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PHTH 7212 Pathophysiology > Wrist Hand Surgeries - Dr. Worst > Flashcards

Wrist Hand Surgeries - Dr. Worst Flashcards

1
Q

7 common Surgeries of Wrist and hand

A
  1. CTS (carpal tunnel syndrome)
  2. Trigger fingers
  3. Arthroscopy
  4. TFCC
  5. Fractures
  6. DSTS
  7. Tendon Repairs
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2
Q

CTS

A

Carpal tunnel syndrome

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3
Q

How common is Carpal tunnel syndrome (CTS)?

A

1% of population

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4
Q

CTS symptoms (7)

A
  1. Median nerve distribution
  2. Pain
  3. Paresthesias
  4. Pinch Grip weakness
  5. Thenar atrophy (chronic)
  6. Night pain (curled hand position)
  7. Clumsiness in hand in fine motor skills (from sensory problems, not motor)
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5
Q

CTS cluster of S/S (10)

A
  1. Pregnancy-fluid accumulation
  2. Diabetes
  3. Colles wrist frature
  4. Systemic, endocrine, metabolic disorders
  5. Occupational (Secretary/Power tools)
  6. Exam
  7. EMG/NVC (nerve conduction test)
  8. Alcoholism
  9. Anything with peripheral neuropathy
  10. Using lumbricals

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6
Q

CTS Treatments (4 general things)

A
  1. Change causative factors
  2. Splinting in neutral position (not cock-up)
  3. PT modalities, Mobs, Exercises, stretching, etc.
  4. Inject area (not the nerve) with corticosteroid (lidocaine, kenalog)

(modalities research doesn’t have consistant outcome)

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7
Q

Carpal Tunnel Release Surgery? (4 things about when it could be considered)

A
  1. symptoms > 3 months
  2. sensory deficits (objective)
  3. > 3.61 Semmes-Weinstein microfilaments
  4. maybe thenar atrophy/weakness

One of the most common surgeries performed

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8
Q

Carpal Tunnel Release Surgery types and duration

A

Takes ~ 10 minutes

  1. Open CTS release: 10-15% complications
  2. Arthroscopic: 2-3x more complications at 35% (bc more conservative with cutting
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9
Q

CTS release Surgery recovery

A
  1. Dressings
  2. Fingers open (increased scaring if not kept open)
  3. Elevation
  4. No evidence for immobilization

Early mobilization: gentle composite fist

  1. 2 weeks: sutures removed and scare management (mobs) is important
  2. <5% recurrance
  3. Tendon gliding exercises important
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10
Q

Wrist tendonitis/osis

A

same principles apply from Dr. davies lecture on tendonitis/osis for elbow

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11
Q

Where are the most common locations for hand tendonitis/osus?

A

1st, 2nd, & 6th dorsal wrist extensors

There is also Tenosynovitis

(but more along the lines of senosing tenosynovitis)

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12
Q

Stenosing tenosynovitis

A

Narrowing of a tendon sheath from chronic pressre/inflammation that leads to fibrosis

DeQuervain’s/trigger finger

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13
Q

What is a very good treatment for tendonosis and why?

A

eccentric exercises because it realigns the collagen fibers

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14
Q

Draw/explain Tendinosis cycle

A
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15
Q

DeQuervains

A

Stenosing Tenosynovitis of the abductor pollicis longus and extensor pollicis brevis at radial styloid ; Tested by Finklestein Test

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16
Q

Wrist sprain grades (3)

A

Grade I: ligaments stretched or slightly torn

Grade II: ligaments partially torn

Grade III: ligaments completely torn

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17
Q

Wrist sprain treatment

A

Splinting to help calm down

Then Therapy: gentle strenthening

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18
Q

TFCC Injuries (MOI)

A

activities that involve ulnar deviation and vibration

power tools

gymnasts

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19
Q

TFCC Injuries (characteristics - 5)

A
  1. Acute Onset
  2. CKC exposed to injury
  3. Typically due to hyperextension and ulnar deviation
  4. Easily confused with UCL sprains
  5. Extensor Carpi Ulnaris Tendon attaches on the TFCC
20
Q

TFCC injury symptoms

A

deep pain on ulnar side of wrist axial loading through 5th metacarpal

21
Q

Arthroscopic TFCC Repair

A

debridement or repair with sutures

Wafer Procedure

22
Q

ulnar fovea sign

A

tests for TFCC injury or ulnotriquetral ligament tear (TFCC will have an associated DRUJ instability)

