications?

1) Soft tissue contractures

2) Joint stiffness

How well did you know this?

Not at all

Perfectly

Smith Injury-What is the major complication?

Median nerve injury

How well did you know this?

Not at all

Perfectly

Distal Radius Fractures: Name 3 factors influencing fracture management

1) Mechanism of injury
2) Anatomical location
3) Relationship of fragments (Degree of comminution/displacement)

How well did you know this?

Not at all

Perfectly

Distal Radius Fractures:Medical Management-stable fractures use this

cast immobilization

Distal radius fractures: Name the 4 phases of rehabilitation

1) Early healing phase/Immobilization phase 2) Intermediate phase/post immobilization phase 3) Late Remodeling phase 4) Radiographic healing complete->No restrictions

Phase I, II, III, or IV? Goals include: Protect/support/control pain, prevent loss of ROM of non-immobilized joints, maintain tendon excursion, control edema, monitor for signs of infection/nerve compression/RSD, optimize function, maintain posture

Phase I

Phase I, II, III, or IV? Goals include: Support/protect healing structures, increase wrist ROM, restore soft tissue length and mobility

Phase II

Phase I, II, III, or IV? Goals include: Corect joint contractures, maximize soft tissue length/mobility, improves

Phase III

Phase I, II, III, or IV? Goals include: Return to Full function

Phase IV

Rehabilitation phase? Callus formation, fracture enough to withstand AROM, cast is removed

Phase II

Rehabilitation phase? Fracture defect bridged by fibrous bone-fracture clinically healed and able to withstand PROM, strengthening exercises and dynamic splinting

Phase III

Rehabilitation phase? No restrictions

Phase IV

What type of fractures make up 60-70% of all carpal fractures?

Scaphoid fractures

70% of scaphoid fractures occur is which part of the bone?

70% in the middle of the bone

Scaphoid fractures-Rate of healing is influenced by what?

Influenced by the location of fracture

Scaphoid fracture-The entire blood supply to the scaphoid enters through this location

distal pole

Scaphoid fracture-Which fracture location heals slower?

Proximal pole heal slower than fractures of the distal pole

Scaphoid fracture-Clinical Findings: Radiological findings always present early on?

Not always present early on

Scaphoid fracture-Clinical Findings: History of high force __ __

History of high force hyperetension injury

Scaphoid fracture-Clinical Findings: Pain in __ __ region

Pain in snuff box region

Scaphoid fracture-Clinical Findings: Decreased __ __ strength

Decreased pinch grip strength

Scaphoid fracture: In order to heal a scaphoid fracture, requires these 3 things:

1) Coaptation of fragments 2) Adequate blood supply 3) Early Dx and adequate Rx: immobilization from tie of injury until union is established

Scaphoid fractures: Name 3 complications

1) High incidence of non-union 2) AVN of proximal pole 3) OA

Scaphoid fractures: Scaphoid non-union, name 2 extrinsic factors

1) Delayed Diagnosis | 2) Inadequate immobilization

Scaphoid fractures: Scaphoid non-union, suggested times for immobilization for proximal pole, middle 1/3 and distal 1/3

Proximal pole - up to 30 weeks Middle 1/3 - 6-12 weeks Distal 1/3 - 4-8 weeks

Scaphoid fractures: Scaphoid non-union/Evaluation: History of __, Symptoms: could be asymptomatic unitl __ develops, Pain/swelling, reduced __ strength, limited __ (wrist DF/PF and RD with overstress)

History of falls on outstretched hand, Symptoms: could be asymptomatic unitl DJD develops, Pain/swelling, reduced grip strength, limited ROM (wrist DF/PF and RD with overstress)

Scaphoid fractures: Scaphoid non-union/intrinsic factors: What happens after fragments of > 1 mm? 2) What occurs between the proximal and distal carpal rows?

1) Displacement | 2) Instability

Lunate fracture-Which pole is mostly affected?

Volar pole of the bone

Lunate fracture-Complications?

Kienbock's disease->AVN of lunate from repeated trauma

Lunate fracture-Name 3 predisposing factors of Kienbock's AVN of lunate

1) Pattern of intrinsic blood supply 2) Negative ulnar variance 3) Radial slope

Kienbock's AVN-Clinical findings: Age? More males or females?

age 20-40, Male: female - 2:1

Kienbock's AVN-Clinical findings: Decreased __ and __

grip strength and ROM

Kienbock's AVN of the lunate-Medical Treatment: How is treated? Be specific

Treated surgically with immobilization with external fixator

UCL injury of thumb is also known as...

1) Skiers thumb | 2) Gamekeeper's thumb

MOI of UCL injury of thumb?

