Wrist and Hand

Question 1

Thenar

Answer 1

median - APB, Opp Poll, FPB
ulnar - Add Poll

C6-C7 - ABP, OP
C6-T1 - FPB
C8-T1 - Add Poll

Question 2

Hypothenar

Answer 2

Ulnar
C8 - Palm brev; C8-T1 all else

Palm brev, abd digit min, flex dig min brev, opp dig min

Question 3

Palmar

Answer 3

lumbricles - median/ulnar; C6-C8

IO - dorsal and palmar; ulnar, C8-T1

Question 4

Bishop’s Sign, Claw Hand

Answer 4

injury to ulnar nerve

Question 5

Drop Wrist

Answer 5

palsy of radial nerve

Question 6

Ape Hand

Answer 6

palsy of median nerve

Question 7

Boutonniere Deformity

Answer 7

DIP hypertext, PIP flex

Question 8

Swan Neck Deformity

Answer 8

DIP flex, PIP hyperext

Question 9

Dupuytren Contracture

Answer 9

tightening of fascia causing clawlike hand

Question 10

Median (forearm)

Answer 10

FCR, Palm long - C6-C7
FDP (and ulnar), FPL, Pro quad - C8-T1
FDS - C7-T1

Question 11

Ulnar (forearm)

Answer 11

FCU - C8-T1

Question 12

Radial (forearm)

Answer 12

C6-C7 - ECRL/B, AbPL, EPB

C6-C8 - ED, EDM, ECU, EPLO, EI

Question 13

Finklestein’s Test

Answer 13

DeQuervain’s syndrome

Question 14

Tinel’s Sign and Phalen

Answer 14

Carpal Tunnel

Question 15

Lunotriquetral Ballotment Test

Answer 15

instability of LT jt, possible dislocation

Question 16

Allen’s Test

Answer 16

dysfxn of radial or ulnar arteries

Question 17

MP Torsion/Grind/Compression, Transverse Compression Test

Answer 17

possible fx

Question 18

Bunnel Littler Test

Answer 18

intrinsic vs. capsular tightness

Question 19

Murphy’s Sign

Answer 19

dislocated lunate

Question 20

Valgus/Varus Stress Test

Answer 20

collateral ligament spain

Question 21

Fromet’s Sign

Answer 21

Add Poll paralysis

Question 22

Shuck, Press, Shear Tests

Answer 22

LT pathology

Question 23

TFCC Grind Test

Answer 23

TFCC lesion

Question 24

Piano Key

Answer 24

laxity of RU jt

Question 25

Wartenburg Sign

Answer 25

neuritis of superficial radial nerve

Question 26

After Tendon Repair/Laceration

Answer 26

initially strong, repair strength decreases 5-21 days after tensile strengthening generally begins around 3 weeks general blocking exercises initiated around 1 week A2 and A4 pulleys most important fails - adhesions/rupture lag sign - considered sign of tendon adherence, gliding impairment

Question 27

Trigger Finger (Stenosing Flexor Tenosynovitis) (CET)

Answer 27

C - two flexor strain (FDS and FDP), unable to slide smoothly under A1 pulley E - painful snapping, triggers after making full fist and trying to extend, palpable tendon nodule in thickened A1 pulley T - corticosteroid injection w/ anesthetic into flexor sheath

Question 28

Jersey Finger (ADP Avulsion) (CET)

Answer 28

C - forced ext of DIP during active flex, getting caught in jersey E - pain and swelling at volar DIP, unable to actively flex T - splint, and refer to surgeon

Question 29

Jersey Finger Protocol

Answer 29

0-10 days - dorsal blocking splint, wrist 30 flex, MCP 70 flex, PIP/DIP full ext Day 10-Wk 3 - DBS in neutral, MCP 50 flex Wk 3-5 - A/AAROM, place and hold exercises Wk 5-10 - strengthening/grasping, tendon gliding, DC splint wk 6, night splint until wk 8 Wk 10+ - aggressive ROM, strengthening, unrestricted activities

Question 30

Mallet Finger (Extensor Injury Zone 1) (CET)

Answer 30

C - avulsion of extensor tendon from DIP, forced flexion of finger tip E - extensor lag, pain at dorsal PIP T - cont splint DIP 6-10 wks (PIP free); 6 wk - night splint for 3 more weeks; splinting during sports for 6 more weeks splint - finger cannot drop into flex or must start over

Question 31

Central Slip Extensor Tendon Injury (Possible Boutonniere Deformity) (CET)

Answer 31

C - PIP forcibly flex while actively ext E - NO active ext, tender at dorsal middle phalanx T - splint full ext 6 wks Refer to MD if unable to ext after splint

