Wrist + Hand injuries Flashcards
Proximal and distal row of carpals
Prox
-Scaphoid, Lunate, Triquitrum
Distal
-Trapezium, trapezoid, capitate, hamate
Is there any ligs holding the pro/distals rows of carpals together
No ligs holding proximities and distal rows together, only adjacent carpals
what is in the distal radioulnar jt cavity
Fibrocartilagenous articular disk connects the edge of ulnar notch to base of ulnar styloid process
which carpals articulate with the triangular fibrocartilage disk
Lunate and triquitrum
With the fibrocartilage disk in place how much of the load does the radius and ulna take
radius- 80% of axial load
Ulna- 20% of axial load
How can the fibrocartilage disk be injured
during forced extension/pronation
How does the pro row of carpals move on the radius in flex and extension
flex- as prox carpal row flexes forward it will also glide post
ext- carpals will glide venrally
@ what joint is flexion and extension greater in the wrist
flexion- greater at midcarpal jt
ext- greater at radoiocarpal jt
What 3 mm are supplied by the median n in the hand
Flexor pollicis brevis
Abducor pollicis brevis
Oppones pollicis
What mm on the thenar side is supplied by ulnar
Adductor pollicis
what supplies the lumbricals
Lat 2 supplied by median
med 2 supplied by ulnar
What supplies all interossei
ulnar n
mc moi for wrist sprain and how will the pt present
MOI: forced flexion–> leads to ligamentous injury on dorm of wrist
pt- will present with swelling and decreased flex/ext with pain @ end ranges
What is the tx for a wrist sprain
Rest
Imobalize for 3 days then start progressive wrist curls
What is dequeravains tenosynovitis due to and what is effected
Result of repetitive activities of ulnar + radial dev (or trauma into ulnar dev)
-Abductor pollicis longs and extensor pollicis brevis become irratated in their sheath
tx of dequervains tenosynovitis
Cryotherapy
splint to immobilize 1st CMC jt
modalities
What are the symptoms of keinbocks disease (avascular necrosis of lunate)
- Swelling, pain, stiffness in wrist
- Clicking in wrist
- weakened grip strength
- tenderness over lunate
- decreased ROM
What is the radiological presentation of keinbocks disease + what sign is associated with it
- No issues present at first on x ray
- Change in density of lunate is seen
- Collapse of lunate, proximities migration of capitate
Negative ulnar variance
tx of keinbocks disease
Imobalize wrist for 2-3m to help restore blood flow to the bone (but not prolonged past this point)
MOI of scaphoid fx and Signs/Symptoms
FOOSH injury driving scaphoid against radius
Signs- Pain on radial side of wrist, flex/ext/dev may be limited
Imaging protocol for schaphoid fx
may not be able to be seen initially
-immobilize for 2-3 weeks and re take x rays
management of scaphoid fx (immobilize times etc)
must be in cast for 3 m (in no repair in 3 m than surgical repair is needed)
What is the normal Capitate lunate radius alignment and scaphoid to lunate angle
CPL should be collinear and scaphoid should be angles 45 degrees
What is a SLAC wrist
a wrist in which the scaphoid lunate lig is ruptured
