Wrist / Hand

Question 1

what dorsal compartment is the ECU located within?

Answer 1

6th dorsal compartment

Question 2

where does the ECU insert?

Answer 2

fifth MC base

Question 3

with what two resisted motions will you test for subluxation of the ECU at the wrist?

Answer 3

resisted extension / ulnar deviation

Question 4

what are the two general treatments for ECU tendinopathy?

Answer 4

extension splint and occupational therapy

Question 5

what is the name for an open Salter Harris 1 distal phalangeal fracture?

Answer 5

Seymour fracture

Question 6

t/f open fractures through the nailbed require urgent surgical debridement in the operating room

Answer 6

true

Question 7

what is the typical treatment for displaced distal phalangeal shaft fracture?

Answer 7

surgical pinning

Question 8

a patient sustains mallet finger injury with > 30% joint involvement. what is the next step?

Answer 8

surgical referral to consider restoration of joint congruity

Question 9

a patient sustains a mallet finger injury with volar avulsion of the distal phalanx. what is the next step in treatment other than splinting?

Answer 9

surgical referral

Question 10

t/f most patients with mallet finger injury will have some degree of extensor lag even with full compliance

Answer 10

true

Question 11

what condition is characterized by traumatic avulsion of the FDP from the distal phalanx?

Answer 11

jersey finger

Question 12

inability to flex the DIP joint is most indicative of what injury?

Answer 12

Jersey finger

Question 13

what is the most specific physical exam finding for jersey finger?

Answer 13

loss of active DIP joint flexion

Question 14

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?

Answer 14

PIP joint at the level of the FDS tendon

Question 15

if a patient experiences jersey finger with tendon retraction to the palm, what is the timeline for surgery?

Answer 15

7-10 days surgery should be performed

Question 16

what is the most common dislocation pattern of the PIP (direction of dislocation of middle to proximal phalanx?)

Answer 16

dorsal dislocation of the middle phalanx

Question 17

how long should a typical dorsal dislocation PIP injury be immobilized after reduction?

Answer 17

3 weeks

Question 18

what soft tissue structure is almost always disrupted in a volar disclocation of the PIP joint?

Answer 18

central extensor slip

Question 19

how should a volar PIP dislocation be immobilzed after reduction?

Answer 19

full PIP extension

Question 20

t/f early follow up radiographs are mandatory for PIP dislocation s/p reduction

Answer 20

true

Question 21

how long should reduced volar PIP dislocations be splinted in full extension to protect the central slip?

Answer 21

6 weeks

Question 22

intraarticular head or base fractures of the metacarpals typically require what type of management?

Answer 22

surgical

Question 23

non operative management for a metacarpal neck or shaft fracture will typically be done initially with what period of wrist / hand splint?

Answer 23

3-4 weeks

Question 24

transverse fractures of the metacarpal shaft usually angulate dorsally by pull of what muscles?

Answer 24

interossei

Question 25

what two metacarpals are more prone to rotational deformity from fracture due to lack of surrounding ligamentous stabilizers?

Answer 25

2nd/5th

Question 26

where does the central slip of the extensor tendon insert?

Answer 26

dorsal base of the middle phalanx

Question 27

central slip extensor tendon injury tends to result in what deformity?

Answer 27

boutonniere

Question 28

t/f in an injury to the central extensor slip, if left untreated, the lateral bands will migrate palmarly

Answer 28

true

Question 29

what physical exam test can be used to assess the integrity of the central extensor slip?

Answer 29

Elson test - digit placed on a table with PIP flexed over the edge - patient attempts active extension of the PIP joint

Question 30

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

Answer 30

true

Question 31

what motion of the PIP joint is contraindicated during the treatment / recovery from central extensor slip injury?

Answer 31

flexion

Question 32

a tuft fracture or displaced phalangeal shaft fracture usually presents with what external sign?

Answer 32

subungual hematoma

Question 33

a non displaced, stable fracture of the phalanx can usually be treated with custom splinting and ROM exercises over what period of time?

