Wrist,Hand & Fingers - CH. 24 Flashcards
which compartment of the forearm is more susceptible to mm/nn ischemia?
deep flexor compartment - flexor digitorum profundus, flexor pollicis longus, pronator quadratus
what’s another condition you must consider as you suspect a fracture of the forearm?
volkmann’s fracture - flexed fingers and wrist
diff b/w colle’s fracture and smith’s fracture
barton’s fracture?
colle’s fracture - posterior displacement of the radial head
smith’s fracture - anterior displacement of radial head
barton’s fx- intraarticular fx - usually happens falling the back of the hand
describe madelung deformity
congenital deformity usually occuring in younger females (6-13 yrs) - the carpals are wedged in between the ulna and radius
mng - you can tape them up using ‘c’ strips or surgery if conservative tx doesn’t work
name order of carpal bones (proximal to distal)
Scaphoid Lunate Triquetrum - attached to TFCC Pisiform - attached to TFCC \_\_\_\_\_\_\_\_\_\_\_ Trapezium Trapezoid Capitate Hamate
where does the medial and lateral collateral ligaments attach?
medial - ulnar styloid - to pisiform
lateral - radial styloid - scaphoid
nn innervation of the hand
ulnar - intrinsic mm
median - 3/4 thenar mm
radial - 2 lumbricals
tests for carpal tunnel
phalen’s
tinels
how to test for lunate instability
lunotriquetral ballotment test
- pinch grip of lunate and A-P glides of the triquetrum
(+) crepitus and laxity / P
how to test for circulation issues in the hand?
allen’s test:
pt squeezes and opens hand 3/4 times
on last squeeze, AT put firm pressure on both ulnar and radial arteries - open hand now should be blanched
if you release one of the arteries it should go back to red and pink right away - normal response
if not, then there’s a compromised artery or blood flow to hand
what hand deformities may arise with median nn compression or palsy? demo each of them
ape hand - thumb is at the same level of the fingers (due form the extensors
claw hand - median and nn compression
what condition that you must consider with a humeral fracture? or direct trauma on this nn?
redial nn compression or palsy
“wrist dop syndrome”
what hand deformities will you see with ulnar nn compression?
bishops deformity (ring and pinky finger in contracture)
describe Klenbock’s disease
lack of blood flow to the lunate which leads to avascular necrosis of the lunate
what disease can result from a mismanaged scaphoid fracture?
prieser’s disease
a tennis player whips a hard shot and the impact of the hit creates instant pain on the palmer side of the hand (ulnar side) - what condition may have likely occurred?
mng?
hamate fracture (hook of hamate)
possible doughnut pad to take pressure off spot
an athlete presents with a subungual hematoma? describe two ways in which you can release the pressure?
- using an antiseptic plus and high temp. cautery to burn a hole in the nail
- manual nail drill and antiseptic
an athlete comes to you with a palpable/ audible snap of their tendons - upon inspection you find that there’s resistance to re-extension of the finger after flexion? What condition could this be?
trigger finger
an athlete comes to you tenderness at the dorsal aspect of PIP joint - you see that the finger is flexed at the PIP joint and extended at the MCP joint. What condition could this be?
boutinnerie’s deformity
injury to the extensor expansion
an extensor tendon avulsion - inability to extend the DIP joint?
mallet finger
an athlete tried to grab their opponent’s jersey - comes off complaining that they can’t flex their finger when they make a fist - what happened? mng of condition
jersey finger
check for fracture and splint / buddy tape
a patient walks in with over flexed fingers of an unknown cause - what condition do you think could likely be happening?
dupuytren’s contracture
an athlete comes over complaining of pain and swelling at the ulnar side of their thumb - she recalls hyperextending and bringing her thumb out (abduction) - what may you likely find?
gamekeeper’s thumb - ulnar collateral ligament of the MCP joint of the thumb
indication of psuedoboutinnere deformity
the finger can easily be hyperextended compared to other fingers at the PIP joint
a distal tear of the volar plate from the middle phalanx is considered what? demo it with your hand
swan neck deformity
an avulsion of the volar plate from the proximal phalanx
psuedoboutinnere
an athlete comes to you with pain and point tenderness at the base of the thumb and a slt deformity of the base of thumb - what condition may likely have occurred?
bennett’s fracture
typical mx of a PIP fracture and dislocation?
axial load of a partially flexed finger
