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T OCS > Wrist and hand > Flashcards

Wrist and hand Flashcards

1
Q

Dequervains Tenosynovitis

A

Anatomy involved” Brevis sandwich”

  • Extensor pollocis longus/Brevis, Abductor pollicis longus
  • (+) Finkelsteins test
  • most common overuse injury at wrist
  • stenosing 1st compartment (EPB, APL)
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2
Q

Treatment for Dequervains

A
  1. Rest during initial stage (25-72% cure rate)
  2. Thumb spica splint- leave IP free to move
  3. Cortisone injection
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3
Q

Intersection syndrome

A
  • Inflammatory condition of 1st and 2nd compartments, where they intersect ( APL/EPB (1st) and ECRL and ECRB)
  • 4-6 cm proximal to RC joint

Dx: extended wrist, circumduct thumb

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4
Q

Treatment for intersection syndrome

A
  1. Rest
  2. Activity modification
  3. Splinting
  4. NSAIDS
  5. injection
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5
Q

1st compartment

A
  1. Extensor Pollicis brevis

2. Abductor Pollicis longus

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6
Q

2nd compartment

A
  1. Extensor Carpi radialis longus

2. Extensor Carpi radialis brevis

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7
Q

Stener Lesion

A
  • UCL displaced under the adductor aponeurosis, healing cannot occur.
  • consult with Orthopedist
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8
Q

bennets fracture

A
  • Most common fx of 1st MC
  • MOI: axial compressive load on a flexed thumb
  • get proximal displacement of 1st metacarpal due to APL tendon attachment
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9
Q

Jersey Finger

A

Flexor digitorum profundus avulsion fx

  • MOI: forced hyperextension against active flexion (going to grab jersey)
  • most common at 4th MCP, sometimes 5th
  • Loss o AROM at DIP joint- “make a fist”- fingertip cant touch palm
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10
Q

Volar plate avulsion fx

A
  • volar plate fibrocartilage that reinforces joint capsule of MCP, PIP and DIP
  • prevents hyperextension– MOI extension
  • x-ray shows “V sign”
  • > 40% articular surface involved in fx, surgica stabilization needed.
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11
Q

6 criteria to dx wrist fx in ER

A
  1. Swollen
  2. Pain with palpation
  3. Pain with AROM flex or ext
  4. Pain with PROM flex or ext
  5. Pain with gripping
  6. Pain with supination
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12
Q

Most common carpal fx *

A

Scaphoid

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13
Q

Scaphoid fx *

A
  • x-ray usually negative, want MRI, CT, bone scan
    Special test: Axial load of thumb
  • palpate scaphoid in snuffbox with one hand, with other, take thumb and compress into snuffbox +LR of 49- Excellent! to rule in and out
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14
Q

Hook of hamate fx

A

MOI: abutment of hook of hamate on an object (golf club handle etc)

  • common in racket sports
  • cant use standard x-rays need carpal tunnerl and supinated oblique views
  • dx with CT and bone scan
  • EXCISION HAS BETTER OUTCOME THAN ORIF (7-10 week return to sport vs 12 weeks for cast)
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15
Q

AVN of lunate

A

AVN of lunateKienbocks disease

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16
Q

Scapholunate injury

A

MOst common wrist ligament injury
MOI: fall on pronated wrist, excessive wrist ext/ulnar dev
Special Test: Watson/scaphoid shift test
- palpate scaphoid on volar aspect of hand and give dorsal pressure
- extend and ulnarly deviate wrist and let go
- (+) for clunk/pain- because no lig integrity, no spring back and once pressure released, scaphoid flexes into radius

Tx: surgery primary

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17
Q

Lunotriquetrial injury

A

MOI: Foosh
Sx: ulnar sided wrist pain
Special test: Lunotriquetrial Shear test
- give dorsal pressure to triquetrium to shear lunate dorsally. (+) painful click with instability
x-ray usually normal,
Tx: conservative, immobilization 2/2 not usually progressing to arthritis
- persistent pain –> surgery

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18
Q

DRUJ and TFCC

A

TFCC primary stabilizer of DRUJ

  • consists of
  • dorsal and palmar radioulnar ligament
  • ulnolunate lig
  • ulnotriquetrial lig
  • disc

MOI: acute trauma (fall) FOOSH or sport related

Special tests: Supination lift test, press test (100% sen),
piano key sign, DRUJ ap/pa hypermobility, grind test

Tx: brace (wrist widget, compression tape to DRUJ, surgery)

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19
Q

Distal Radius Fx

A

Can be Smith, Colles or Barton Fx

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20
Q

Smith’s fx

A
  • “Dinner fork deformity”
  • volar displacement of distal radius
    Tx: ALL NEED REDUCTION
    Non-op- splint until swelling goes down then cast
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21
Q

Colles fx

A
  • fx of distal radius in a DORSAL direction (vs volar for smith’s)
  • also extraarticular fx (vs Barton’s)
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22
Q

Barton’s fx

A

Fx of distal radius in either a dosal or volar direction but it is an INTRAARTICULAR fx (vs smiths and colles)

