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OCS > Wrist/Hand > Flashcards

Wrist/Hand Flashcards

1
Q

of metacarpals and phalanges

A

5 metacarpals
14 phalanges (each finger with 3, thumb with 2)
-base of each met is concave and head is convex

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2
Q

Thumb joint

A

-metacarpal has saddle shaped articular surface to accommodate trapezium

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3
Q

8 carpal bones

A

Distal: trapezium, trapezoid, capitate, hamate

Proximal row: scaphoid, lunate, triquetrum

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4
Q

Scaphoid

A
  • bridges the mid-carpal joint and is susceptible to fracture
  • receive it’s blood supply from a distal to proximal direction making proximal portions susceptible to avascular necrosis
  • long with a narrowed waist - “boat shaped” appearance
  • PA view
  • lateral radiograph shows normal resting alignment is flexed position compared to lunate
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5
Q

Lunate

A
  • PA view - quadrangular appearance
  • lateral view - more crescent shaped
  • Kienbock’s disease- avascular necrosis of the lunate
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6
Q

Triquetrum

A
  • large triangular shaped bone on ulnar side of proximal row

- pisiform is superimposed on the triquetrum

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7
Q

Hamate

A
  • unique hook extending volarly
  • hook is attachment point for flexor retinaculum on ulnar side
  • painful fractures
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8
Q

capitate

A
  • largest of the carpal bones

- keystone of transverse arch of wrist

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9
Q

Trapezoid

A

-very stable articulation with 2nd MC (2nd CMC joint), the capitate, and trapezium = most stable articulation of the carpus

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10
Q

Trapezium

A
  • found at base of thumb - location of mobile 1st CMC joint
  • distal surface is saddle joint matching the base of the MC
  • most mobile bone in the distal row
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11
Q

Ulnar variance

A
  • negative ulnar variance associated with Kienbock’s disease

- positive ulnar variance may lead to degenerative changes of TFCC

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12
Q

Triangular fibrocartilage

A
  • meniscus
  • susceptible to degenerative changes and acute tears
  • attaches medially to base of ulna styloid
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13
Q

DIP and PIP joint supports

A
  • articular capsule
  • fibrous collateral ligaments
  • thinner fan-like accessory ligaments
  • volar plate
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14
Q

Volar plate

A
  • thick and broad at the base of the distal bone of each joint, but form thinner long extensions onto proximal bone (“check reins”)
  • volar plate of PIP joints can avulse with hyperextension injuries or dislocations
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15
Q

Collateral ligaments

A
  • taut in flexion and extension for DIP

- taut only in extension for PIP

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16
Q

Hberden’s nodes and Bouchard’s nodes

A

Heberden’s nodes = DIP joint

  • Bouchard’s nodes = PIP joints
  • OA
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17
Q

MP joints

A
  • biaxial joints with flexion/extension as well as abd/add
  • collateral ligaments attach dorsolaterally on MC head and travel distally to volar lateral surface of proximal phalanx
  • collateral ligament is taut in flexion, but relaxed in ext
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18
Q

