Wrist / Hand Flashcards
what dorsal compartment is the ECU located within?
6th dorsal compartment
where does the ECU insert?
fifth MC base
with what two resisted motions will you test for subluxation of the ECU at the wrist?
resisted extension / ulnar deviation
what are the two general treatments for ECU tendinopathy?
extension splint and occupational therapy
what is the name for an open Salter Harris 1 distal phalangeal fracture?
Seymour fracture
t/f open fractures through the nailbed require urgent surgical debridement in the operating room
true
what is the typical treatment for displaced distal phalangeal shaft fracture?
surgical pinning
a patient sustains mallet finger injury with > 30% joint involvement. what is the next step?
surgical referral to consider restoration of joint congruity
a patient sustains a mallet finger injury with volar avulsion of the distal phalanx. what is the next step in treatment other than splinting?
surgical referral
t/f most patients with mallet finger injury will have some degree of extensor lag even with full compliance
true
what condition is characterized by traumatic avulsion of the FDP from the distal phalanx?
jersey finger
inability to flex the DIP joint is most indicative of what injury?
Jersey finger
what is the most specific physical exam finding for jersey finger?
loss of active DIP joint flexion
a patient experiences a jersey finger injury with bony avulsion. where is the most likely place in the flexor compartment that the tendon will retract to?
PIP joint at the level of the FDS tendon
if a patient experiences jersey finger with tendon retraction to the palm, what is the timeline for surgery?
7-10 days surgery should be performed
what is the most common dislocation pattern of the PIP (direction of dislocation of middle to proximal phalanx?)
dorsal dislocation of the middle phalanx
how long should a typical dorsal dislocation PIP injury be immobilized after reduction?
3 weeks
what soft tissue structure is almost always disrupted in a volar disclocation of the PIP joint?
central extensor slip
how should a volar PIP dislocation be immobilzed after reduction?
full PIP extension
t/f early follow up radiographs are mandatory for PIP dislocation s/p reduction
true
how long should reduced volar PIP dislocations be splinted in full extension to protect the central slip?
6 weeks
intraarticular head or base fractures of the metacarpals typically require what type of management?
surgical
non operative management for a metacarpal neck or shaft fracture will typically be done initially with what period of wrist / hand splint?
3-4 weeks
transverse fractures of the metacarpal shaft usually angulate dorsally by pull of what muscles?
interossei
what two metacarpals are more prone to rotational deformity from fracture due to lack of surrounding ligamentous stabilizers?
2nd/5th
where does the central slip of the extensor tendon insert?
dorsal base of the middle phalanx
central slip extensor tendon injury tends to result in what deformity?
boutonniere
t/f in an injury to the central extensor slip, if left untreated, the lateral bands will migrate palmarly
true
what physical exam test can be used to assess the integrity of the central extensor slip?
Elson test - digit placed on a table with PIP flexed over the edge - patient attempts active extension of the PIP joint
t/f in the treatment of central extensor slip injury, immobilization should encompass the PIP in full extension but leave the DIP to allow active flexion/extension
true
what motion of the PIP joint is contraindicated during the treatment / recovery from central extensor slip injury?
flexion
a tuft fracture or displaced phalangeal shaft fracture usually presents with what external sign?
subungual hematoma
a non displaced, stable fracture of the phalanx can usually be treated with custom splinting and ROM exercises over what period of time?
2-3 weeks
displaced distal phalangeal shaft fractures are unstable and often require what?
surgery - pin fixation
in an injury to the thumb UCL ligament avulsion will most often happen from what portion of the ligament?
insertion at the base of the proximal phalanx
what is a Stener lesion of the thumb?
avulsion of the UCL ligament and interposition of the adductor pollicus between the torn ligament and the insertion, preventing healing
to determine the integrity of the UCL ligament of the thumb, valgus stress should be applied with what degrees flexion of the proximal phalanx?
30 degrees
for a partial tear of the thumb UCL resulting in minimal laxity, how long should the MCP and IP be immobilized? in what type of splint?
4-6 weeks, thumb spica splint
what is the treatment for a Stener lesion?
surgery
if a UCL lesion of the thumb completely heals, what is the normal return to play window?
2-3 months
what is the difference between simple and complex dislocation of the thumb?
simple - can be reduced manually
complex - requires open reduction to remove interposed tissue
what is the typical MOI of an MCP joint dislocation?
hyperextension
most MCP dislocations occur with the proximal phalanx moving in what direction relative to the metacarpal?
dorsal
a volar skin “dimple” near the A1 pulley after hyperextension injury to the MCP joint is pathognomonic for what type of injury?
complex dislocation
in what type of MCP joint dislocation will the proximal phalanx appear 70 -90 degrees hyperextended?
simple
up to what percentage of MCP joint dislocations have an associated fracture?
50%
for a simple dislocation of the MCP in the fingers 2-5, how long should the joint be immobilized following reduction?
2 weeks
for a thumb MCP joint dislocation, how long should rigid immobilization occur after reduction? how long should subsequent splinting to protect against forced hyperextension last?
4 weeks rigid immobilization followed by 2 weeks of protection against hyperextension
t/f most second to fifth CMC dislocations require closed or open reduction with surgical pinning
true
what is the typical time of RTP to gripping or hand contact after CMC joint dislocation?
6-8 weeks
where would you palpate the proximal pole of the scaphoid for tenderness?
at the scapholunate junction just distal to the dorsal radial tubercle
t/f for scaphoid injury, forced passive wrist extension produces pain at a fracture site
true
in what type of dislocation does the lunate remain in place relative to the radius while the capitate dislocates relative to the lunate?
perilunate dislocation
what is the treatment for displaced scaphoid fracture?
surgery
t/f management of non displaced scaphoid waist fracture is controversial as there are similar union rates and functional results when non operative immobilization is compared to percutaneous screw fixation
true
how is a proximal pole scaphoid fracture treated?
surgically
what is the MOI of perilunate injury?
wrist hyperextension and ulnar deviation during axial loading
lunate dislocation volarly can cause deficit in what nerve?
median nerve
what measurement of widening between the scaphoid and the lunate may indicate scapholunate ligament tear?
> 3mm
what is the treatment for all acute perilunate fractures and dislocations?
surgical repair
what is the most common MOI for distal radius fracture?
FOOSH
dorsal displacement in conjunction with distal radius fracture results in what type of deformity?
dinner fork deformity
dorsally displaced distal radius fracture pose risk to what nerve structure?
median nerve
t/f < or equal to 10 degrees of dorsal tilt of the articular surface is generally considered acceptable for displacement of distal radius extraarticular fractures in the skeletally mature
true
t/f for an intraarticular pattern distal radius fracture, most practitioners generally accept < or equal to 2mm gap or 1mm step off at the joint surface
true
what is the minimum amount of recovery time for a distal radius fracture prior to RTP?
4-6 weeks
participation in contact sports or load bearing after distal radius fracture is precluded until what is evident?
stable union of the fracture site
