Wrist,Hand & Fingers - CH. 24

Question 1

which compartment of the forearm is more susceptible to mm/nn ischemia?

Answer 1

deep flexor compartment - flexor digitorum profundus, flexor pollicis longus, pronator quadratus

Question 2

what’s another condition you must consider as you suspect a fracture of the forearm?

Answer 2

volkmann’s fracture - flexed fingers and wrist

Question 3

diff b/w colle’s fracture and smith’s fracture

barton’s fracture?

Answer 3

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

Question 4

describe madelung deformity

Answer 4

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

Question 5

name order of carpal bones (proximal to distal)

Answer 5

Scaphoid
Lunate
Triquetrum - attached to TFCC
Pisiform - attached to TFCC 
\_\_\_\_\_\_\_\_\_\_\_
Trapezium 
Trapezoid
Capitate
Hamate

Question 6

where does the medial and lateral collateral ligaments attach?

Answer 6

medial - ulnar styloid - to pisiform

lateral - radial styloid - scaphoid

Question 7

nn innervation of the hand

Answer 7

ulnar - intrinsic mm
median - 3/4 thenar mm
radial - 2 lumbricals

Question 8

tests for carpal tunnel

Answer 8

phalen’s

tinels

Question 9

how to test for lunate instability

Answer 9

lunotriquetral ballotment test
- pinch grip of lunate and A-P glides of the triquetrum
(+) crepitus and laxity / P

Question 10

how to test for circulation issues in the hand?

Answer 10

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

Question 11

what hand deformities may arise with median nn compression or palsy? demo each of them

Answer 11

ape hand - thumb is at the same level of the fingers (due form the extensors

claw hand - median and nn compression

Question 12

what condition that you must consider with a humeral fracture? or direct trauma on this nn?

Answer 12

redial nn compression or palsy

“wrist dop syndrome”

Question 13

what hand deformities will you see with ulnar nn compression?

Answer 13

bishops deformity (ring and pinky finger in contracture)

Question 14

describe Klenbock’s disease

Answer 14

lack of blood flow to the lunate which leads to avascular necrosis of the lunate

Question 15

what disease can result from a mismanaged scaphoid fracture?

Answer 15

prieser’s disease

Question 16

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?

Answer 16

hamate fracture (hook of hamate)

possible doughnut pad to take pressure off spot

Question 17

an athlete presents with a subungual hematoma? describe two ways in which you can release the pressure?

Answer 17

1. using an antiseptic plus and high temp. cautery to burn a hole in the nail
2. manual nail drill and antiseptic

Question 18

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?

Answer 18

trigger finger

Question 19

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?

Answer 19

boutinnerie’s deformity

injury to the extensor expansion

Question 20

an extensor tendon avulsion - inability to extend the DIP joint?

Answer 20

mallet finger

Question 21

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

Answer 21

jersey finger

check for fracture and splint / buddy tape

Question 22

a patient walks in with over flexed fingers of an unknown cause - what condition do you think could likely be happening?

Answer 22

dupuytren’s contracture

Question 23

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?

Answer 23

gamekeeper’s thumb - ulnar collateral ligament of the MCP joint of the thumb

Question 24

indication of psuedoboutinnere deformity

Answer 24

the finger can easily be hyperextended compared to other fingers at the PIP joint

Question 25

a distal tear of the volar plate from the middle phalanx is considered what? demo it with your hand

Answer 25

swan neck deformity

Question 26

an avulsion of the volar plate from the proximal phalanx

Answer 26

psuedoboutinnere

Question 27

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?

Answer 27

bennett’s fracture

Question 28

typical mx of a PIP fracture and dislocation?

Answer 28

axial load of a partially flexed finger