Normative values - pronation/supination

A

80-90*

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19
Q

Normative values - wrist flex/ext

A

Flex - 90*

Ext - 80*

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20
Q

Normative values - radial/ulnar deviation

A

Radial - 15-20*

Ulnar - 20-30*

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21
Q

Normative values - MC joint flex/ext

A

Flex - 85-90*

Ext - 30-45*

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22
Q

Normative values - MC abd/add

A

Abd - 20-30*

Add - 0*

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23
Q

Normative values - PIP Flex/ext

A

Flex - 100-110*

Ext - 0*

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24
Q

Normative values - DIP Flexion

A

70-80*

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25
Q

Normative values - Thumb CMC joint flex/abd

A

Flex - 20*

Abd 50-55*

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26
Q

Normative values - thumb MCP joint flex/ext

A

Flex - 50-55*

Ext - 0*

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27
Q

Normative values - Thumb IP Joint flex/ext

A

Flex - 80-85*

Ext - 0*

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28
Q

1st CMC joint

A
  • 1st MC and trapezium

- biaxial motion of palmar abduction

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29
Q

Dorsoradial ligament

A
  • strongest ligament for the 1st CMC joint

- major stabilizer to prevent dorsal subluxation of 1st MC

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30
Q

50% of wrist flex/ext occurs at which joints

A

inter-carpal or mid-carpal joint and radiocarpal joint

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31
Q

Weak link of the wrist

A

proximal carpal row

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32
Q

Extrinsic extensor compartments mneumonic

A

221211

of extensors within each of 6 compartments

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33
Q

1st compartment

A
  • APL
  • EPB
  • dequervain’s
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34
Q

2nd compartment

A
  • ECRL

- ECRB

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35
Q

3rd compartment

A

EPL

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36
Q

4th compartment

A

ED

-EI

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37
Q

5th compartment

A

-extensor digiti minimi (or quinti)

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38
Q

6th compartment

A
  • ulnar most tendon

- ECU

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39
Q

Extrinsic flexors of the wrist

A
  • FCU
  • FCR
  • FDP
  • FDS

FDS tendons stack on top of FDP tendons in 2 rows of 2

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40
Q

FDS tendons

A
  • split into 2 slip with seach attaching to a ridge on the edges of the volar middle phalanx
  • FDP tendon passes through the middle of these 2 slips to attach to the distal phalanx base
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41
Q

Pulleys

A
  • arranged in an X - “cruciate pulleys”
  • or arranged in a circle - “annular pulleys”
  • 3 cruciate pulleys: C1, C2, C3
  • 5 annular pulleys - A1-A5

MOST IMPORTANT: A2 and A4 - these maintain integrity of system

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42
Q

Dorsal interrossei

A
  • group of 4 bipennate muscles arising from metacarpals and inserting on proximal phalanges
  • abduct index and ring finers away from long finger
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43
Q

Palmar interossei

A
  • group of 3 unipennate muscles arising from MC of index, ring, and small fingers
  • attach to base of each proximal phalanx
  • 1st palmar interossei is found on ulnar side of 2nd MC and acts to adduct index finger
  • 2nd and 3rd arise from radial sides of ring and small MCs and adduct fingers towards long finger
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44
Q

Hypothenar intrinsic muscles

A
  • abductor digit minimi
  • flexor digiti minimi
  • opponens digiti minimi
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45
Q

Thenar eminence

A

4 muscle groups:

  • APB
  • opponens pollicis
  • FPB
  • AP
46
Q

Anterior interosseous nerve

A
  • from median nerve

- innervates FPL, FDP to index and long fingers, and pronator quadratus

47
Q

Ulnar nerve

A
  • travels through cubital tunnel an dinnervates FCU and FDP to ring and small fingers
  • divides into superficial and deep branch when it enters guyon’s canal
48
Q

Radial nerve

A
  • ECRL

- posterior interosseous nerve innervates all other dorsal extrinsic muscles

49
Q

TTP radial styloid

A
  • fracture
  • de quervain’s
  • arthritis
  • radial nerve neuritis
50
Q

TTP scaphoid

A
  • fracture
  • AVN
  • scapholunate ligament injury
51
Q

TTP thumb

A
  • fracture
  • sprain/tendon injury
  • gamekeeper thumb (ulnar aspect of thumb MP joint)
52
Q

TTP 1st CMC joint

A

-OA

53
Q

TTP scaphoid-trapezium-trapezoid joint

A

-scaphoid-trapeziium-trapezoid synovitis or arthritis

54
Q

TTP 1st dorsal compartment (APL, EPB)

A
  • de quervain

- tendon rupture

55
Q

TTP 3rd dorsal compartment (EPL)

