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MJ- F3 E2: MSK/Rheum > Wrist/Hand > Flashcards

Wrist/Hand Flashcards

1
Q

How does a Lunate and Perilunate Dislocation occur?

A

Carpal dislocations result from hyperdorsiflexion (hyperextension)

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2
Q

What must occur in order for a perilunate dislocation to occur?

A

Severe ligament injury necessary to tear the distal row from the lunate to produce perilunate dislocation

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3
Q

What are the 2 fractures associated w/ Lunate and Perilunate dislocation?

A
  1. Scaphoid fracture
  2. Radial styloid fracture
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4
Q

Tx for lunate and perilunate dislocation?

A

Surgical repair

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5
Q

What condition?

A

Lunate and Perilunate dislocation

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6
Q

Patho behind what condition?

  • Inflammation of the sheath that surrounds the abductor pollicus longus and extensor pollicus brevis tendons
  • Tendon sheath thickens and constricts the tendons
A

DeQuervain’s tenosynovitis

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7
Q

Which condition?

  • Pain and tenderness in the first dorsal extensor compartment (anatomic snuffbox) aggravated by attempts to move thumb or make a fist
  • +/- swelling
  • Crepitation as patient flexes and extends thumb may be noted
A

DeQuervain’s tenosynovitis

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8
Q

Which special test? For what condition?

  • Place the thumb in palm.
  • Form a fist.
  • Passive ulnar deviation

–>This stretches the inflamed tendons over the radial styloid, reproducing the patient’s pain.

A

Finklestein test

Pain= DeQuervain’s tenosynovitis

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9
Q

Tx for DeQuervain’s tenosynovitis?

A
  • NSAIDs
  • Thumb spica splint
  • Avoid offending activity
  • Steroid injection
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10
Q

What type of splint is used for DeQuervain’s tenosynovitis?

A

Thumb spica splint

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11
Q

What is also known as:

•“Gamekeeper’s thumb” or “Skier’s thumb”

A

Ulnar Collateral Ligament Sprain

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12
Q

Ulnar Collateral Ligament sprain= UCL injury at what joint

A

1st MCP joint

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13
Q

How does an Ulnar Collateral Ligament sprain occur?

A

acute or chronic valgus stress of the 1st MCP joint

(Acute MC)

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14
Q

What condition?

A

Ulnar Collateral Ligament Sprain

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15
Q

Where is pain localized in an Ulnar Collateral Ligament Sprain?

A

To ulnar aspect of thumb

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16
Q

What indicates a mild vs moderate sprain vs complete tear of an Ulnar Collateral Ligament sprain?

A

Mild sprain= pain but no laxity

Moderate sprain= pain with partial laxity

Complete tear= Pain and significant laxity

17
Q

How do you treat a mild to moderate Ulnar Collateral Ligament Sprain?

A

brace

18
Q

Ulnar Collateral Ligament Sprain tx:

How do you treat a c_omplete tear_ or _avulsion fractur_e involving >25% of the articular surface

A

Surgical consult

19
Q

What is the MOI of a collateral ligament injury (“jammed fingers”)?

A

Forced lateral deviation of the IP joints, usually PIP

20
Q

How do you test for Collateral ligament injury (jammed finger). Where will they have pain?

A

•Exam – pain over ligament, valgus/varus stress with PIP at 30 deg

21
Q

How do you tx Collateral ligament injuries (“jammed fingers”)

A

•Buddy Tape, continue participation

•Refer children (growth plate often involved)

22
Q

What is the etiology of an IP joint dislocation?

A

•Forced hyperextension of the PIP or DIP joint.

23
Q

Pathology of what?

  • Rupture of the volar plate +/- avulsion fracture of the base of the middle phalanx (PIP joint) or distal phalanx (DIP joint)
  • Dorsal displacement of middle phalanx on proximal phalanx (PIP joint) or distal phalanx on middle phalanx (DIP joint);
  • Possible interposition of volar plate in IP join (complex dislocation).
A

Dislocation of the IP joints

24
Q

What is Trigger Finger?

Where is it MC?

MC etiology?

A
  • Nodular thickening of the flexor tendon
  • MC at the MCP joint

MC idiopathic (inc risk with RA/DM)

25
Q

What 2 conditions put you at increased risk for Trigger finger?

A
  1. DM
  2. RA
26
Q

What are the 2 tx options for Trigger Finger?

A
  • Steroid injections x2 only
  • Surgical release if persistent despite injection
27
Q

Which condition?

  • Palmar fibromatosis
  • “Viking disease”
  • Nodular thickening and contraction of palmar fascia
  • Minimal discomfort
  • Flexion of finger at MCP then PIP
A

Dupuytren’s Contracture

28
Q

Dupuytren’s Contracture is MC in which finger?

A

Ring finger

29
Q

Who is Dupuytren’s Contracture MC in?

A

Men >50

Northern European Descent

30
Q

Distinguish b/w Stage 1, 2 and 3 of Dupuytren’s Contracture

A

1- Small lump/nodule in the palm on palmer crease

2- Spreads up fascia and into fingers (cord develops)

3- Spreads up fingers. Creates tight cord- causes fingers to bend and unable to straighten

31
Q

What is the tx for Dupuytren’s Contracture? How does it work?

A

Xiaflex injection

  • Breaks down collagen adhesion
  • Injected into contracted cord

•Manipulation the following day

32
Q

Which condition?

  • Cystic swelling overlying a tendon sheath
  • Herniation of synovial tissue from a tendon sheath
A

Ganglia of Wrist and hand

33
Q

What ages are generally affected by ganglia of wrist and hand?

What is the cause?

A

15-40y/o

Cause- Idiopathic or repetitive activities that load the wrist (tumbling, diving, rowing)

34
Q

What are the 2 common and 1 less common locations of Ganglia of wrist and hand?

A

•Common locations

  • Dorsum of the wrist
  • Volar radial aspect of wrist

•Less common locations

  • Base of finger
35
Q

If a person has Ganglia of Wrist and Hand and is asymptomatic how do you tx?

A

provide reassurance

36
Q

If a person has acute, severe sxs associated w/ Ganglia of Wrist and Hand how do you tx? (3)

A
  • immobilization (though rarely a permanent solution) will relieve symptoms and may cause a decrease in sz
  • Needle aspiration (may need to be repeated)
  • Surgical excision- if reoccurrence w/ repeated aspiration)
37
Q

What are the 2 MC causes of arthritis of the hand

A
  1. OA
  2. Secondary degenerative joint dz
38
Q

What 2 joints are most often involved in OA? What occurs?

A
  • DIP and PIP joints
  • Stiffness and loss of motion in the fingers
39
Q

What is the name of the 2 nodes seen in OA and where are they located?

A

•Heberden nodes = nodules at the DIPs

•Bouchard nodes = bony nodules at the PIPs

MJ- F3 E2: MSK/Rheum (7 decks)

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