Question 32

Collateral Ligament Injuries (Jammed PIP, usually) (CET)

Answer 32

C - forced ulnar or radial deviation at IP jt E - pain at ligament, inc varus/valgus T - buddy tape

Question 33

Guidelines for MC and P

Answer 33

``` early ROM and tendon gliding radiograph healing lags behind clinical presentation MCP in flex to avoid ext contractures IPs resting in full ext don't immobility > 3 weeks ```

Question 34

MC Fx

Answer 34

good blood supply, heal in 6 weeks (splint in position of function) wrist 30-60 ext, MCP 70 flex, IP 0-10 (not splint for Boxer's)

Question 35

Boxer's (5th MC Neck) Fx (CEIT)

Answer 35

C - punch that doesn't land on 2/3rd MC E - malposition when patient makes fist I - lat T - closed (hand splinted in ulnar gutter 3 weks, MCP 80 PIP straight DIP free) surgery - displacement > 40, percut pin, ORIF, 3 weeks protective splint

Question 36

Coach's Finger (PIP dislocation) (CET)

Answer 36

C - dorsal dislocation most common E - tender volar plate w/ deformity T - reduced and splinted in flex

Question 37

MCP Dislocation (CET)

Answer 37

C - force dorsally or volarly E - pain and swelling T - reduction and splint that prevents full ext

Question 38

Bennet Fx of Thumb (CIT)

Answer 38

C - adduction or fall on part flex thumb I - lat T - closed or open reduction, casting

Question 39

Gamekeeper's Thumb (UCL) (CEIT)

Answer 39

C - extreme valgus of thumb E - weakened key pinch, valgus stress testing I - plain films T - 30-35 rad dev indicated complete UCL tear = surgery Stener - possible complication, apon torn and occasionally entraps UCL

Question 40

Structures that provide ulnar stability of thumb

Answer 40

add apon, add poll, UCL, volar plate

Question 41

UCL Non-Op

Answer 41

initially - immobilized short arm splica cast w/ IP free Wk 3-4 - A/PROM of thumb Wk 6 - gripping continue bracing 2 mo in contact situations

Question 42

UCL Repair

Answer 42

3 wks - remove MCP in 6 wks - A/P (gentle) ROM of thumb, begin dynamic splinting if necessary 8 wks - DC splint, wrist/thumb static splint or short opponens splint for short; begin strengthening 3-4 mo - RTP

Question 43

Carpal Tunnel Synreom (CET)

Answer 43

C - inflammation of tendons and synovial sheaths, repeated wrist flex E - Phalen, Tinel's, medial compression, sensory changes, paresthesia T - non-op (prefab wrist splint in neutral) op (release)

Question 44

Carpal Tunnel Release

Answer 44

7 days - DC splint, gentle wrist/finger mvmt, ADLs only for 2 wks 2 wks - ROM and gradual strengthening 2-4 wks - pinch/grip strengthening, RTP if pain permits

Question 45

Bowler's Thumb

Answer 45

digital nerve injury from compression of bowling ball

Question 46

Hamate Fx (CET)

Answer 46

C - contact while athlete is holding sports implement, racquet, or club into ulnar side of hand E - wrist pain, weak, pt tender T - casting/immob 6-8 wks

Question 47

Scaphoid Fx (CEIT)

Answer 47

C - hypertext and rad dev of wrist E - tender snuffbox and tub; long compression I - P/L, oblique, ulnar flex PA; MRI T - Stable - 6 wks sugar tong (long arm) thumb splica followed by 6 wks short arm splica cast - Non/Min Displaced - percut fix w/ cannulated screws - Marked Displacement - ORIF RTP 18+ wks high risk of AVN

Question 48

Distal Rad Fx

Answer 48

Colles - dorsal angulation Smith - palmarly displaced Silver Fork - deformed w/ hand dorsally displaced Tx - wrist braced 4-6 wks

Question 49

DeQuervain Tenosynovitis (CET)

Answer 49

C - forceful grasp w/ uln dev (tennis serve) E - pain at rad aspect of wrist, Finklestein's, pain w/ turning T - immob in rad thumb splica splint

Question 50

TFCC (CEIT)

Answer 50

C - FOOSH, rot injury, repetitive axial loading E - ulnar side wrist, crepitus, pain w/ gripping and rad dev, shuck/shear/grind/press tests I - PA, lat, oblique w/ sh abd T - wrist brace 4-6 wks, RTP 3 mo

Question 51

Kienbach's Disease (CET)

Answer 51

AVN of lunate C - unknown (thought to be from fall) E - pain similar to sprained wrist, stiffness, dec grip strength, pain w/ sup T - early intervention is immob w/ cast, progressed - fusion or removal