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CONA 2 > Wrist/Hand Complaints > Flashcards

Wrist/Hand Complaints Flashcards

1
Q

Anatomy & Biomechanics

1—Stability is primarily ____________

2—Carpal bones divided into distal and proximal rows

A

ligamentous

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2
Q

Anatomy & Biomechanics

3–Extrinsic and intrinsic connections

4–________ does most of the axial weight bearing

A

Radius

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3
Q

Anatomy & Biomechanics

5–2nd and 3rd metacarpals: ________ joints of the hand

A

stabilizing

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4
Q

Conditions that Need Immediate Referral

1) SCAPHOID fx
2) _________ forearm fx
3) Carpal instability
4) Avascular necrosis = AVN
5) _________ ___________ tear

A

Distal

Triangular fibrocartilage

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5
Q

Evaluation of Pain

ANTERIOR?
1) \_\_\_\_\_\_\_\_\_\_\_ dislocation
2) Carpal instability
3) \_\_\_\_\_\_\_\_\_\_\_\_ fx
4) Nerve entrapment:
A) Median- = \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_
B) Ulnar = \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_
A

Lunate

Hamate

carpal tunnel syndrome

Tunnel of Guyon

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6
Q

Evaluation of Pain

POSTERIOR?
1) ___________ fx
2) Carpal instability
(yes, I’m aware it is listed under both—I’m not doing any more pushups)
3) _______________ syndrome
4) Tendonitis (non-specific)
5) Radial nerve entrapment (Wartenberg’s)

A

Scaphoid

de Quervain’s

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7
Q

History of Trauma?

A) Fall on an outstretched hand
1) Consider ___________ fracture
(especially if pain in “anatomical snuff box”)
2) Triangular fibrocartilage damage at ________ side
3) Other fractures may occur

A

scaphoid

ulnar

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8
Q

Weakness upon Presentation?

1—Often reported as “difficulty gripping”
—Check power (_________ nerve)
and precision (________ nerve) grip ability
2—Pain will often cause weakness

A

ulnar

median

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9
Q

Instability?

1—-Associated with a sense of __________, or simply the misinterpretation of a sense of clumsiness

2—Usually the result of trauma, but can be seen in patients with generalized ________

A

weakness

laxity

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10
Q

Restricted Motion?

1—Decreased AROM & PROM indicates joint effusion

2—No trauma = Inflammatory arthritis

3—YES!!! TRAUMA!!! = Consider _______ or dislocation

A

fracture

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11
Q

Superficial Complaints?

1–Painful nodules on the dorsal wrist
If a history of chronic repetitive motion →_______ likely

2—Multiple nodules & swelling over the dorsum with pain and stiffness → _________ ___________

3—Skin lesions?
Usually systemic conditions (rheumatic fever or RA)

A

Ganglions

Rheumatoid arthritis

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12
Q

History & Evaluation

A--Pain, swelling, restricted motion, weakness
B--VIPPPIRONE
C--Nodules?
1) Ganglion cysts
2) RA nodules
3) Lipomas
D--Power grip (assess integrity of \_\_\_\_\_\_\_\_ nerve)
E--Precision grip (\_\_\_\_\_\_\_\_  nerve)
F--2-point discrimination
A

ulnar

median

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13
Q

Ulnar Variance
Negative ULNA IS LOWER THAN RADIUS
&
Positive ULNA IS HIGHER THAN RADIUS

A

KNOW

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14
Q

Distal Motor Function Testing

A—Radial N.- Finger _____________
Hand Postures:
1) Median nerve- “_______ _______”
(extensor muscles draw thumb parallel with fingers; patient loses ability to flex or oppose the thumb)

2) Mixed Ulnar/Median- “Bishop/Benediction” hand (predominantly median pathology)

3) Ulnar nerve- “Ulnar claw”
(the posture of the finger is FLEXED PIP and DIP joints being more pronounced in the 4th and 5th digits)

A

extensors

Ape hand

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15
Q

Carpal Instability-Scapholunate

1—_____________ is the #1 instability in the wrist (Lunotriquetral #2, Triquetrohamate #3)
2–Usually from __________
3—Tearing of the interosseous ligaments and radiocarpal ligaments (palpable instability
4—Watson’s test will be positive

A

Scapholunate

FOOSH

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16
Q

Carpal Instability-Scapholunate (cont.)