Forced or reptitive radial deviation of thumb

Name 3 complications for a UCL injury

1) Chronic laxity leading to DJD 2) Decreased pinch and grip strength 3) Pain

Name 7 diagnosis for Thumb UCL injury

1) History of forced thumb abduction/thumb sprains 2) Complaint of ulnar sided MCP joint pain 3) Complaints of weakness in pinch/grip 4) Decreased key and tip pinch strength 5) Decreased grip strength 6) Pain/swelling 7) Occassionally a palpable mass

Name 2 diagnosis for thumb UCL injuries that involve degrees

1) Instability =>15 degrees of valgus deformity with ulnar stress to the thumb MCP joint as compared to teh uninvolved side 2) Testdone with joint in 15-20 degrees of flexion and full flexion

Name 3 methods of treatment for a UCL injury

1) Splinting 2) Casting 3) Surgical repair of ligament

Name 3 indications for surgical intervention for thumb UCL injury

1) Complete rupture of UCL 2) UCL injury with fracture that is rotated, displaced,or interarticular 3) Stener Lesion- the aponeurosis of the adductor pollicis muscle becomes interposed between the ruptured UCL of the thumb and its site of insertion at the base of hte proximal phlanx. No longer in contact with its insertion site, the UCL cannot spontaneously heal

Name 3 methods of surgical intervention for thumb UCL injuries

1) Direct reinsertion of ligament onto bone (primary repair less than 6 weeks post injury) 2) Tendon transfers (adductor pollicis/palmaris longus for delayed repair/chronic instability 3) Fusion of MCP joint

UCL surgical repair prognosis-What % of full function with surgeryand time frame? What can lead to a poor porgnosis?

1) 96% - full function with surgery < 3 weeks post injury | 2) Poor prognosis for repairs done > 6 weeks

Carpal Tunnel Syndrome (CTS) - Define

Median nerve compression within the carpal tunnel

Carpal Tunnel Syndrome (CTS) - Related to these 2 things

1) Volumetric increases of contents of the tunnel | 2) Decreases of the dimensions of the tunnel

Which test will you be positive with CTS?

Positive tinnels

CTS-Weakness occurs distally or proximally?

Distally

CTS-Name 3 causes of CTS

1) Changes in anatomical structures/trauma 2) Underlying systemic or physiological disorders 3) Repeated microtrauma due to reptitive use of the UE

CTS-Pressures within the carpal tunnel with various wrist positions.....Neutral, 20* flexion, 44* flexion, 20* extension

1) Neutral - 20 mmHg 2) 20* flexion - 35 mmHg 3) 44* flexion - 45 mmHg 4) 20* extension - 30 mmHg

CTS-Ratio of females:males?

3:1

CTS-Read this list of associated disorders/confounding factors with CTS

1) DM 2) RA 3) Thyroid disease 4) Obesity 5) Pregnancy/menopause 6) Tumors 7) tendency for tenosynovitis 8) postural disoders/injuries 9) Nutritional deficits

CTS-Name 3 tests

1) Phalen's test - reproduces neurosensory symptoms (place dorsal side of hands down and together) 2) Tinnel test at carpal tunnel, test for paresthesiae....tap the median nerve 3) Semmes Weinstein

CTS-What is double crush syndrome? Give an example

When you have 2 types of syndromes affecting the same nerve (CTS + TOS)

CTS-Name 2 ways of diagnosis. Are they conclusive?

1) Electrophysiological studies | 2) EMG/NCV studies could be inconclusive

CTS-Name 3 indications for surgical treatment

1) Conservative treatment > 6 months with no help 2) Severe symptoms interfering with sleep and function 3) Clinical and electrophysiological evidence of median nerve dysfunction

CTS-Surgery-1) What happens 3-19% of the time? 2) What happens to grip/pinch strength and dexteriy for up to 25 months? 3) What happens to wrist strength to 10-30% of patients?

1) complications/treatment failures 2) Decreased 3) Loss

CTS-Surgery-7 factors Interfering with success: 1) Age? 2) Pre-op symptoms? 3) NCV? 4) Blood? 5) abuse? 6) labor? 7) Poor mental health

1) > 65 2) Severe 3) Poor NCV results 4) Hemodialysis 5) ETOH abuse/smoking 6) Heavy labor 7) Poor mental health

CTS-How is the surgery performed?

Release of the transverse retinacular ligament (open or arthroscopic)

CTS-Name 3 complications from surgery

1) Nerve adherence 2) Hypersensitivity 3) Pillar pain

What is De Quervain's Tenosynovitis?

Inflammation of the tendon sheath of the APL and EPB

What is De Quervain's Tenosynovitis attributed to?

Attributed to excessive friction between the two tendons

What is the diffference between tendinitis and tenosynovitis?

Inflammation of the synovial tract

Name 5 De Quervain's Tenosynovitis associated factors

1) DM 2) Hypothyroidism 3) pregnancy 4) RA 5) Gender

Name 3 symptoms and clinical findings for De Quevain's Tenosynovitis: 1) Thumb flex/ext/combination of forearm twisting with forceful gripping? 2) radial syloid? 3) Strength?

1) Reptitive 2) Trauma 3) Decreased

3 Clinical findings of De Quervain's Tenosynovitis: 1) Base of the thumb? 2) resisted extension of thumb MCP joint? 3) Finkelstein's?

1) Pain/swelling/heat 2) c/o pain 3) Positive