Wrist/Hand Common Presentations Flashcards
Distal radius fractures:
- Colles
- Smith
- Barton
- Buckle
- Colles - dorsal displacement (outward)
- Smith - forward displacement (inward)
- Barton - through radius and articular surface into joint
- Buckle - compressive fracture at distal radius
Scaphoid fracture most common in what age groups/sex?
15-30 males
Because scaphoid fracture is common at waist, what should we be concerned about?
increased concern for decrease vascular supply and proximal necrosis
Common MOI for scaphoid fracture:
FOOSH in position of radial deviation
Symptomology of scaphoid fracture:
- Deep, dull radial wrist pain (anatomical snuff box)
2. Pain with gripping/ squeezing
Physical examination of scaphoid fracture:
- Tenderness anatomical snuff box/ scaphoid
- Local swelling/ bruising
- Often not visible on x-rays directly following injury
- Thumb spica splint x 3 weeks with f/u x-rays if clinical suspicion is high
Common MOI for hook of hamate fracture:
FOOSH
Consider indicators of injury to what two structures with hook of hamate fracture:
- Ulnar nerve function
- Ulnar artery injury
Goal with a lunate fracture?
Early recognition
Clinical presentation of lunate fracture:
MOI - FOOSH
Symptoms - pain with palpation, swelling and tenderness
What is Kienbock’s disease?
- Can be progression of lunate frx
- Osteonecrosis of the lunate
- Unknown etiology, common Hx trauma
- Important for screening
Concern for what with Kienbock’s disease?
carpal collapse
Management of Kienbock’s disease:
- Sx
- Conservative: immobilization 6-10 weeks f/b progression of ROM/ resistive exercises
Inflammatory arthropathies of the hand/wrist:
- RA - smaller nodule formations, ulnar drift
- Septic Arthritis
- Gouty Arthritis (nodule formations)
What is boutonniere deformity?
Flexion of the PIPJ, hyperextension of the DIPJ
MOA for boutonniere deformity?
- A rupture of the central band
- Lateral bands slip to the palmar side of the axis of rotation of the PIPJ
What is Swan Neck (finger) deformity?
Hyperextension of the PIPJ and flexion of the DIPJ
MOA for Swan Neck (finger) deformity?
- Disruption of the volar plate at the PIPJ
- Lateral bands bowstring dorsally, increasing the moment arm of the intrinsic and causing PIPJ extension
What is mallet deformity?
Flexion of the DIPJ: extensor tendon rupture
Symptomatology of osteoarthropathy of CMC joint:
- Pain at base of thumb
- Hx of prior trauma
- crepitus
- Pain ROM at end-range (multi-directional)
- Pain with resistance
Incidence of osteoarthropathy of CMC joint:
Age -
Sex -
Women > Men
Age > 45 years more commonly
Patient hx of arthropathies:
- Typically insidious
- Periods of exacerbation/ remission (inflammatory arthropathies)
Physical examination of arthropathies:
- Deformities (more common inflammatory arthropathies): Also including nodules
- Tenderness to palpation of joint line
- Diminished ROM
- Painful/ weak resistance testing
- Painful/ weak grip testing
- Painful/ hypomobile joint mobility testing
Inflammatory management of RA:
- Consider period of remission vs. exacerbation
- Thermal/ cryotherapy
Exercise management of RA:
- Gripping/ resistive exercises
- ROM exercises
Joint protection for RA:
- splinting
- activity modification
What is dupuytren contracture?
- Nodule formation palmar/ digital fascia
- Pitting of skin observed
- Impairs motion
Natural course of dupuytren contracture?
- “Cord” structures cause contractures and impaired motion of tendons
- MCP & PIP commonly affected
- Less commonly affected DIP - Thickening/ shortening of fascia
Risk factors for dupuytren contracture?
- Caucasian
- Increasing age
- Male gender (7-15x > women)
- Alcoholism
- DM
- Smoking
- Hand trauma/ Sx
Which digit most commonly affected by dupuytren contracture?
5th (70%)
T/F Dupuytren contracture is commonly bilateral.
True
MOI of wrist/hands sprains:
Force to wrist exceeding normal range
Consider fracture of what with wrist/hands sprains?
