Wrist & Hand (SY) Flashcards
What is a Colles fx?
Fx 1 1/2’ proximal to distal end of radius displaced dorsally
What other fx occurs in more than 50% of the cases of Collies fxs?
fx of radiocarpal joint or avulsion fx of ulnar styloid process
What are most complications due to in Collies fxs?
malalignment/malunion of fragments resulting in joint incongruity
What happens with residual dorsla tilting >5 degrees of the radius post collies fx?
lose inward tilt of articular surface of >3 degrees and poor functional results
What can happen to the wrist with shortening of the radius post Distal radius fx?
increased axial load to the ulnar shaft leading to DJD and pain in ulnar aspect of wrist
What are some presentations of RSD (reflex sympathetic Dystrophy?
Burning pain edema discoloration vasomotor/trophic changes sudomotor changes soft tissue contractures joint stiffness
What is a Smith Fx?
(reverse colles) fracture of the distal radius displaced ventrally (fall on flexed wrist or direct blow to forearm)
What is the major complication of a Smith fx?
Median Nerve injury
What is the medical management of a Smith’s fx?
Cast immobilization, pins and plate
What is normal wrist extension/flexion? Functional?
70/80. 40/40
What is normal radial/ulnar deviation? Functional?
15/30. 15/15
What is normal pronation/supination? Functional?
80/70. 50/50
How common are Scaphoid fxs?
60-70% of carpal fractures
Where do most Scaphoid fx’s occur?
in the middle of the bone
What affects the rate of healing of a Scaphoid fx?
Location of fx. Proximal scaphoid fxs hear slower than distal fxs
Are scaphoid fx’s typically present of radiograph early on?
Not always present early on
Where will you feel pain in a Scaphoid fx?
in the snuff box
What is a common cause of scaphoid fx?
high force hyperextension injury
What happens to pinch strength with a scaphoid fx?
Decreases
Three things required in order to heal a scaphoid fx
Coaptation of fragments
adequate blood supply
early diagnosis and adequate Rx (immobilization from time of injury until union)
What is the incidence of non-union in scaphoid fx’s?
high.
What are some factors in non-union of the scaphoid?
delayed diagnosis
inadequate immobilization
displacement of fragments > 1mm
instability between proximal and distal carpal rows
How long should you immobilize scaphoid if injury is proximal 1/3? Middle 1/3? Distal 1/3?
4-8 weeks. 6-12 weeks. 30 weeks
are there always symptoms with a scaphoid fx?
Not always until DJD appears
What are the symptoms of a scaphoid fx?
pain
swelling
decreased grip strength
limited ROM
What part of the lunate usually gets fractured?
Volar pole of the bone
Complications of a lunate fx?
Kienbocks disease- AVN of lunate resulting in collapse
What are some predisposing factors of Keinbock’s AVN?
Pattern of intrinsic blood supply?
Negative Ulnar variance
Radial slope
Who typically presents with Keinbock’s AVN?
Male:female-2:1 age 20-40
What are some signs/symptoms of Keinbock’s?
Pain about lunate/swelling
Decreased grip strength
Decreased ROM
How do you treat Keinbock’s AVN?
Primarily a surgical problem. Immobilization w/ external fixator
silicone arthroplasty is inserted and carpals are usually fused
What is De Quervain’s Tenosynovitis?
Inflammation of the tendon sheath of the APL and EPB attributed to excessive friction between the two tendons
What are associated factors with De Quervain’s Tenosynovitis?
DM Hypothyroidism pregnancy RA gender (female?)
What are some differential diagnoses for De Quervain’s Tenosynovitis?
Thumb CMC arthritis
Scaphoid fx
entrapment of superficial branch of radial n
radiocarpal dysfxn
you will have a +/- Finkelstein’s test with De Quervain’s Tenosynovitis?
Positive. also have pain with resisted extension of thumb MCP joint
What is some general Rx’s for De Quervain’s Tenosynovitis?
Splinting/rest
NSAIDS
Injection
Surgery
What are some specific PT Rx’s for De Quervain’s Tenosynovitis?
Pt education Modalities Manual Therapy Tendon Gliding exercises Strengthening
What is Skier’s/Gatekeepers Thumb?
Injury of Ulnar Collateral Ligament of thumb
What is the method of injury for Gatekeepers Thumb?
forced or repetitive radial deviation of the thumb
What are some complications with an UCL injury?
Chronic laxity leading to DJD
Decreased pinch and grip strength
Pain
How do you test for instability of the UCL?
> 15 degrees of valgus deformity with ulnar stress to the thump MCP joint as compared to the uninvolved side.
-Test done in 15-20 degrees of flexion and full flexion
What do you do before stress testing the UCL?
X-ray done prior to detect avulsion fx of the MC bone
What are the treatments of an UCL injury?
Splinting, Casting and surgery
What are some indications to surgically repair an UCL?
UCL injury w/ Fx that is rotated, displaced or interarticular
Stener Lesion
What is a Stener lesion?
aponeurosis of adductor pollicis muscle becomes interposed btwn the ruptured UCL and its site of insertion at the base of proximal phalanx.
-UCL cannot spontaneously heal
When is prognosis worse with UCL surgical intervention?
With delayed repair of a complete UCL tear