Answer 33

2-3 weeks

Question 34

displaced distal phalangeal shaft fractures are unstable and often require what?

Answer 34

surgery - pin fixation

Question 35

in an injury to the thumb UCL ligament avulsion will most often happen from what portion of the ligament?

Answer 35

insertion at the base of the proximal phalanx

Question 36

what is a Stener lesion of the thumb?

Answer 36

avulsion of the UCL ligament and interposition of the adductor pollicus between the torn ligament and the insertion, preventing healing

Question 37

to determine the integrity of the UCL ligament of the thumb, valgus stress should be applied with what degrees flexion of the proximal phalanx?

Answer 37

30 degrees

Question 38

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?

Answer 38

4-6 weeks, thumb spica splint

Question 39

what is the treatment for a Stener lesion?

Answer 39

surgery

Question 40

if a UCL lesion of the thumb completely heals, what is the normal return to play window?

Answer 40

2-3 months

Question 41

what is the difference between simple and complex dislocation of the thumb?

Answer 41

simple - can be reduced manually complex - requires open reduction to remove interposed tissue

Question 42

what is the typical MOI of an MCP joint dislocation?

Answer 42

hyperextension

Question 43

most MCP dislocations occur with the proximal phalanx moving in what direction relative to the metacarpal?

Answer 43

dorsal

Question 44

a volar skin "dimple" near the A1 pulley after hyperextension injury to the MCP joint is pathognomonic for what type of injury?

Answer 44

complex dislocation

Question 45

in what type of MCP joint dislocation will the proximal phalanx appear 70 -90 degrees hyperextended?

Answer 45

simple

Question 46

up to what percentage of MCP joint dislocations have an associated fracture?

Answer 46

50%

Question 47

for a simple dislocation of the MCP in the fingers 2-5, how long should the joint be immobilized following reduction?

Answer 47

2 weeks

Question 48

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?

Answer 48

4 weeks rigid immobilization followed by 2 weeks of protection against hyperextension

Question 49

t/f most second to fifth CMC dislocations require closed or open reduction with surgical pinning

Answer 49

true

Question 50

what is the typical time of RTP to gripping or hand contact after CMC joint dislocation?

Answer 50

6-8 weeks

Question 51

where would you palpate the proximal pole of the scaphoid for tenderness?

Answer 51

at the scapholunate junction just distal to the dorsal radial tubercle

Question 52

t/f for scaphoid injury, forced passive wrist extension produces pain at a fracture site

Answer 52

true

Question 53

in what type of dislocation does the lunate remain in place relative to the radius while the capitate dislocates relative to the lunate?

Answer 53

perilunate dislocation

Question 54

what is the treatment for displaced scaphoid fracture?

Answer 54

surgery

Question 55

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

Answer 55

true

Question 56

how is a proximal pole scaphoid fracture treated?

Answer 56

surgically

Question 57

what is the MOI of perilunate injury?

Answer 57

wrist hyperextension and ulnar deviation during axial loading

Question 58

lunate dislocation volarly can cause deficit in what nerve?

Answer 58

median nerve

Question 59

what measurement of widening between the scaphoid and the lunate may indicate scapholunate ligament tear?

Answer 59

>3mm

Question 60

what is the treatment for all acute perilunate fractures and dislocations?

Answer 60

surgical repair

Question 61

what is the most common MOI for distal radius fracture?

Answer 61

FOOSH

Question 62

dorsal displacement in conjunction with distal radius fracture results in what type of deformity?

Answer 62

dinner fork deformity

Question 63

dorsally displaced distal radius fracture pose risk to what nerve structure?

Answer 63

median nerve

Question 64

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

Answer 64

true

Question 65

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

Answer 65

true

Question 66

what is the minimum amount of recovery time for a distal radius fracture prior to RTP?

Answer 66

4-6 weeks

Question 67

participation in contact sports or load bearing after distal radius fracture is precluded until what is evident?

Answer 67

stable union of the fracture site