WRIST/HAND - CLINICAL APPLICATION Flashcards
results from a fall on the palm when hand is abducted
pain in anatomical snuff box during dorsiflexion and abduction of the hand
scaphoid fracture
result in nonunion of the fractured bony parts of the traction produced by the hypothenar muscles
ulnar nerve may be injured causing decreased grip strength
ulnar artery may also be damaged
hamate fracture
good blood flow - fx usually heal rapidly
bone fragments rotate distally resulting in a shortened finger or does not flex in harmony with other fingers
metacarpal fractures
usually comminuted and a painful hematoma (local collection of blood)
distal phalange fracture
a sprain of the radial collateral ligament and an avulsion fx of the lateral part of the proximal phalanx of the thumb
bull rider’s thumb
rupture or chronic laxity of the collateral ligament of the 1st MP joint
MOI: hyperabduction of the MP joint of the thumb
in severe injuries, the head of the metacarpal has an avulsion fx
skier’s thumb
thickening of palmar fascia
progressive flexive contracture of ulnar two fingers
result of fibrotic changes typically in males over 50
***looks kind of like finger gun
dupuytren’s contracture
synovial sheaths of tendons can become inflamed (different from tendonitis where tendon inflamed)
hurts worse when stretches (versus with tendonitis hurts worse contracting)
tenosynovitis
the study of ridge patterns of the palm
dermatoglyphics
Bleeding is usually profuse when a laceration occurs here
laceration of palmar arches
Intermittent bilateral attacks marked by cyanosis and often accompanied by parathesia and pain are characteristically brought on by cold and emotional stimuli
treatment is to dilate the digital arteries
ischemia of digits
usually occur in two places: the forearm and the wrist
the most common site is where the nerve passes through the carpal tunnel
lesions of median nerve
manifest by hypoesthesia (reduced sense of touch or sensation) in the medial one and a half finger and weakness of the intrinsic muscles of the hand
ulnar canal syndrome (guyon tunnel syndrome)
people who ride long distances on bikes with their hands in an extended position against the hand grips put pressure on the hook of hamate which compresses their ulnar nerves
results in sensory loss on the medial side of the hand and weakness of the intrinsic hand muscles
handlebar neuropathy
paralysis of triceps, brachioradialis, supinator and extensor muscles of wrist and fingers
radial nerve injury in the arm
rupture of the extensor tendons on the base of the phalanx (DIP jt)
usually from a blow to the tip of the finger
often causes avulsion fracture
spint in extension for 6-8 wks or may need surgery
mallet finger
movement of tendon away from joint
can increase mechanical advantage because increases moment arm but ultimately results in active insufficiency
bowstringing
muscle reaches a length where it can no longer apply effective force
active insufficiency
If cruciform and annular ligs of fingers rupture, what would happen?
bowstringing
Hyperextension injury
rupture of volar plate of the PIP, lateral bands become slack allowing flexion of DIP
PIP hyperextended while DIP is flexed
associated with rheumatoid arthritis
swan neck deformity
rupture of extensor tendon at its attachment to the base of the middle phalanx (central slip)
lateral bands pull PIP into flexion, DIP into extension
treatment - splint in extension
Boutonniere deformity
synovial lining becomes inflamed and swollen
swelling in lining causes compression of blood supply and tendon itself
finger gets stuck because tendon cannot slide through pulley
trigger finger
fracture of the 5th metacarpal
punches with a closed and abducted fist, head of bone rotates over the distal end of the shaft producing a flexion deformity
boxers fracture
With carpal tunnel, what nerve may be damaged in a short period of compression?
median n
Because the palmar fascia is thick and strong, swellings resulting from ____ ____ usually appear on the dorsal of the hand, where the fascia is thinner
Hand Infections
usually a result of crushing or hyperextension injuries
bc of the fx and flexor tendons, the bone fragments must be carefully realigned to restore normal function of the fingers
proximal & middle phalange fracture
Depending on the site of the hand infection, pus will accumulate in what muscles of the hand?
1) thenar
2) hypothenar
3) midpalmar
4) adductor compartments
When the cause of the ischemia of fingers are idiopathic (unknown) or primary, is called
Raynaud disease
radial nerve injured causing the inability to extend the wrist and the fingers at the MCP joints
wrist drop