A

-EPL tendon rupture or tendonitis

56
Q

PROM > AROM more than 10*

A

-weakness or tendon adhesions

57
Q

AROM = PROM

A

-similar and accompanied by capsular end feel = joint or capsular restriction

58
Q

Grip dynamometer - 5 handle positions

A

-when using all 5 positions, a graph of grip measurements should form a bell shaped curve if patient exerts maximal effort and has no median or ulnar nerve injury

59
Q

Finkelstein test

A

-De Quervain’s
+ = produes pain
-perform in stages
-sn 100%, sp 100%

60
Q

Differentiating de quervain’s from intersection syndrome

A
  • by noting location of patient’s symptoms
  • in intersection syndrome, patient will c/o pain 4 cm from wrist, more proiximal than dorsal and then 1st dorsal compartment
  • also test for intersection syndrome by resisting wrist extension
61
Q

1st CMC grind test

A
  • compress 1st MC into trapezium using axial load and rotate

- sn 42-53%, sp 80-93%

62
Q

Scaphoid shift test

A
  • palpate scaphoid tubercle and passively ulnar deviate and extend patient’s wrist
  • while applying pressure, move into radial deviation and flexion
  • relief of pressure causes scpahoid to reduce with palpable clunk
    • = clunk and recreates patient’s symptoms
  • sn 69%,, sp 66%
63
Q

Scapholunate ballottement test

A

-patient’s forearm pronated
-stabilize lunate with thumb and index finger, with other hand grasp scaphoid and move scaphoid on lunate dosrally and volarly
+ = recreates patient’s pain, laxity, crepitus

64
Q

Finger extension test

A

-patient’s wrist and MP joints flexed, resist long finger extension at MP joint
+ = pain in 3rd and 4th dorsal compartments indicates an occult dorsal wrist ganglion
-sn 100%

65
Q

Scaphotrapeziototrapezoid joint instability/arthritis

A

-patient’s wrist and forearm in neutral
-apply pressure to scaphoid tubercle while radially and ulnar deviating the wrist
+ = pain

66
Q

Lunotriquetral ballottement test

A

-forearm pronated, palpate lunate with 1 hand and pisotriquetral complex with other - move pisotriquetral complex dorsally and volarly while stabilizing lunate
+ = pain or laxity/clicking/crepitus
-sn 64%, sp 44%

67
Q

Ulnar fovea sign

A

-disruptions of DRUJ ligaments
-patient’s wrist and forearm in neutral, palpate “soft spot” bw ulnar styloid, FCU tendon, volar surface of ulnar head and pisiform
+ = pain
-Sn 95%, sp 87%

68
Q

TFCC load

A
  • ulnarly deviate wrist and apply an axial load through wrist and ulna, move carpals on ulna volarly and dorsally
    • = reproduces pain or leads to crepitus
69
Q

Ulnocarpal instability

A
  • suspennt’s forearm in pronation away from exam table - observe position of carpals in relation to ulnar styloid
    • = ulnar aspect of carpals “sag” volarly and a prominent ulnar head
70
Q

Pisiform boost test

A
  • forearm in a vertical position and neutral rotation - push pisiform dorsally while translating ulnar head volarly
    • = reproduces patient’s symptoms or excess laxity
  • Sn 66%, sp 64%
71
Q

Piano key sign (DRUJ instability)

A
  • patient’s forearm in neutral, stabilize radius and press ulnar styloid in a volar direction
  • when pressure is released, + = ulna will “spring” back up to its original position
72
Q

Piano key test (DRUJ balottement)

A
  • stabilize radius and apply volar and dorsal overpressure to the ulna in pronation, supination, and with forearm in a neutral position
  • compare bilaterally and compare for pain/laxity
    • = pain or laxity
73
Q

(B) test for subluxation of DRUJ

A
  • forearm in pronation, palpate dorsal DRUJ with index finger and place long fingers on ulnar head - rotate patient’s forearms
  • compare movement between raidus and ulna between the 2 sides
  • sn 90-100%
74
Q

