Wrist/Hand Fractures, Peripheral Nerve Entrapment, CRPS

Question 1

What is a Colles fracture?

Answer 1

A complete fracture of the distal radius with posterior (dorsal) displacement of the distal fragment.

Question 2

What is the typical mechanism of injury for a Colles fracture?

Answer 2

FOOSH (fall on an outstretched hand).

Question 3

What characteristic deformity is associated with a Colles fracture?

Answer 3

Dorsiflexion or ‘silver fork’ deformity.

Question 4

How is the fracture displacement and angulation of a Colles fracture identified?

Answer 4

Evident on the lateral film.

Question 5

What do radiographs of the AP view show in a Colles fracture?

Answer 5

The usual comminuted fracture.

Question 6

What is the primary goal in the management of a Colles fracture?

Answer 6

Precise reduction of the fracture to maintain the normal length of the radius.

Question 7

What is the most common management method for a Colles fracture?

Answer 7

Closed reduction and casting.

Question 8

In which cases may a short-arm cast be used for a Colles fracture?

Answer 8

Stable fractures in good alignment.

Question 9

What may more complicated cases of a Colles fracture require?

Answer 9

Open reduction and external fixation.

Question 10

What is a common sequela of a Colles fracture?

Answer 10

Loss of full rotation of the forearm.

Question 11

When are exercises typically prescribed after a Colles fracture?

Answer 11

Once the cast is removed, usually at around 6 weeks post-fracture.

Question 12

What is a Smith fracture?

Answer 12

A complete fracture of the distal radius with anterior (palmar) displacement of the distal fragment

Sometimes referred to as a reverse Colles fracture.

Question 13

What is the usual mechanism for a Smith fracture?

Answer 13

A fall on the back of a flexed hand

This type of fracture typically occurs due to impact on the wrist in a specific position.

Question 14

What is the typical management for a Smith fracture?

Answer 14

Closed reduction and long-arm casting in supination for 3 weeks, followed by 2-3 weeks in a short-arm cast

This management approach aims to ensure proper healing and alignment of the fracture.

Question 15

What nerve can be compressed as it enters the posterior wrist capsule?

Answer 15

Posterior interosseous nerve

Compression may occur due to repetitive wrist extension maneuvers.

Question 16

What is the major disability associated with radial nerve injury?

Answer 16

Weak wrist and finger extension

This condition leads to the wrist and fingers adopting a position termed ‘wrist drop.’

Question 17

What condition results from radial nerve injury characterized by a specific hand position?

Answer 17

‘Wrist drop’

This position results from weak wrist and finger extension.

Question 18

How does radial nerve injury affect handgrip?

Answer 18

Weakened handgrip

Due to poor stabilization of the wrist and finger joints.

Question 19

What specific movements are typically affected by radial nerve injury?

Answer 19

Inability to extend the thumb, proximal phalanges, wrist, and elbow

The extent of inability depends on the level of injury.

Question 20

Which forearm movement is affected by radial nerve injury?

Answer 20

Supination

Additionally, adduction of the thumb is also affected.

Question 21

What area experiences decreased or impaired sensation due to radial nerve injury?

Answer 21

Posterior surface of the first interosseous space

This sensory loss is a consequence of radial nerve dysfunction.

Question 22

What is Wartenberg Syndrome?

Answer 22

A compression of the superficial sensory radial nerve.

Question 23

What inflammation can lead to Wartenberg syndrome?

Answer 23

Inflammation of the tendons of the first posterior (dorsal) compartment.

Question 24

What symptoms are associated with Wartenberg syndrome?

Answer 24

Pain, paresthesias, and numbness of the radial aspects of the hand and wrist.

Question 25

Which muscles' tendons can compress the superficial radial nerve?

Answer 25

Brachioradialis and ECRL muscles.

Question 26

What is the mechanism of nerve compression in Wartenberg syndrome?

Answer 26

Tendons can press on the nerve in a scissor-like fashion when the forearm is pronated.

Question 27

What is Wartenberg sign?

Answer 27

A sign described by abduction or clawing of the little finger when the patient extends the fingers.

Question 28

What is ulnar nerve entrapment?

Answer 28

Compression of the ulnar nerve at specific anatomical locations.

Question 29

Where can ulnar nerve entrapment occur at the elbow?

Answer 29

In the cubital tunnel.

Question 30

Where can ulnar nerve entrapment occur at the wrist?

Answer 30

At the Guyon canal.

