Wrist/Hand

Question 1

What is mallet/baseball/drop finger? Mechanism? Structures involved? What type of splint is best?

Answer 1

damage to the extensor tendon of the finger when a ball or other object strikes the tip of the finger. Presents as a drooped finger. Unable to extend DIP (flexion deformity). An aluminum, stack, or ring splint are all equally efficacious.

Question 2

Boutonneriere deformity?

Answer 2

presents as flexion of the PIP joint, extension of the DIP joint. Caused by forceful blow to a bent finger, causing damage the central slip mechanism. Pt is unable to extend PIP.

Question 3

Jersey Finger

Answer 3

usu occurs in tackling sport, usu to ring finger. Causes forced extension of DIP during active flexion. FDP tendon injury, so pt will be unable to flex DIP.

Question 4

Gamekeepers Thumb/Skier’s Thumb

Answer 4

valgus force directed to thumb MCP joint that causes failure of ulnar collateral ligament (2nd digit side). Will present with pain at base of thumb.

Question 5

Swan neck deformity

Answer 5

DIP hyperflexion, PIP hyperextension. Can be caused by RA (volar plate injury) or untreated mallet finger.

Question 6

Bennett fracture

Answer 6

fx at base of thumb that extends into CMC joint. Usually associated with dislocation. Caused by fighting/punching.

Question 7

Name of the carpal bones of the hand

Answer 7

Scaphoid Lunate Triquetrum Pisiform Trapezium Trapezoid Capitate Hamate

Question 8

What is a stenar lesion? What is it associated with?

Answer 8

the proximal end of the UCL is trapped outside of the adductor aponeurosis. Associated with UCL injury.

Question 9

What runs through guyon’s canal?

Answer 9

ulnar nn and ulnar artery. Adjacent to carpal tunnel.

Question 10

What makes up the snuffbox and what’s inside?

Answer 10

APL, EPL, EPB. The scaphoid lies inside those borders.

Question 11

What joint is the stack splint appropriate to use with?

Answer 11

DIP only (looks like a shoe)

Question 12

What is the most commonly dislocated joint?

Answer 12

PIP (“coaches finger”)

Question 13

If finger joint dislocation is dorsally directed… what structures compromised? how should finger be splinted?

Answer 13

volar plate injured. Should be splinted in flexion to avoid full extension.

Question 14

If finger joint dislocation is volarly directed… what structures compromised?

Answer 14

dorsal structures injured. Should be splinted in extension to guard against full flexion.

Question 15

After dislocation + reduction, make sure the nailbeds of all the fingers are ____ and ____.

Answer 15

in the same plane and pointing toward the scaphoid

Question 16

boxer’s fracture

Answer 16

neck of 5th MC, splint in 70-90 degrees of flexion

Question 17

kienbock’s disease

Answer 17

AVN of lunate

Question 18

What is watson’s sign?

Answer 18

aka scaphoid shift test. Assess for scapholunate stability. Dorsally load the lunate and deviate wrist. (+) = pain and pop.

Question 19

Special tests for TFCC?

Answer 19

supination lift, piano key, grind test

Question 20

AIN vs PIN?

Answer 20

AIN is a branch of the median nerve and pt will be unable to make the OK sign with injury to AIN. PIN = branch of radial nerve.

Question 21

Preiser’s disease

Answer 21

AVN of scaphoid

Question 22

What is trigger finger?

Answer 22

thickening of flexor tendon sheath and inflammation of synovium. A1 pulley gets stuck and finger locks into flexion.

Question 23

Exclusive dermatomal area of median nerve?

Answer 23

tip of index finger

Question 24

Exclusive dermatomal area of ulnar nerve?

Answer 24

tip of pinky finger

Question 25

Safe position of hand splint/cast to limit ulnar shortening

Answer 25

wrist extension, MCP partial flexion, IP extension

Question 26

Colles fx vs smith’s fx

Answer 26

Colles = DORSAL angular displacement of distal radius, smith’s = VOLAR displacement

Question 27

What is cubital tunnel syndrome? Special tests?

Answer 27

entrapment of ulnar nerve at cubital tunnel. Special tests = tinels, pain with prolonged flexion, wartenbergs sign (inability to adduct 5th digit)

Question 28

Fromet’s sign

Answer 28

used to detect ulnar nerve lesion, resulting in loss of grip strength power.

Question 29

Murphey’s sign

Answer 29

make a fist, if head of 3rd MC is level with 2nd and 4th, the sign is positive for lunate dislocation

Question 30

Bunnell-littler test

Answer 30

measure PIP ROM with MCP joint flexed and extended. If the PIP has more ROM with flexion, the test is positive and indicative of intrinsic muscle tightness

Question 31

Role of the extensor slip?

Answer 31

extend the PIP joint