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SCS Prep > Wrist and Hand > Flashcards

Wrist and Hand Flashcards

1
Q

Thenar

A

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

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

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2
Q

Hypothenar

A

Ulnar
C8 - Palm brev; C8-T1 all else

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

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3
Q

Palmar

A

lumbricles - median/ulnar; C6-C8

IO - dorsal and palmar; ulnar, C8-T1

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4
Q

Bishop’s Sign, Claw Hand

A

injury to ulnar nerve

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5
Q

Drop Wrist

A

palsy of radial nerve

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6
Q

Ape Hand

A

palsy of median nerve

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7
Q

Boutonniere Deformity

A

DIP hypertext, PIP flex

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8
Q

Swan Neck Deformity

A

DIP flex, PIP hyperext

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9
Q

Dupuytren Contracture

A

tightening of fascia causing clawlike hand

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10
Q

Median (forearm)

A

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

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11
Q

Ulnar (forearm)

A

FCU - C8-T1

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12
Q

Radial (forearm)

A

C6-C7 - ECRL/B, AbPL, EPB

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

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13
Q

Finklestein’s Test

A

DeQuervain’s syndrome

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14
Q

Tinel’s Sign and Phalen

A

Carpal Tunnel

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15
Q

Lunotriquetral Ballotment Test

A

instability of LT jt, possible dislocation

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16
Q

Allen’s Test

A

dysfxn of radial or ulnar arteries

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17
Q

MP Torsion/Grind/Compression, Transverse Compression Test

A

possible fx

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18
Q

Bunnel Littler Test

A

intrinsic vs. capsular tightness

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19
Q

Murphy’s Sign

A

dislocated lunate

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20
Q

Valgus/Varus Stress Test

A

collateral ligament spain

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21
Q

Fromet’s Sign

A

Add Poll paralysis

22
Q

Shuck, Press, Shear Tests

A

LT pathology

23
Q

TFCC Grind Test

A

TFCC lesion

24
Q

Piano Key

A

laxity of RU jt

25
Q

Wartenburg Sign

A

neuritis of superficial radial nerve

26
Q

After Tendon Repair/Laceration

A

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

27
Q

Trigger Finger (Stenosing Flexor Tenosynovitis) (CET)

A

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

28
Q

Jersey Finger (ADP Avulsion) (CET)

A

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

29
Q

Jersey Finger Protocol

A

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

30
Q

Mallet Finger (Extensor Injury Zone 1) (CET)

A

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

31
Q

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

A

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

32
Q

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

A

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

33
Q

Guidelines for MC and P

A 
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
34
Q

MC Fx

A

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)

35
Q

Boxer’s (5th MC Neck) Fx (CEIT)

A

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

36
Q

Coach’s Finger (PIP dislocation) (CET)

A

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

37
Q

MCP Dislocation (CET)

A

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

38
Q

Bennet Fx of Thumb (CIT)

A

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

39
Q

Gamekeeper’s Thumb (UCL) (CEIT)

A

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

40
Q

Structures that provide ulnar stability of thumb

A

add apon, add poll, UCL, volar plate

41
Q

UCL Non-Op

A

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

42
Q

UCL Repair

A

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

43
Q

Carpal Tunnel Synreom (CET)

A

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)

44
Q

Carpal Tunnel Release

A

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

45
Q

Bowler’s Thumb

A

digital nerve injury from compression of bowling ball

46
Q

Hamate Fx (CET)

A

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

47
Q

Scaphoid Fx (CEIT)

A

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

48
Q

Distal Rad Fx

A

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

49
Q

DeQuervain Tenosynovitis (CET)

A

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

50
Q

TFCC (CEIT)

A

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

51
Q

Kienbach’s Disease (CET)

A

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

SCS Prep (16 decks)

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