Ulnar compression test (DRUJ inflammation or arthritis)

A
  • comperss ulnar head into sigmoid notch of radius
  • combine compression with pronation and supination
    • = patient’s symptoms
75
Q

Extensor carpi ulnaris sublux

A

-palpate ECU tendon with wrist in slight ulnar deviation, have patient slowly rotate forearm
+ = ECU tendon snaps or pain

76
Q

Midcarpal instability

A

-patient’s wrist in neutral and forearm in pronation, apply volar directed force at capitate and simaltaneously load the wrist axially and ulnarly deviate
+ = painful clunk

77
Q

Pisotriquetral grind test

A
  • palpate pisiform and apply a dorsal pressure - apply a volar counter pressure to triquetrum
    • = pain
78
Q

Ulnar collateral ligament stress test (skier thumb or gamekeeper thumb)

A

-apply a valgus stress to MP joint of thumb at 0* and 30* flexion, laxity of greater than 30-40* with valgus stress or more than 15* greater than CL side = positive for rupture

79
Q

Collateral ligament stress test

A
  • most often used to test integrity of collateral ligament of PIP joints
  • examine UCL - apply valgus force to joint
  • examine radial collaeral ligament - apply varus force
  • perform with joint in 0* ext and 30* PIP flexion
    • = pain or laxity
80
Q

bunnel - littler test (intrinsic muscle tightness or contracture)

A

-hold patient’s wrist in extension an dMP joint of test finger in hyperextension
-measure passive PIP joint flexion
-flex MP joint and reassess PIP joint flexion
+ = PIP joint motion increases with MP joint flexion

81
Q

Allen test (vascular disorder)

A
  • ask patient to open and close fist several times while compression radial and ulnar arteries at the wrist
  • ask patient to open hand - should be white and blanched
  • release one of the arteries and observe bblood flow back into the hand
  • repeat entire process for other artery
    • = sluggish revascularization or does not revascularize
82
Q

Tinel sign for CTS

A
  • tap over median nerve at carpal tunnel
    • = reproduction of paresthesia
  • sn 50%, sp 77%
83
Q

Tinel sign for cubital tunnel syndrome

A
  • tap over cubital tunnel between medial condyle of humerus and olecrenon
    • = paresthesia in ulnar nerve distribution
  • sn 54%, sp 99%
84
Q

Tinel sign for compression at superficial sensory branch of radial nerve

A
  • tap at the radial styloid

- + = paresthesia in corresponding nerve distribution

85
Q

Phalen test (CTS)

A
  • extension patient’s elbow and allow the wrist to flex and fingers to extend for 60 seconds
  • result in (+) if paresthesia develops
  • sn 68%, sp 73%
86
Q

OK sign (AIN lesion)

A

-patient makes OK sign
-look for IP joint flexion of thumb and DIP joint flexion of index finger
+ = patient brings

87
Q

Froment sign

A
  • ulnar nerve lesoin
  • have patient hold index card using key pinch and try to pull card away
  • positive = ip joint of thumb flexes indicating use of FPL muscle due to weakness or loss of aP and FPB (deep head) muscles
88
Q

Scratch collapse test

A

-nerve lesion
-scratch patient’s skin over the area supplied by the nerve with suspected compression, while patient performs resisted shoulder ER bilaterally.
+ = brief loss of muscle resistance

89
Q

Tendon injury - surgery

A

read about this

90
Q

most commonly fractured bone in the body

A
  • distal phalanx of digits
91
Q

Tuft fractures

A
  • distal phalanx fractures

- often comminuted

92
Q

Mallet finger deformity

A
  • terminal tendon of extensor mechanism is disrupted

- could be just soft tissue or could be bone avulsed

93
Q

Jersey finger injury

A
  • volar surface of distal phalanx
  • tear of the insertion of FDP
  • commonly occurs on ring finger
  • MOI: active fisting action of the fingers (grabbing a jersey) following by an agressive force into finger ext
94
Q