Question 31

What should be evaluated if ulnar neuropathy at the Guyon canal is suspected?

Answer 31

The pisotriquetral joint and the hook of the hamate.

Question 32

What may result from abnormalities at the pisotriquetral joint or the hook of the hamate?

Answer 32

Secondary ulnar neuropathy.

Question 33

What medical history should be inquired about when evaluating ulnar neuropathy?

Answer 33

Diabetes and peripheral neuropathies.

Question 34

What are the two types of interventions for ulnar nerve compression?

Answer 34

Surgical and conservative.

Question 35

What are indications for surgical intervention for ulnar nerve compression?

Answer 35

* Preventing deformity * Increasing functional use of the hand

Question 36

What does conservative intervention for mild ulnar nerve compression involve?

Answer 36

* Applying a protective splint * Patient education to avoid compromising positions

Question 37

What does CRPS stand for?

Answer 37

Complex Regional Pain Syndrome ## Footnote CRPS is a classification of disorders that can occur after a minor injury.

Question 38

How many types of CRPS are recognized by the International Association for the Study of Pain?

Answer 38

Two types ## Footnote The two types are CRPS 1 and CRPS 2.

Question 39

What characterizes CRPS 1?

Answer 39

Triggered by a noxious event not limited to a single peripheral nerve ## Footnote CRPS 1 was previously termed RSD.

Question 40

What characterizes CRPS 2?

Answer 40

Triggered by a direct partial or complete injury to a nerve ## Footnote CRPS 2 was previously termed causalgia.

Question 41

List some signs and symptoms of both types of CRPS.

Answer 41

* Pain * Edema * Stiffness * Skin temperature changes * Sweating ## Footnote These symptoms can vary in intensity and presentation.

Question 42

True or False: A third type of CRPS has been suggested.

Answer 42

True ## Footnote This third type is characterized by irreversible changes and severely limited mobility.

Question 43

What are the characteristics of the suggested third type of CRPS?

Answer 43

* Irreversible changes in skin and bones * Marked muscle atrophy * Unyielding pain * Severely limited mobility ## Footnote This type indicates a more severe progression of the syndrome.

Question 44

What are the two classifications of pain in Type I CRPS?

Answer 44

Sympathetically maintained pain and sympathetically independent pain ## Footnote Sympathetically maintained pain involves an abnormal reaction of the sympathetic nervous system.

Question 45

What characterizes sympathetically maintained pain in Type I CRPS?

Answer 45

An abnormal reaction of the sympathetic nervous system ## Footnote This type of pain is distinct from sympathetically independent pain.

Question 46

What types of edema can occur in Type I CRPS?

Answer 46

Pitting and nonpitting edema ## Footnote Edema in CRPS may result from vasomotor instability and lack of motion.

Question 47

What causes the stiffness in Type I CRPS?

Answer 47

Increased fibrosis in ligamentous structures and adhesion formation around tendons ## Footnote Stiffness tends to increase with time.

Question 48

What are the three clinical phases of CRPS 1?

Answer 48

1. Acute inflammatory phase 2. Dystrophic stage 3. Atrophic stage ## Footnote Each phase has distinct characteristics and duration.

Question 49

What characterizes the acute inflammatory phase of CRPS 1?

Answer 49

Lasts from 10 days to 2-3 months; reversible with treatment; limb is flushed, warm, dry; severe, constant diffuse pain; edema; increased hair and nail growth; ends with limb being cold, sweaty, and cyanotic. ## Footnote This phase involves paradoxical sympathetic stimulation leading to vasoconstriction.

Question 50

What symptoms are associated with the dystrophic stage of CRPS 1?

Answer 50

Lasts another 3-6 months; pale, mottled, edematous, sweaty limb; pain is continuous, more severe; nails may crack/brittle; limited limb movement; muscle wasting; joint stiffness; osteoporosis; contractures. ## Footnote Constricted blood vessels can cool limb temperature significantly.

Question 51

What defines the atrophic stage of CRPS 1?

Answer 51

Irreversible damage to muscles and joints; bones atrophy over 2-3 months; joints become weak, stiff, or ankylosed; pain lessens but may become spasmodic; skin looks glossy, pale, or cyanotic. ## Footnote This stage is marked by a decrease in pain that is no longer mediated by the sympathetic nervous system.

Question 52

What is a key feature of pain in the atrophic stage of CRPS 1?

Answer 52

Pain lessens but may become spasmodic or breakthrough. ## Footnote This indicates a shift in pain characteristics, moving away from sympathetic mediation.