WRIST/HAND - CLINICAL APPLICATION

Question 1

results from a fall on the palm when hand is abducted

pain in anatomical snuff box during dorsiflexion and abduction of the hand

Answer 1

scaphoid fracture

Question 2

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

Answer 2

hamate fracture

Question 3

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

Answer 3

metacarpal fractures

Question 4

usually comminuted and a painful hematoma (local collection of blood)

Answer 4

distal phalange fracture

Question 5

a sprain of the radial collateral ligament and an avulsion fx of the lateral part of the proximal phalanx of the thumb

Answer 5

bull rider’s thumb

Question 6

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

Answer 6

skier’s thumb

Question 7

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

Answer 7

dupuytren’s contracture

Question 8

synovial sheaths of tendons can become inflamed (different from tendonitis where tendon inflamed)

hurts worse when stretches (versus with tendonitis hurts worse contracting)

Answer 8

tenosynovitis

Question 9

the study of ridge patterns of the palm

Answer 9

dermatoglyphics

Question 10

Bleeding is usually profuse when a laceration occurs here

Answer 10

laceration of palmar arches

Question 11

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

Answer 11

ischemia of digits

Question 12

usually occur in two places: the forearm and the wrist

the most common site is where the nerve passes through the carpal tunnel

Answer 12

lesions of median nerve

Question 13

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

Answer 13

ulnar canal syndrome (guyon tunnel syndrome)

Question 14

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

Answer 14

handlebar neuropathy

Question 15

paralysis of triceps, brachioradialis, supinator and extensor muscles of wrist and fingers

Answer 15

radial nerve injury in the arm

Question 16

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

Answer 16

mallet finger

Question 17

movement of tendon away from joint

can increase mechanical advantage because increases moment arm but ultimately results in active insufficiency

Answer 17

bowstringing

Question 18

muscle reaches a length where it can no longer apply effective force

Answer 18

active insufficiency

Question 19

If cruciform and annular ligs of fingers rupture, what would happen?

Answer 19

bowstringing

Question 20

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

Answer 20

swan neck deformity

Question 21

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

Answer 21

Boutonniere deformity

Question 22

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

Answer 22

trigger finger

Question 23

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

Answer 23

boxers fracture

Question 24

With carpal tunnel, what nerve may be damaged in a short period of compression?

Answer 24

median n

Question 25

Because the palmar fascia is thick and strong, swellings resulting from ____ ____ usually appear on the dorsal of the hand, where the fascia is thinner

Answer 25

Hand Infections

Question 26

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

Answer 26

proximal & middle phalange fracture

Question 27

Depending on the site of the hand infection, pus will accumulate in what muscles of the hand?

Answer 27

1) thenar
2) hypothenar
3) midpalmar
4) adductor compartments

Question 28

When the cause of the ischemia of fingers are idiopathic (unknown) or primary, is called

Answer 28

Raynaud disease

Question 29

radial nerve injured causing the inability to extend the wrist and the fingers at the MCP joints

Answer 29

wrist drop