Wrist/Hand

Question 1

How does a Lunate and Perilunate Dislocation occur?

Answer 1

Carpal dislocations result from hyperdorsiflexion (hyperextension)

Question 2

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

Answer 2

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

Question 3

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

Answer 3

1. Scaphoid fracture
2. Radial styloid fracture

Question 4

Tx for lunate and perilunate dislocation?

Answer 4

Surgical repair

Question 5

What condition?

Answer 5

Lunate and Perilunate dislocation

Question 6

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

Answer 6

DeQuervain’s tenosynovitis

Question 7

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

Answer 7

DeQuervain’s tenosynovitis

Question 8

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.

Answer 8

Finklestein test

Pain= DeQuervain’s tenosynovitis

Question 9

Tx for DeQuervain’s tenosynovitis?

Answer 9

• NSAIDs
• Thumb spica splint
• Avoid offending activity
• Steroid injection

Question 10

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

Answer 10

Thumb spica splint

Question 11

What is also known as:

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

Answer 11

Ulnar Collateral Ligament Sprain

Question 12

Ulnar Collateral Ligament sprain= UCL injury at what joint

Answer 12

1st MCP joint

Question 13

How does an Ulnar Collateral Ligament sprain occur?

Answer 13

acute or chronic valgus stress of the 1st MCP joint

(Acute MC)

Question 14

What condition?

Answer 14

Ulnar Collateral Ligament Sprain

Question 15

Where is pain localized in an Ulnar Collateral Ligament Sprain?

Answer 15

To ulnar aspect of thumb

Question 16

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

Answer 16

Mild sprain= pain but no laxity

Moderate sprain= pain with partial laxity

Complete tear= Pain and significant laxity

Question 17

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

Answer 17

brace

Question 18

Ulnar Collateral Ligament Sprain tx:

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

Answer 18

Surgical consult

Question 19

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

Answer 19

Forced lateral deviation of the IP joints, usually PIP

Question 20

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

Answer 20

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

Question 21

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

Answer 21

•Buddy Tape, continue participation

•Refer children (growth plate often involved)

Question 22

What is the etiology of an IP joint dislocation?

Answer 22

•Forced hyperextension of the PIP or DIP joint.

Question 23

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).

Answer 23

Dislocation of the IP joints

Question 24

What is Trigger Finger?

Where is it MC?

MC etiology?

Answer 24

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

MC idiopathic (inc risk with RA/DM)

Question 25

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

Answer 25

1. DM 2. RA

Question 26

What are the 2 tx options for Trigger Finger?

Answer 26

* **Steroid injections _x2 only_** * Surgical release if persistent despite injection

Question 27

Which condition? * **Palmar fibromatosis** * “Viking disease” * **Nodular thickening** and **contraction** of palmar fascia * **_Minimal discomfort_** * Flexion of finger at MCP then PIP

Answer 27

Dupuytren's Contracture

Question 28

Dupuytren's Contracture is MC in which finger?

Answer 28

Ring finger

Question 29

Who is Dupuytren's Contracture MC in?

Answer 29

Men \>50 Northern European Descent

Question 30

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

Answer 30

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**

Question 31

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

Answer 31

**_Xiaflex injection_** * Breaks down collagen adhesion * Injected into contracted cord **•Manipulation** the following day

Question 32

Which condition? ## Footnote * Cystic swelling overlying a tendon sheath * Herniation of synovial tissue from a tendon sheath

Answer 32

Ganglia of Wrist and hand

Question 33

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

Answer 33

15-40y/o Cause- Idiopathic or repetitive activities that load the wrist (tumbling, diving, rowing)

Question 34

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

Answer 34

•Common locations * **Dorsum** of the wrist * **Volar radial** aspect of wrist •Less common locations * Base of finger

Question 35

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

Answer 35

provide reassurance

Question 36

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

Answer 36

* **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)

Question 37

What are the 2 MC causes of arthritis of the hand

Answer 37

1. OA 2. Secondary degenerative joint dz

Question 38

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

Answer 38

* DIP and PIP joints * Stiffness and loss of motion in the fingers

Question 39

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

Answer 39

•**Heberden** nodes = nodules at the **DIPs** **•Bouchard** nodes = bony nodules at the **PIPs**