  • –For scapholunate: Terry Thomas sign will be present (>=___mm space)
  • –_______&____________ if significant widening
  • –Don’t be afraid to re-x-ray in 2 weeks if x-ray normal and no improvement
A

3

Casted and surgical

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17
Q

Triangular Fibrocartilage Injury

1—_____ side wrist pain (increased with ____ deviation)
2—Associated with a + ulnar variance
3—Tear or degeneration within meniscus
4–+ TFC test
5–+ MRI
6–Able to treat this (surgical if not improved)

A

Ulnar

ulnar

SLIDE 22

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18
Q

DeQuervain’s Disease/Stenosing Tenosynovitis

1–Radial wrist pain increased with ______ deviation or repetitive THUMB use
2–Overuse microtrauma or forceful grip
3–May radiate into thumb or up forearm a little
4–Abductor Pollicus Longus (APL) & Extensor Pollicus Brevis (EPB)
5–Tenderness to palpation

A

ulnar

19
Q

DeQuervain’s Tenosynovitis

1—-+ Finkelstein’s test
2—-Pain on resisted thumb _________/_________
3—Tx w/ CMT thumb distraction, PT, cortisone, thumb spike

A

extension/abduction

20
Q

Intersection Syndrome

1—____________ distal forearm pain and crepitus
2–Inflammatory response to 2 muscles intersecting- APL & EPB mm
3–From repetitive flexion/extension
4–Tender 4-6 cm proximal to Lister’s tubercle
5–Tx as ___________

A

Dorsoradial

tendonitis

21
Q

Peripheral Nerve Entrapments Near the Wrist

1---\_\_\_\_\_\_\_\_ N.
Carpal tunnel syndrome
2---\_\_\_\_\_\_ N.
Tunnel of Guyon syndrome
3---\_\_\_\_\_\_\_ N.
Wartenberg syndrome (Cheiralgia Paresthetica, “handcuff neuropathy”, etc.)
A

Median

Ulnar

ULNAR

22
Q

Carpal Tunnel Syndrome

1–Most common upper extremity neuropathy
2–Increase in FEMALE > 40 y.o.
3–50% are _____________
4–Pain/numbness/tingling in the PALMAR surface of the thumb, plus 2½ fingers
5–Secondary to direct pressure on ________ nerve from repetitive flexion/extension, transverse carpal ligament, ganglion, inflammation
6–Also seen in pregnancy, RA, connective tissue diseases, diabetes

A

bilateral

median

23
Q

History & Evaluation of CTS

–With pain & paresthesia there is a complaint of clumsiness with precision grip
–Worse at NIGHT
+ Phalen’s/reverse Phalen’s
+ Tinel’s?
–Weak pinch test
–Weak opposition/precision grip
–Weak Jamar
–_________ atrophy if chronic

A

Thenar

24
Q

Management of CTS

  • -Splint in rest position of wrist
  • -Vitamin C, Bs
  • -Adjust _________ A-P (to induce distal radioulnar approximation) and C/S
  • -Ergonomic advice (mouse, keyboard, chair, etc.)
  • -Surgical usually only if + EMG findings
A

lunate

25
Q

Tunnel of Guyon Syndrome

1–Pain/numbness/tingling in ___&______ digits
2–Osseofibrous tunnel between pisiform and hamate hook
3–Common in bikers (“_______ _______”)
4–+ Tinel? +2-point discrimination?
5–WEAK flexor digiti minimi

A

4th & 5th

handlebar palsy

26
Q

Fractures

1---Scaphoid > Lunate/Hook of Hamate
2---Can turn to AVN
3---Scaphoid
---Anatomical snuff box pain from \_\_\_\_\_\_\_\_\_
---only 20% is proximal pole but --AVN
---+ thumb percussion
4---Hook of Hamate
Unstable because of pull of FCU, opponens digiti minimi, flexor digiti minimi
Lunate
AVN= \_\_\_\_\_\_\_\_\_\_\_ Disease
A

FOOSH

Kienbock’s

27
Q

Dorsal Impaction Syndrome

1–Dorsal wrist pain secondary to repetitive ________ with weight bearing
2–Capsulitis/synovitis (usually located at lunocapitate joint area)
3–Tx as tendonitis

A

extension

28
Q

Ganglion Cysts

–Very common
–Dorsal/palmar wrist pain
–Palpable GEL LIKE nodule
(usually movable - mucoid degeneration from overuse)
–Location: metacarpal heads and dorsal _________ area
–Fluctuate in SIZE
–Treatment can include ergonomic advice
–Refer for surgery ONLY if PAIN SEVERE ,______ cysts, etc.