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23
Q

Boxers fracture

A

fx of 5th MCP

Tx: splinting, non op > 90% success rate

24
Q

Bunnell Littler

A

Tests for intrinsic muscle tightness (lumbricles) vs joint capsular tightness

  • Test PIP flexion in both MCP flexion and ext
  • if there is more flexion with MCP flexed (lumbricles on slack) then intrinsic tightness (lumbricle)tightness is indiated
  • if there is the same ROM with MCP flexed or ext, think capsular tightness
  • normal is more PIP flexion with MCP ext
25
Q

Swan neck deformity

A
  • PIP hyperextension, DIP flexion

Tx: usually surgery

26
Q

Boutenniere’s

A
  • PIP flexion, DIP hyperextended

Rupture of central band, puts tension on distal phalanx causing it to hyperextend
Tx: conservative. Splinting and exercise

27
Q

OA at the hand CPR (5)

A
  1. Hand pain, aching or stiffness
  2. hard tissue enlargement of 2 or more of 10 selected joints
  3. < 3 cm swollen MCP joints
  4. Hard tissue enlargement of 2 more more DIP joints
  5. deformity of 2 or more of 10 selected joints
28
Q

Mallet Finger

A
  • avulsion of distal slip of extensor tendon
  • cant fully extend DIP actively
  • can passively extend DIP
    MOI: tip of finger into rapid forced flexion
29
Q

Compartment 3

A

Extensor Pollicis longus

30
Q

Compartment 4

A

Extensor digitorum, and extensor indices

31
Q

Compartment 5

A

Extensor digit minimi

32
Q

Compartment 6

A

Extensor carpi ulnaris

33
Q

What passes through the carpal tunnel

A

4 tendons of flexor digitorum superficialis
4 tendons of flexor digitorum profundis
1 tendon of flexor hallicis longus
1 median nerve

34
Q

Safe position for splinting of the hand

A

wrist extended
MCP slightly flexed
IP joints extended
thumb palmarly abducted

35
Q

Distal row vs proximal carpal row

A

distal row stable, very litte movement. Proximal row more mobile.

36
Q

Heberdens nodes

A

osteophyte that forms at DIP jt

37
Q

bouchards nodes

A

osteophytes that form at PIP joint

38
Q

Gamekeepers thumb

A

disruption of UCL at thumb; complete tear can lead to a steners lesion

39
Q

Carpal mechanics

A
  • proximal row moves opposite motion (with radial deviation, proximal row moves ulnarly)
  • Distal row moves in that same direction (with radial deviation, the distal row moves radially)
40
Q

concave/convex distal radius and carpal

A

CONCAVE distal radius on convex carpal

41
Q

Finger pulleys

A 
Either cruciate (3) or annular (5)
- they keep the tendons close to the bone (like traveling through a tunnel), if a pulley is ruptured tendon bowstrings
A2 and A4 pulleys MOST imPORTANT at the levels of the proximal and middle phalanges

Trigger finger can be at A1

42
Q

OK sign

A

AIN - anterior interosseus nerve lesion- brings pulp of fingers (tear shape) vs tip to tip circular shape

43
Q

2 strand flexor tendon repair

A

early passive protocol (Kleinert, duran)

44
Q

4, 6, 8 strand repair

A

active ROM protol early

45
Q

flexor tendon immobilization

A

slight wrist flexion, MP flexion, IP Ext

46
Q

VISI and DISI

A

Volar/Dorsal intercollated carpal instability- can lead to midcarpal row subluxation (lunate)- tilted in a dorsal direction (DISI)

47
Q

Depuytren’s disease

A

contracture of distal palmar crease fascia –> flexion contractures at MP or PIP joints

48
Q

Ape hand

A

Median nerve injury

49
Q

Claw hand

A

Ulnar nerve injury

50
Q

sign of benediction

A

high median nerve injury- ACTIVE test- looks like claw hand but claw hand is resting position. You ask pt to make a fist and then they go and present like claw hand., resting they look normal

51
Q

Carpal Tunnel prediction rule

A
  1. age > 45
  2. shaking hands relieves symptoms
  3. CTQuestionaire score > 1.9
  4. decreased thumb sensation
  5. Wrist ratio AP/ML > .67
52
Q

DISI injury

A

dorsal intercollated segmental instability
- Scapho-lunate lig injury
(think in relation to lunate)
- scaphoid normally wants to move volarly
- if there is a disruption to SL lig, the scaphoid will keep going volarly and the triquetrium are DORSAL in relation

53
Q

VISI injury

A

volar intercollagted segmental instability

  • triquetrial-lunate lig injury
  • normally triquetrium wants to keep moving dorsally
  • if there is damage to the TL lig, the SL lig still intact which wants to move volarly, Triquetrium moves dorsally, but all in relation to lunate
54
Q

Ligament of struthers injury

A

Pronator teres WEAKNESS to differentiate bw PT syndrome

  • pain at elbow
  • because its proximal to PT, PT is affected! weakness of PT and pain at elbow think L of struthers injury not PT!
55
Q

Recurrent branch of median N

A

2 LOAF

2 lumbricles
Opponens pollicus
Abductor pollicus brevis
Flexor pollicus brevis

56
Q

Froment’s sign

A

ULNAR NERVE ISSUE!
- KEY CHUCK GRIP!
(+) flexion of IP at thumb due to ADD pollicus weakness

57
Q

AIN innervations

A

think OK sign

  • flexor digitorum profundus
  • flexor pollicus longus
  • pronator quadratus

T OCS (16 decks)

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