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Tri 6 - MSK ll (Tom) > Wrist and Hand > Flashcards

Wrist and Hand Flashcards

1
Q

Tenosynovitis / tendonosis of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB)

A

De Quervain’s syndrome

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2
Q

Overuse of the thumb

A

De Quervain’s syndrome

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3
Q

De Quervain’s syndrome occurs more in?

A

females

(less stability and smaller radial tunnel)

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4
Q
  • Weak, painful grip
  • Weak thumb extension
    • Finkelstein test
A

De Quervain’s syndrome

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5
Q

Rest and immobilization are effective in _____ of patients and Corticosteroid injection help _____.

A

25 to 72%, ~60%

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6
Q

“Squeaker” syndrome, AKA

A

Intersection syndrome

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7
Q

d/t odd squeak-like crepitus

and “wet leather” crepitus on motion

A

Intersection syndrome

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8
Q

Intersection syndrome involves tenosynovitis of the…

A

radial wrist extensors

  • extensor carpi radialis longus (ECRL)
  • extensor carpi radialis brevis (ECRB)
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9
Q

Intersection syndrome

A 
Weightlifters, Tennis players
and Skiers (Pole use)
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10
Q

Out-pouching from carpal synovium, bursa or tendon sheath

A

Ganglion Cysts

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11
Q

65% of Ganglion Cysts are over the

A

scapholunate ligament

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12
Q

what % of cysts come back after aspiration?

A

60

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13
Q

Genetic condition causing contracture of the deep fascia of the hand

A

Dupuytren’s Disease

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14
Q

M>F, ages 40-60, ulnar side of the hand more commonly affected

A

Dupuytren’s Disease

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15
Q

Associated with Northern European ancestry, chronic alcoholism, DM, epilepsy and chronic pulmonary disease.

A

Dupuytren’s Disease

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16
Q

Gradual onset –> one ore more small tender lumps in the palm –> Tough bands of tissue form that cause one or more fingers to bend toward the palm.

A

Dupuytren’s Disease

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17
Q

Dupuytren’s surgical treatment

A

Fasciectomy with zigzag stitch

local anaesthetic

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18
Q

complications of Dupuytren’s surgery

A

Scar Mobility, Nerve damage, Infection / Skin Necrosis, Reflex Sympathetic Dystrophy, Pain and Stiffness

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19
Q

traumatic disruption of terminal extensor tendon of DIP

A

Mallet Finger

Baseball/Drop finger

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20
Q

treatment for mallet finger with Fx

A

K-wire (Kirschner) open fixation or button technique with interosseous wire

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21
Q

treatment for mallet finger without Fx

A

splint in neutral or slight hyperextension

Stack, Aluminum, Sugar Tong Alumifoam, Custom Thermoplastic

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22
Q

mallet finger can lead to what deformity?

A

swan neck

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23
Q

Week 0-6 splinting timeline for Mallet finger

A

continuous splint; change tape a lot.

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24
Q

Week 6-7 splinting timeline for Mallet finger

A

same as 0-6 but begin active flexion to 20-25 degrees.

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25
Q

Week 7-8 splinting timeline for Mallet finger

A

same with up to 35 degrees of flexion.

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26
Q

Week 8-12 splinting timeline for Mallet finger

A

night splinting only (if no extension lag) and begin mild exercise.

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27
Q

Week 12 splinting timeline for Mallet finger

A

unrestricted use

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28
Q

Fibrous nodule, typically in a flexor tendon.

A

trigger finger

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29
Q

diabetics are at a high risk for?

A

trigger finger

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30
Q

In trigger finger the nodule slides under the

A

annular ligament

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31
Q

trigger finger pain is worse with

A

AROM and passive stretch of involved tendon

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32
Q

trigger finger pain on AROM

A

Conservative care

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33
Q

trigger finger Pain + “click”

A

Conservative care

Steroids

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34
Q

trigger finger Pain + “sticking”

A

Steroids

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35
Q

trigger finger Pain + “locking”

A

surgical

36
Q

95% short term relief for trigger finger and 50% “cure” rate

A

Steroids

37
Q

trigger finger surgical

complications include

A

tendon contracture

38
Q

trigger finger spinlting for

A

7-21 days

39
Q

Fracture-dislocation of the first metacarpal base where the metacarpal articulates with the trapezium.

A

Bennett’s fracture

40
Q

the fragment in Bennett’s Fx remains intact with the carpometacarpal joint by the

A

volar anterior oblique ligament.

41
Q

MOI for Bennets Fx

A

thumb forced backward (abduction) with partial flexion of the MCP

42
Q

Common in basketball, skiers and fist fights.

