Wrist & Hand (SY)

Question 1

What is a Colles fx?

Answer 1

Fx 1 1/2’ proximal to distal end of radius displaced dorsally

Question 2

What other fx occurs in more than 50% of the cases of Collies fxs?

Answer 2

fx of radiocarpal joint or avulsion fx of ulnar styloid process

Question 3

What are most complications due to in Collies fxs?

Answer 3

malalignment/malunion of fragments resulting in joint incongruity

Question 4

What happens with residual dorsla tilting >5 degrees of the radius post collies fx?

Answer 4

lose inward tilt of articular surface of >3 degrees and poor functional results

Question 5

What can happen to the wrist with shortening of the radius post Distal radius fx?

Answer 5

increased axial load to the ulnar shaft leading to DJD and pain in ulnar aspect of wrist

Question 6

What are some presentations of RSD (reflex sympathetic Dystrophy?

Answer 6

Burning pain
edema
discoloration
vasomotor/trophic changes
sudomotor changes
soft tissue contractures 
joint stiffness

Question 7

What is a Smith Fx?

Answer 7

(reverse colles) fracture of the distal radius displaced ventrally (fall on flexed wrist or direct blow to forearm)

Question 8

What is the major complication of a Smith fx?

Answer 8

Median Nerve injury

Question 9

What is the medical management of a Smith’s fx?

Answer 9

Cast immobilization, pins and plate

Question 10

What is normal wrist extension/flexion? Functional?

Answer 10

70/80. 40/40

Question 11

What is normal radial/ulnar deviation? Functional?

Answer 11

15/30. 15/15

Question 12

What is normal pronation/supination? Functional?

Answer 12

80/70. 50/50

Question 13

How common are Scaphoid fxs?

Answer 13

60-70% of carpal fractures

Question 14

Where do most Scaphoid fx’s occur?

Answer 14

in the middle of the bone

Question 15

What affects the rate of healing of a Scaphoid fx?

Answer 15

Location of fx. Proximal scaphoid fxs hear slower than distal fxs

Question 16

Are scaphoid fx’s typically present of radiograph early on?

Answer 16

Not always present early on

Question 17

Where will you feel pain in a Scaphoid fx?

Answer 17

in the snuff box

Question 18

What is a common cause of scaphoid fx?

Answer 18

high force hyperextension injury

Question 19

What happens to pinch strength with a scaphoid fx?

Answer 19

Decreases

Question 20

Three things required in order to heal a scaphoid fx

Answer 20

Coaptation of fragments
adequate blood supply
early diagnosis and adequate Rx (immobilization from time of injury until union)

Question 21

What is the incidence of non-union in scaphoid fx’s?

Answer 21

high.

Question 22

What are some factors in non-union of the scaphoid?

Answer 22

delayed diagnosis
inadequate immobilization
displacement of fragments > 1mm
instability between proximal and distal carpal rows

Question 23

How long should you immobilize scaphoid if injury is proximal 1/3? Middle 1/3? Distal 1/3?

Answer 23

4-8 weeks. 6-12 weeks. 30 weeks

Question 24

are there always symptoms with a scaphoid fx?

Answer 24

Not always until DJD appears

Question 25

What are the symptoms of a scaphoid fx?

Answer 25

pain swelling decreased grip strength limited ROM

Question 26

What part of the lunate usually gets fractured?

Answer 26

Volar pole of the bone

Question 27

Complications of a lunate fx?

Answer 27

Kienbocks disease- AVN of lunate resulting in collapse

Question 28

What are some predisposing factors of Keinbock's AVN?

Answer 28

Pattern of intrinsic blood supply? Negative Ulnar variance Radial slope

Question 29

Who typically presents with Keinbock's AVN?

Answer 29

Male:female-2:1 age 20-40

Question 30

What are some signs/symptoms of Keinbock's?

Answer 30

Pain about lunate/swelling Decreased grip strength Decreased ROM

Question 31

How do you treat Keinbock's AVN?

Answer 31

Primarily a surgical problem. Immobilization w/ external fixator silicone arthroplasty is inserted and carpals are usually fused

Question 32

What is De Quervain's Tenosynovitis?

Answer 32

Inflammation of the tendon sheath of the APL and EPB attributed to excessive friction between the two tendons

Question 33

What are associated factors with De Quervain's Tenosynovitis?

Answer 33

``` DM Hypothyroidism pregnancy RA gender (female?) ```

Question 34

What are some differential diagnoses for De Quervain's Tenosynovitis?

Answer 34

Thumb CMC arthritis Scaphoid fx entrapment of superficial branch of radial n radiocarpal dysfxn

Question 35

you will have a +/- Finkelstein's test with De Quervain's Tenosynovitis?

Answer 35

Positive. also have pain with resisted extension of thumb MCP joint

Question 36

What is some general Rx's for De Quervain's Tenosynovitis?

Answer 36

Splinting/rest NSAIDS Injection Surgery

Question 37

What are some specific PT Rx's for De Quervain's Tenosynovitis?

Answer 37

``` Pt education Modalities Manual Therapy Tendon Gliding exercises Strengthening ```

Question 38

What is Skier's/Gatekeepers Thumb?

Answer 38

Injury of Ulnar Collateral Ligament of thumb

Question 39

What is the method of injury for Gatekeepers Thumb?

Answer 39

forced or repetitive radial deviation of the thumb

Question 40

What are some complications with an UCL injury?

Answer 40

Chronic laxity leading to DJD Decreased pinch and grip strength Pain

Question 41

How do you test for instability of the UCL?

Answer 41

> 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

Question 42

What do you do before stress testing the UCL?

Answer 42

X-ray done prior to detect avulsion fx of the MC bone

Question 43

What are the treatments of an UCL injury?

Answer 43

Splinting, Casting and surgery

Question 44

What are some indications to surgically repair an UCL?

Answer 44

UCL injury w/ Fx that is rotated, displaced or interarticular Stener Lesion

Question 45

What is a Stener lesion?

Answer 45

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

Question 46

When is prognosis worse with UCL surgical intervention?

Answer 46

With delayed repair of a complete UCL tear