Phalangeal fractures

A
  • 50% of hand fractures

- stable fractures can be buddy taped

95
Q

Angle of proximal phalanx shaft fractures

A

volar direction in part due to tension from intrinsic motors

96
Q

Boxer fracture

A
  • most common metacarpal fracture
  • metacarpal neck fracture (most commonly small finger)
  • MOI: punch with clinched fist into a solid object
  • flexion of distal fragment
97
Q

Metacarpal shaft fractures

A

-typically displaced with the apex-dorsal due to pull of intrinsic muscles

98
Q

Bennett fracture

A

-fracture dislocation of thumb metacarpal - intraarticular CMC joint

99
Q

Rolando fracture

A
  • base of thumb MC
  • 2 or more fragments on the articular surface
  • comminuted
100
Q

Scaphoid fracture

A
  • 70% occur at waist of bone
  • most frequently fractured carpal bone
  • can result in SNAC wrist deformity
101
Q

SNAC

A

scaphononunion advanced collapse wrist deformity

102
Q

Hamate fracture

A
  • occur at the hook most often due to compressive force transmitted through the base of the palm or shear during forceful torque of the wrist
  • conventional radiographs don’t show the fracture
  • carpal tunnel view (wrist and fingers in full extension and beam angled through carpal tunnel) is required
103
Q

Colles fracture

A
  • extraarticular fracture occurring 1.5-2 inches proximal to articular surface of distal radius
  • dorsal angulation with traction injury to volar surface of bone
104
Q

4 basic stages of ligament tears leading to lunate instability

A
  1. minor sprain to palmar aspect of SL ligament without total disruption
  2. continuing force, causing dissociation of the SL ligament
  3. continuing hyperextension causes additional force through the wrist
  4. radioscaphocapitate ligament forces the capitate to collapse into radiocarpal space and push lunate in palmar direction

Lunate frequently spontaneously reduces leaving little evidence of dislocation other than recurring pain

105
Q

S/S associated with most common patterns of the SL dissociation

A
  1. TTP over scaphoid tuberosity, waist, or scapholunate joint line
  2. laxity of the scapholunate joint during a ballotment test
  3. significant scaphoid shift exam
  4. radiographic evidence

Symptoms:

  1. pain on radial side of wrist at rest or w/ activity
  2. complaints of decreased grip strength
106
Q

UCL sprain of thumb

A
  • hyperextension with radial deviation
  • “skier’s thumb” = acute version
  • “gamekeepers thumb” also used to refer to this
107
Q

PIP joint sprain grades

A

I - produce tensile stress in a collateral ligament, but do not disrupt the coninuity of the ligament

II - more unstable and involve a complete ligament tear or avulsion, but still stable during AROM

III - complete ligament rupture as well as an injury to the volar plate or dorsal capsule

108
Q

Ganglion cysts

A
  • most common soft tissue mass in wrist and hand
  • 10-15% associated with predisposing traumatic event
  • begin small and gradually increase in size
  • most common develops at the SL joint
109
Q

Dupuytren disease

A
  • fibropoliferative disease of digital and palmar fascia
  • cords form and extend distally and proximally
  • cords shorten and thicken causing flexion contractures
  • painful and self limiting
  • genetic and environmental factors
  • male, northern European descent
110
Q

de Quervain’s

A
  • APL and ePB
  • thickening of tendon sheaths and accumulation of mucopolysaccharides
  • clinical presentation includes c/o pain, tenderness, finkelstein’s, resisted thumb extension
111
Q

Trigger finger

A

-stenosiing tendovaginitis that includes snapping or locking of finger or thumb during flexion w/ or w/o pain

112
Q

Nerve injuries

A

-review

OCS (13 decks)

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