A

Bennett’s fracture

43
Q

Bennett’s Fracture should be treated conservatively or referred out?

A

refer to hand specialist

44
Q

Acute instability of the ulnar collateral ligament

Skier’s Thumb

A

Gamekeeper’s Thumb

45
Q

most common soft tissue injury to the thumb

A

Gamekeeper’s Thumb

46
Q

Gamekeeper’s Thumb occurs by forceful

A

abduction and extension of the MP joint

47
Q

After a complete tear of the 1st MCP UCL, the adductor aponeurosis separates the proximal and distal stumps, preventing ligament healing

A

Stener lesion

48
Q

tender fullness or lump on ulnar MCP head or neck is highly suggestive of a

A

Stener lesion

49
Q

For Gamekeeper’s Thumb stress in full _______ (accessory ligament) and 30 degrees of _____ (UCL)

A

extension, flexion

50
Q

hyper-extended PIP and flexed DIP

A

Swan Neck Deformity

51
Q

at what stage of Swan Neck Deformity is operative reduction required?

A

Stage IV

52
Q

Common extensor tendon is damaged and a palmar dislocation occurs

A

Boutonniere Deformity

53
Q

flexed PIP and hyper-

extended DIP

A

Boutonniere Deformity

54
Q

In Boutonniere Deformity the PIP slips through the

A

common extensor tendon

55
Q

Boutonniere Deformity Treatment is

A

Extension splint (dynamic-late or static-early).

56
Q

0-4 weeks Extension splint

A

PIP @ 0 degrees, others free 24 hours/day. Exercise passive PIP extension and DIP flexion.

57
Q

4-8 weeks Extension splint

A

Gentle AROM as above in dynamic splint.

58
Q

10-12 weeks Extension splint

A

Gentle full fist stretching for all joints. Continue bracing DIP flexion for up to 5 months.

59
Q

Avulsion of Flexor Digitorum Profundus usually from hyper-extension of a flexed finger.

A

Jersey Finger

SURGICAL

60
Q

after Dorsal dislocations the Inability to move the joint signifies

A

fracture or incomplete reduction

61
Q

in-game Dorsal dislocations can be

A

buddy-taped

62
Q

Complete collaterl l. rupture are those in which stressing the collaterals produces more than

A

20° of deviation.

63
Q

After collateral reduction, it is critical to hold the PIP joint in full

A

extension.

64
Q

Collateral l. injury taped in flexion will result in a

A

Boutonniere deformity

65
Q

Hyperextension or dorsal dislocation

A

Volar Plate Injury

66
Q

Volar Plate injury treatment

A

block splint

  • 4 ws
  • start at 30 deg flexion
67
Q

Fracture of the metacarpal neck (usually fifth)

A

Boxer’s Fx

68
Q

Most common Fx of the carpals (70%)

A

Scaphoid Fx

69
Q

Scaphoid Fx MOI

A

FOOSH (not sprain)

70
Q

snuffbox pain and weak grip

A

Scaphoid Fx (FOOSH)

71
Q

All suspected scaphoid Fx with negative initial films should be

A

splinted for 10-14 days and re-radiographed

72
Q

% of properly treated scaphoids that go bad?

A

10

73
Q

The m/c dislocated wrist bone and 3rd m/c fractured.

Xrays usually negative initially

A

lunate

74
Q

if suspected lunate Fx

A

immobilize and re-xray in 2-3wks

75
Q

associated with increased risk for TFCC injury (if positive) or Kienbock’s avascular necrosis of the lunate (if negative)

A

“Ulnar variance”

76
Q

avascular necrosis of the lunate

A

Kienbock’s disease

77
Q

njury to the TFCC is often seen in chiros who _________ during adjustments

A

“load and torque”

78
Q

Conservative Rx for TFCC injury 0-6 weeks

A

Long arm cast or long arm splint

79
Q

Conservative Rx for TFCC injury 6 weeks

A

ROM exercises and immobilization splint

80
Q

Conservative Rx for TFCC injury 8 weeks

A

strengthening (not torsion)

81
Q

Radial Styloid; tension forces sustainedduring ulnar deviation/supination

A

Chauffeur’s Fracture

82
Q

The distal fracture fragment is displaced volarly (ventrally).

A

Smith’s Fracture

83
Q

“Garden Spade” deformity

A

Smith’s Fracture

84
Q

m/c found after falling on to the back of the hand.

A

Smith’s Fracture

85
Q

Any fracture of the distal radius that has dorsal displacement

A

Colle’s Fracture

86
Q

“Silver fork deformity”

A

Colle’s Fracture

Tri 6 - MSK ll (Tom) (9 decks)

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