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OCS prep (TQ) > Wrist and hand (OCS-A summary) > Flashcards

Wrist and hand (OCS-A summary) Flashcards

1
Q

What are the muscles of the thenar eminence with innervation? (4)

A
  • adductor pollicis (ulnar)
  • abductor pollicis brevis (median)
  • flexor pollicis brevis (median and ulnar)
  • opponens pollicis (median)
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2
Q

What are the muscles of the hypothenar eminence with innervation? (3)

A
  • abductor digiti minimi (ulnar)
  • flexor digiti minimi (ulnar)
  • opponens digiti minimi (ulnar)
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3
Q

What is the action of the lumbricals with innervation?

A
  • actively flexes MCPs, with passive PIP/DIP extension
  • 1st/2nd - median
  • 3rd/4th - ulnar
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4
Q

What are the actions of the interossei with innervation?

A
  • palmar interossei - adduction (PAD)
  • dorsal interossei - abduction (DAB)
  • ulnar innervation
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5
Q

What is the sequence of the proximal and distal carpal bones?

A
  • proximal: scaphoid, lunate, triquetrum, pisiform
  • dorsal: trapezium (“um, Thumb”), trapezoid, capitate, hamate

(She, Likes, To, Park)
(Tiny, Toy, Cars, Here)

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6
Q

Which carpal bone is most commonly fractured?

A
  • scaphoid
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7
Q

What is a carpal attachment for the flexor retinaculum that is often fractured?

A
  • hook of hamate
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8
Q

Which carpal bone is most important structurally for the rest of the carpals?

A
  • capitate; it’s a keystone
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9
Q

What is a normal angle of inclination at the distal forearm (radius/ulna)?

A
  • 15-20*

- radius is longer than ulna

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10
Q

What are normal ROMs for wrist:

  • flexion
  • extension
  • radial deviation
  • ulnar deviation
A
  • flexion: 80-90*
  • extension: 70-80*
  • radial deviation: 15*
  • ulnar deviation: 30-45*
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11
Q

The MCP collateral ligaments are taut with:

A
  • abd/add
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12
Q

MCP volar plates are taut with:

A
  • extension; resist hyperextension
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13
Q

Which ligament for the 1st CMC helps avoid dorsal subluxation?

A
  • dorsoradial ligament

- strongest ligament for the 1st CMC

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14
Q

The TFCC is on what side of the wrist?

A
  • attaches the ulnar styloid process to the edge of the radiocarpal articular surface
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15
Q

What muscles are associated with DeQuervain’s tendinopathy?

A
  • abductor pollicis longus
  • extensor pollicis brevis
  • both lie in the radial styloid space
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16
Q

What’s the difference in action between the flexor digitorum profundus and superficialis?

A
  • profundus flexes both PIP and DIP

- superficialis only flexes PIP

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17
Q

How many pulleys are there in the hand? Which are considered most important for hand function?

A
  • 3 cruciate pulleys and 5 annular pulleys per finger (different for thumb)
  • A2 and A4 are considered most important
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18
Q

Which pulley is often resected with a trigger finger?

A
  • A1
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19
Q

“Bowstringing” is seen at the PIP. What is the likely cause?

A
  • A2 failure; will likely have reduced flexion in the finger as well
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20
Q

What is supplied by the anterior interosseous nerve? What nerve does it branch from?

A
  • flexor pollicis longus
  • flexor digitorum profundus
  • pronator quadratus
  • branch of the median nerve
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21
Q

Where is Guyon’s canal? What is the result of entrapment in this region? What activity is associated with compression in this region?

A
  • between the pisiform and hook of hamate
  • ulnar nerve can become compressed, leading to sensation loss and intrinsic hand weakness
  • associated with cycling
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22
Q

What is supplied by the posterior interosseous nerve? What nerve does it branch from?

A
  • all extensors except extensor carpi radialis longus
  • supinator
  • abductor pollicus longus
  • radial nerve
23
Q

What is the blood supply for the distal scapoid?

A
  • superficial and deep branches of the radial artery
24
Q

What does the Finklestein test look for? How is it performed?

A
  • Dequervain’s tendinitis
  • Clench fist and ulnarly deviate
  • pain in APL and EPB tendons
25
Q

What is similar to Dequervain’s in presentation? What is the difference?

A
  • intersection syndrome
  • pain in intersection syndrome is more proximal (~1/3rd up the forearm from the wrist), and more likely to have pain with wrist extension
26
Q

What is the CPR for potential scaphoid fx? (i.e., want imaging)

A
  • TTP at snuffbox
  • TTP at scaphoid tubercle
  • TTP with scaphoid longitudinal compression
  • high sensitivity
27
Q

What’s the difference between a Smith and Colles fracture?

A
  • both are distal radius fractures, associated with FOOSH
  • Smith: fall with wrist FLEXED; distal radius angles VOLARLY (SV; alphabetical)
  • Colles: fall with wrist EXTENDED; distal radius angles DORSALLY; dinner fork (CD)
  • defined by the direction the distal fragment is displaced; makes sense with MOI
28
Q

What is Kienbock’s disease? What is the general demographic? What type of imaging can detect it?