Carpal fracture
Symptomology of wrist/hands sprains:
- Local pain that resides & returns
- Swelling
- ecchymosis (bruising)
- tenderness
- pain with movements that place tensile load (stretch) on sprained structure
Gamekeeper’s thumb -
Sprain of 1st MCP - ulnar collateral lig sprain
MOI of Gamekeeper’s thumb:
- Valgus moment to 1st MCP
- skiing injury
Physical examination of Gamekeeper’s thumb:
Local tenderness/ swelling
+Ulnar collateral ligament test
T/F Healing of TFCC lesion more likely if more superficial.
True, better vascular supply
Common MOI of TFCC lesion:
- FOOSH
- Repetitive pronation/ supination with loading
Physical Examination of TFCC lesion:
- Medial wrist pain (with opening door)
- Clicking/ popping with wrist motions
- Tenderness in area of TFCC
- Swelling with more acute trauma
- A/PROM painful/ limited ulnar deviation (also supination with ulnar deviation position to start)
- Pain/ tenderness with mobility testing of radiocarpal joint with ulnar deviation bias
What is intercarpal instability?
- Disruption/damage of interosseous &/or mid-carpal ligaments
- Independent movement of carpals
What is dissociative intercarpal instability?
Involves carpals of the same row
What is Dorsal Intercalated Segment Instability (DISI)?
- Scapholunate dissociation
- Dorsal tilt of lunate
- Lunate remains connected to triquetrium, but not scaphoid
- Lunate no longer follows scaphoid into flexion
What is Volar Intercalated Segment Instability (VISI)?
- Lunotriquetrum dissociation
- Volar tilt of distal lunate
- Lunate remains connected to scaphoid, but not triquetrium
Physical examination of Dorsal Intercalated Segment Instability (DISI):
- FOOSH extension/ ulnar deviation
- Pain/ weakness with Grasping
- Tenderness over scaphoid/ lunate
- Laxity with joint mobility testing
T/F Volar Intercalated Segment Instability (VISI) presents very similarly to DISI.
True
Where does tendinopathy of extensors of wrist and fingers occur?
- Intersection Syndrome (ECRL & ECRB where crossing deep to APL & EPB)
- Tenderness 6-8 cm proximal to Lister’s tubercle
Patient interview of tendinopathies:
- Typically insidious onset
- Microtrauma MOI
Physical examination of tendinopathies:
- Tender locally
- Painful with tensile loading (stretching): P/AROM and resistive testing
- Possibly palpable thickening of tenosynovium
- Crepitus with tendon moving through tendon sheath
What is trigger finger?
Enlargement of tendon/ pulley affecting tendon as it pistons through A1 pulley (nodule gets caught in flexion)
Trigger finger typically where in hand?
MC head
What digit most common for trigger finger?
3rd
Risk factors for trigger finger?
- DM
- young children
- menopausal women
- RA
Physical examination of trigger finger:
- C/o Painful snapping at MCP area during flexion/ extension motions of fingers
- Limited/ painful finger motion
- Crepitus with motion (palpable vs. auditory)
What is De Quervain’s Tenosynovitis (DQT)?
- Disorder involving the tendons of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons
- Thickening of soft tissue structures surrounding the involved tendons = impaired tendon gliding
T/F No active inflammatory process with De Quervain’s Tenosynovitis (DQT).
True
Prevalence of DQT:
Men: 0.5% - 0.7%
Women: 1.3%- 2.1%
Associated patient demographics of De Quervain’s Tenosynovitis (DQT):
- Female Gender
- Work-related injury (texting, typing, tracker ball mouse)
- Computer users who use a mouse or trackball
- Text messaging
- Repetitive fine-motor task (typing)
Physical examination of De Quervain’s Tenosynovitis (DQT):
- Local Tenderness
- Painful ROM that places tensile load (stretch) on APL & EPB (AROM - abduction/extension worse – not so bad PROM)
- Finkelstein’s Test
- Painful resistance testing APL & EPB
What is a ganglia?
- Thin-Walled cyst over joint capsule/ tendon sheath
- Filled with mucoid hyaluronic acid (spontaneous)
- Possible compression on ulnar/ median nerves
Symptoms of ganglia:
- May or may not be painful
- Ache with flexion/ extension of joint
