Wrist and Hand Flashcards
Tenosynovitis / tendonosis of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB)
De Quervain’s syndrome
Overuse of the thumb
De Quervain’s syndrome
De Quervain’s syndrome occurs more in?
females
(less stability and smaller radial tunnel)
- Weak, painful grip
- Weak thumb extension
- Finkelstein test
De Quervain’s syndrome
Rest and immobilization are effective in _____ of patients and Corticosteroid injection help _____.
25 to 72%, ~60%
“Squeaker” syndrome, AKA
Intersection syndrome
d/t odd squeak-like crepitus
and “wet leather” crepitus on motion
Intersection syndrome
Intersection syndrome involves tenosynovitis of the…
radial wrist extensors
- extensor carpi radialis longus (ECRL)
- extensor carpi radialis brevis (ECRB)
Intersection syndrome
Weightlifters, Tennis players and Skiers (Pole use)
Out-pouching from carpal synovium, bursa or tendon sheath
Ganglion Cysts
65% of Ganglion Cysts are over the
scapholunate ligament
what % of cysts come back after aspiration?
60
Genetic condition causing contracture of the deep fascia of the hand
Dupuytren’s Disease
M>F, ages 40-60, ulnar side of the hand more commonly affected
Dupuytren’s Disease
Associated with Northern European ancestry, chronic alcoholism, DM, epilepsy and chronic pulmonary disease.
Dupuytren’s Disease
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.
Dupuytren’s Disease
Dupuytren’s surgical treatment
Fasciectomy with zigzag stitch
local anaesthetic
complications of Dupuytren’s surgery
Scar Mobility, Nerve damage, Infection / Skin Necrosis, Reflex Sympathetic Dystrophy, Pain and Stiffness
traumatic disruption of terminal extensor tendon of DIP
Mallet Finger
Baseball/Drop finger
treatment for mallet finger with Fx
K-wire (Kirschner) open fixation or button technique with interosseous wire
treatment for mallet finger without Fx
splint in neutral or slight hyperextension
Stack, Aluminum, Sugar Tong Alumifoam, Custom Thermoplastic
mallet finger can lead to what deformity?
swan neck
Week 0-6 splinting timeline for Mallet finger
continuous splint; change tape a lot.
Week 6-7 splinting timeline for Mallet finger
same as 0-6 but begin active flexion to 20-25 degrees.
Week 7-8 splinting timeline for Mallet finger
same with up to 35 degrees of flexion.
Week 8-12 splinting timeline for Mallet finger
night splinting only (if no extension lag) and begin mild exercise.
Week 12 splinting timeline for Mallet finger
unrestricted use
Fibrous nodule, typically in a flexor tendon.
trigger finger
diabetics are at a high risk for?
trigger finger
In trigger finger the nodule slides under the
annular ligament
trigger finger pain is worse with
AROM and passive stretch of involved tendon
trigger finger pain on AROM
Conservative care
trigger finger Pain + “click”
Conservative care
Steroids
trigger finger Pain + “sticking”
Steroids
trigger finger Pain + “locking”
surgical
95% short term relief for trigger finger and 50% “cure” rate
Steroids
trigger finger surgical
complications include
tendon contracture
trigger finger spinlting for
7-21 days
Fracture-dislocation of the first metacarpal base where the metacarpal articulates with the trapezium.
Bennett’s fracture
the fragment in Bennett’s Fx remains intact with the carpometacarpal joint by the
volar anterior oblique ligament.
MOI for Bennets Fx
thumb forced backward (abduction) with partial flexion of the MCP
Common in basketball, skiers and fist fights.
Bennett’s fracture
Bennett’s Fracture should be treated conservatively or referred out?
refer to hand specialist
Acute instability of the ulnar collateral ligament
Skier’s Thumb
Gamekeeper’s Thumb
most common soft tissue injury to the thumb
Gamekeeper’s Thumb
Gamekeeper’s Thumb occurs by forceful
abduction and extension of the MP joint
After a complete tear of the 1st MCP UCL, the adductor aponeurosis separates the proximal and distal stumps, preventing ligament healing
Stener lesion
tender fullness or lump on ulnar MCP head or neck is highly suggestive of a
Stener lesion
For Gamekeeper’s Thumb stress in full _______ (accessory ligament) and 30 degrees of _____ (UCL)
extension, flexion
hyper-extended PIP and flexed DIP
Swan Neck Deformity
at what stage of Swan Neck Deformity is operative reduction required?
Stage IV
Common extensor tendon is damaged and a palmar dislocation occurs
Boutonniere Deformity
flexed PIP and hyper-
extended DIP
Boutonniere Deformity
In Boutonniere Deformity the PIP slips through the
common extensor tendon
Boutonniere Deformity Treatment is
Extension splint (dynamic-late or static-early).
0-4 weeks Extension splint
PIP @ 0 degrees, others free 24 hours/day. Exercise passive PIP extension and DIP flexion.
4-8 weeks Extension splint
Gentle AROM as above in dynamic splint.
10-12 weeks Extension splint
Gentle full fist stretching for all joints. Continue bracing DIP flexion for up to 5 months.
Avulsion of Flexor Digitorum Profundus usually from hyper-extension of a flexed finger.
Jersey Finger
SURGICAL
after Dorsal dislocations the Inability to move the joint signifies
fracture or incomplete reduction
in-game Dorsal dislocations can be
buddy-taped
Complete collaterl l. rupture are those in which stressing the collaterals produces more than
20° of deviation.
After collateral reduction, it is critical to hold the PIP joint in full
extension.
Collateral l. injury taped in flexion will result in a
Boutonniere deformity
Hyperextension or dorsal dislocation
Volar Plate Injury
Volar Plate injury treatment
block splint
- 4 ws
- start at 30 deg flexion
Fracture of the metacarpal neck (usually fifth)
Boxer’s Fx
Most common Fx of the carpals (70%)
Scaphoid Fx
Scaphoid Fx MOI
FOOSH (not sprain)
snuffbox pain and weak grip
Scaphoid Fx (FOOSH)
All suspected scaphoid Fx with negative initial films should be
splinted for 10-14 days and re-radiographed
% of properly treated scaphoids that go bad?
10
The m/c dislocated wrist bone and 3rd m/c fractured.
Xrays usually negative initially
lunate
if suspected lunate Fx
immobilize and re-xray in 2-3wks
associated with increased risk for TFCC injury (if positive) or Kienbock’s avascular necrosis of the lunate (if negative)
“Ulnar variance”
avascular necrosis of the lunate
Kienbock’s disease
njury to the TFCC is often seen in chiros who _________ during adjustments
“load and torque”
Conservative Rx for TFCC injury 0-6 weeks
Long arm cast or long arm splint
Conservative Rx for TFCC injury 6 weeks
ROM exercises and immobilization splint
Conservative Rx for TFCC injury 8 weeks
strengthening (not torsion)
Radial Styloid; tension forces sustainedduring ulnar deviation/supination
Chauffeur’s Fracture
The distal fracture fragment is displaced volarly (ventrally).
Smith’s Fracture
“Garden Spade” deformity
Smith’s Fracture
m/c found after falling on to the back of the hand.
Smith’s Fracture
Any fracture of the distal radius that has dorsal displacement
Colle’s Fracture
“Silver fork deformity”
Colle’s Fracture