A

scapholunate

multiple

29
Q

Mallet Finger/Baseball Finger

  • –___________ digitorum tendon avulsion/rupture
  • -DISTAL finger pain
  • -Usually hit on tip of finger= _______________ injury
  • -R/O avulsion fx
  • -Drop finger
  • -Can NOT actively extend DIP
  • -Splint in __________ to prevent contracture-refer for SURGERY
A

Extensor

hyperflexion

extension

30
Q

Football/Jersey Finger

  • –Distal finger pain from forceful DIP ___________
  • –Rupture of FDP
  • –Inability to flex DIP while PIP extended
  • –Refer
A

hyperextension

31
Q

Boutonniere’s Deformity

  • –PIP pain from hyperflexion injury
  • –Tears central slip of ED tendon
  • –Can NOT actively _________ PIP
  • –PIP flexed and DIP extended
  • –Splint and refer
A

extend

32
Q

Collateral Ligament Sprain

  • –Finger pulled SIDEWAYS
  • –Rapid _________
  • –Stability varus/valgus performed at 30° and 70°
  • –X-ray to R/O avulsion
A

swelling

33
Q

Dupuytren’s Contracture

  • -4th and/or 5th finger _________ deformity
  • –Increased in men age
A

flexion

34
Q

Trigger Finger

  • –Finger gets STUCK when trying to EXTEND from FLEXED position
  • –_________ overuse
  • –Stenosing tenosynovitis
  • –May be palpable nodule in FLEXOR tendon
  • –Loss of PINCH strength
  • –Do PT, cross-friction massage
  • –Refer for cortisone injection
A

Grasping

35
Q

Gamekeeper’s Thumb

—Pain at BASE of thumb following fall causing __________ or hyper abduction of thumb
—Torn _______ collateral ligament at MCP
(ski pole injury)
–Abduction > 35°
—X-ray to R/O avulsion fx and refer

A

hyperextension

ulnar

36
Q

Bowler’s Thumb

—Pain/numbness/tingling at PALMAR surface of thumb
—Irritated ULNAR digital n. (causing perineural fibrosis)
—Passive ___________ may result in pain
—Give ergonomic advice
(such as, enlarge thumb hole on ball)

A

extension

37
Q

Finger Splints

1—Immobilize finger sprains:

  • –Grade 1 = ___-______ days
  • –Grade 2 = ___-_____ wks
  • –Grade 3 = ortho consult
A

5 TO 7

2 TO 3

38
Q

Rheumatoid Arthritis

—Autoimmune disorder
—More common in ________ age 20-40 y.o.
—GENETIC predisposition
—Joints SWOLLEN in morning
—Fatigue and ______ ______
—UNIFORM loss of joint space
—Lead to ULNAR drift of MCP’s and _______ ________ deformity of fingers
= extended PIP and flexed DIP & MCP

A

FEMALE

weight LOSS

swan neck

39
Q

Psoriatic Arthritis

  • –___________ finger pain
  • –Skin lesions on ________ tendons
  • –Genetic predisposition
  • –“_________ _________” (swelling of PIPs)
  • –FLUFFY periosteal finger joint appearance
  • –R/O Reiter’s
A

Unilateral

extensor

Sausage fingers

40
Q

Osteoarthritis (DJD)

  • —Heberden’s nodes-dorsal DIP
  • —Bouchard’s nodes- dorsal PIP
A

KNOW

41
Q

Complex Regional Pain Syndromes (CRPS)

Type 1= CRPS 1= Reflex Sympathetic Dystrophy
—Stages are ______ pain….allodynia, ___&_______ skin in distal extremities (throbbing & aching)
—Secondary to severe trauma (fx/crush injury) causing aberrant sympathetic activity
–Vasomotor changes (________ Disease)
–Bone demineralization/regional osteopenia
(Sudeck’s atrophy)
–If it occurs in the shoulder = “_______-_____ ______”

A

burning

shiny & swollen

Raynaud’s

shoulder-hand syndrome

42
Q

Raynaud’s Disease

—Idiopathic _________ disorder
—Due to decreased ________ ________ from vasospasm of blood vessels
(abnormal sympathetic NS response)
—COLD, mottled, painful, burning, NUMB hand
—Intermittent attacks of “pallor, ________, and redness” brought on by COLK or EMOTION
—Look further for connective tissue disorder
—Put hands in warm water to cause dilatation

A

vascular

oxygen supply

cyanosis

43
Q

Raynaud’s: Disease vs. Phenomenon

Phenomenon –
Pallor of the digits with or w/o cyanosis on exposure to cold
Connective tissue diseases - neurologic disorders - arterior occlusive disorders - blood dyscrasias -
Gangrene or trophic changes limited to distal digital skin

RAY–Disease –
No demonstrable or associated source or cause
Young women affected
Bilateral involvement
Absence of clinical occlusion of peripheral arteries
Absence of organic etiology (causing the symptoms)

A

KNOW

44
Q

CRPS

—–Type 2= CRPS 2= Causalgia
Due to _________ nerve damage (sensory afferents)
Same signs/symptoms as Type 1
Allodynia

---Tx of CRPS
CMT
Medication
Sympathetic NS blocks
Acupuncture
A

peripheral

CONA 2 (7 decks)

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