  • palpate the soft spot between the ulnar styloid process, pisiform, anterior surface of the ulnar head, and the FCU.
  • positive: reproduction of the pt’s symptoms
23
Q

“wafer” prodecure (describe it, indications, contraindications)

A
  • a wafer of up to 2-4 mm of distal ulnar head is removed, while the styloid process, TFCC, and attatched ligaments remain attached;
  • the procedure is contra-indicated if more than 4 mm of positive variance;
  • may be indicated for symptomatic positive ulnar variance, ulnocarpal impaction syndrome, or symptomatic TFCC tears;

saw used to cut ulnar head and remove “wafer” at lateral side of TFCC while styloid process still intact. TFCC reattached.

24
Q

How many Trigger Finger people are helped in the short term by one Corticosteroid inection?

A

~66%

25
Q

What is the primary treatment for Jersey finger

A

Surgical repair (mobilize ASAP!)

26
Q

UCL injury to thumb is called (two names)

A

gamekeepers thumb

Skier’s thumb

27
Q

Differential Fisting (purpose and 5 positions)

A

Used for Tendon Gliding

  1. Open hand
  2. MCP Flexion
  3. Hook Fist
  4. Straight Fist
  5. Composite Fist
28
Q

UCL of thumb tear symptoms

A
  1. Painful/Swollen
  2. Pinching and grip difficult
  3. Sometimes can feel little bump where ligament should be

the UCL test tests at extension and slight flexion because there are two fiber bundles in UCL

29
Q

Ganglion cysts

A

don’t forget about them

30
Q

Bible Bump Test

A

Burst the Ganglion Cyst

31
Q

Flexor Tendon Rehab progression

A

Phase I: day 5-3 weeks (PROM, AAROM, AROM)

Phase II: Weeks 4-6 (splints removed)
Phase III: Weeks 6-12

  • Week 7 light resistive exericses
  • Week 8 PROM bilateral comparison WNL
  • Week 10-12 BEgin light ADL’s
  • Week 12 All ADL’s and start resistance trn Weekss 14-16: BEgin heavy and sustained lifting ex and tight gripping ex
32
Q

characteristics of Flexor Tendon Repair recovery

A
  • Flexor tendon repair
  • early protected PORM: dorsal blocking splint
  • Early post -op - Progression to “careful ROM”
  • Place and hold exericses (sub max isometrics) in shortended position (progression to mid-lengthend positions)
  • Splinting Tech: blocking or dynamic splints ( orn 4-6 weeks)
  • Tendon glide assessment
  • Joint mobilizations
  • Progress to resistive exercises
33
Q

scaphoid has _______ blood supply making it vulnerable to _________

A

retrograde

avascular necrosis

34
Q

scaphoid fracture healing time

A

usually about 4 months because of delayed union

35
Q

Hamate fracture

A

usually when doing something with a club or holding something

Handle bars?

36
Q

Lunate dislocation

A

usually caused by FOOSH most common dislocated carpal bone Murphy’s sign

may have pain there, but may spontaniously reduce so may not be able to feel it.

Or Capitate may drop down into the gap
Greater than 3mm gap between scaphoid and lunate on a fisted radiograph

37
Q

metacarpal fractures

A

may have a large bump and an effect on knuckle

Usually casted and immobilized

38
Q

Boxer’s Fracture

A

fracture of neck of 5th metacarpalfrequently sustained during a fight or from punching a wall in anger or frustrationcasted for 2-4 weeks

Can see on observation

May get Gutter splint

39
Q

gutter splint

A

splint located on the radial or ulnar side of the wrist

40
Q

Bennet fracture

A
  • fracture of the base of the first metacarpal (thumb)
  • usually extends into the joint
  • usually has some dislocation.

ORIF with Kirschner pins

Thumb splint might be used

41
Q

PIP Joint Sprains and dislocations

A

Collateral ligaments

42
Q

DIP Joint fractures and Dislocations

A

happens

43
Q

Boutonniere deformity

A

RA. PIP flexion, DIP hyperextension

can try splinting

44
Q

What are the nodes call for RA? OA?

A

RA nodes= Bouchard’s nodes;

OA nodes= Heberden’s nodes

45
Q

swan neck deformity

A

sometimes you can do this if you have hypermobility

Use swan neck splint

RA

PHTH 7212 Pathophysiology (12 decks)

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