A
  • AVN of the lunate
  • associated with middle aged men, trauma, or medical conditions that affect blood supply (anemia, steroids, pancreatitis)
  • can detect more advanced AVN with X-ray (triangular shape), but best w/ MRI
29
Q

What’s a Boxer’s fx vs Gamekeeper’s thumb?

A
  • Boxer’s fx: fracture of the neck of the MC, most commonly the 5th
  • Gamekeeper’s: avulsion or sprain of the UCL of the MCP, often presenting with hyperextension
30
Q

Describe thumb movements.

A
  • abduction: thumb moves in a palmar direction, away from the plane of the hand
  • adduction: thumb moves from the palm, dorsally toward the plane of the fingers
  • flexion: thumb moves in the plane of the hand toward the 5th digit
  • extension: thumb moves in the plane of the hand, away from the other digits
  • opposition: thumb moves towards a finger
  • makes sense in cardinal planes if you align the palm of the hand with the sagittal plane, facing away from the body
31
Q

How does the scapholunate angle related to instability?

What is an appropriate test?

A
  • > 70* is dorsal instability
  • <30* is volar instability
  • due to ligament tears in the proximal carpal row
  • Scapholunate dissociation test: stabilize the lunate and mobilize the scaphoid, looking for gross instability or reproduction of pain with forearm pronated
32
Q

What is a Bennett fx?

A
  • fracture of the base of the 1st MC

- usually requires ORIF

33
Q

What is the presentation for a Bishop’s deformity? Ape hand? Drop wrist?

A
  • Bishop’s: ulnar n. palsey; inability to fully extend 4th/5th digits, with hypothenar wasting
  • Ape: median n. palsey; unable to extend 2nd/3rd digits, with thenar wasting
  • drop wrist: radial n. palsey; unable to extend wrist

** of note, the median/ulnar n. palseys have different presentations depending on distal vs proximal impingement

34
Q

What is the presentation of a Mallet finger deformity?

A
  • avulsion fx at the base of the DIP, or tear of the extensor digitorum of any digit
  • DIP flexion
35
Q

How many flexor tendon zones are there? What is a key zone for prognosis?

A
  • 5 zones, numbered distal to proximal

- injury in zone 2 has poor prognosis due to poor blood supply

36
Q

How many extensor zones are there?

A
  • 8
37
Q

What is the standard care for injury at extensor zone 1-2? What is presentation?

A
  • mallet finger

- splint up to 8 weeks, then can begin gentle DIP ROM

38
Q

What is the standard of care for injury at extensor zone 3-4? What is the presentation?

A
  • Central slip injury

- splint for 6 weeks, but can use DIP AROM during splinting

39
Q

What is a concern for injury for extensor zone 7?

A
  • at higher risk for scar formation; a dorsal wrist injury
40
Q

What is a 5 variable CPR for carpal tunnel?

A
  • shaking hands produces symptom relief
  • Wrist ratio index >0.67
  • symptom severity scale > 1.9
  • reduced median nerve sensory perception at 1st digit
  • age >45
  • if all 5 present, +LR = 18.3
  • if 4, +LR = 4.6
  • if 3, +LR = 2.1
41
Q

What is normal for monofilament testing? What is considered loss of protective sensation?

A
  • normal: 2.83

- loss of protective sensation: 4.56

42
Q

What are 2 keys to rehab post tendon repair at the hand/wrist?

A
  • early protective motion is important to prevent adhesions or stiffness
  • splinting position should place the affected tendon on slack
43
Q

What is the presentation for a Jersey finger?

A
  • lack of DIP flexion, due to FDP tear or avulsion
44
Q

What is the intrinsic plus splinting position?

A
  • MCP flexion, with PIP and DIP extension
45
Q

What is the difference between a Boutonniere and Swan Neck deformity?

A
  • Boutonniere: PIP flexion with DIP hyperextension

- Swan neck: PIP hyperextension with DIP flexion

46
Q

If scissoring or cross over effect is seen with MC fracture, what is the concern?

A
  • could indicate a MC rotational deformity, which should be addressed prior to continuing therapy
47
Q

What is Dupuytren’s? What deformity is it associated with?

A
  • contracture of the palmar fascia
  • can create cords and flexion contractures of the MP or PIP
  • more common in males of European descent
  • can lead to Boutonniere deformity
  • managed with surgery/injection/manipulation
48
Q

What is trigger finger?

A
  • locking of digit during active flexion due to A1 thickening. More common in women. Typically idiopathic.
  • often managed with conservative care; tendon glides, splinting, injection, but can use surgery
49
Q

What is Froment’s sign?

A
  • excessive thumb IP flexion during gripping task (holding piece of paper) due to ulnar nerve injury
50
Q

What are the outcomes for surgery vs conservative care for CTS?

A
  • surgery is often more favorable than conservative care due to the concern for prolonged nerve compression
51
Q

What is nail clubbing concerning for?

A
  • pulmonary disorder such as fibrosis or CA. Yellowed clubbing is concerning for lung CA
  • of note, clubbing is NOT associated with COPD
52
Q

What is spoon nails concerning for?

A
  • soft nails that look scooped out

- sign of iron deficiency or liver disorder

53
Q

What is tripe hand? What is it concerning for?

A
  • rough, thickened, velvety appearance of the palms

- highly associated with visceral malignancy or lung CA

OCS prep (TQ) (25 decks)

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