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MI1 > Wrist Injuries > Flashcards

Wrist Injuries Flashcards

1
Q

What are the common acute and chronic wrist injuries?

A 
Acute:
- Fractures
- Soft tissue strains/tears
Chronic:
- Pain persisting after healed fracture
- Tendinosis/tenosynovitis
- OA carpus
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2
Q

What are the common wrist fractures?

A
  • Colles
  • Smith’s
  • Barton’s
  • Scaphoid
  • Hook of Hamate
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3
Q

What occurs in a Colles fracture?

A

Dorsally displaced piece of distal radius, common in older women (FOOSH)

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4
Q

What occurs in a Smith’s fracture?

A

Volarly displaced piece of distal radius, fall in flexion

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5
Q

What occurs in a Barton’s fracture?

A

Fracture of intra-articular surface of distal radius with dislocation of radial carpal joint, more likely to need ORIF

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6
Q

What occurs in a Scaphoid fracture?

A

FOOSH, more common in younger people, usually compressive (not displaced)
Can disrupt nearby vessel causing vascular necrosis (bone death)

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7
Q

What is the management of a scaphoid fracture?

A

Conservative: Cast including MCP joint
Surgical: Internal fixation

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8
Q

What occurs in a Hook of Hamate fracture?

A

FOOSH, forceful impact of hamate

Can disrupt ulnar nerve causing loss of function in 4th & 5th MC

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9
Q

What are the principles of treatment for wrist fractures?

A 
Support & protect
- Plaster
- Internal/external fixation
Maintain
- ROM unaffected joints
- Isometrics
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10
Q

What are some of the problems associated with wrist fractures?

A
  • Stiffness
  • Persistent swelling
  • Weakness
  • Pain
  • Lack of confidence
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11
Q

What are the common types of soft tissue wrist injuries?

A
  • Triangular fibrocartilage complex (TFCC)
  • Distal radio ulnar joint instability (e.g. ulnar variance)
  • Scapholunate dissociation
  • Lunotriquetral instability
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12
Q

What is the TFCC?

A
  • Cartilage that sits in between ulna and proximal row of carpals & distal radioulnar joint
  • Creates a cushion for weight-bearing loads
  • Allows smooth rotation
  • Connective tissue
  • Includes many structures/ligaments
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13
Q

What is the mechanism of injury for TFCC?

A
  • FOOSH
  • Associated with fracture
  • Commonly, tear through ligaments that hold it down (DRU/PRU)
  • Can sometimes include ECU system
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14
Q

What is the treatment for TFCC?

A
  • Immobilisation in slight flexion/ulnar deviation 4-6/52
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15
Q

What does ulnar variance refer to?

A

Varying lengths of the ulna compared to the radius

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16
Q

When can positive ulnar variance occur? I.e. ulnar longer than radius

A

In people whose growth plates closed too early

17
Q

What occurs in scapholunate dissociation?

A
  • Scaphoid & lunate pushed apart

- Usually caused by FOOSH

18
Q

What can scapholunate dissociation progress to?

A

Scapholunate advanced collapse (SLAC)

  • Capitate falls down into the gap
  • Causes rapid onset of arthritis
  • Requires clenched fist imaging
19
Q

What occurs in lunotriquetral instability?

A
  • Injury to lunotriquetral interosseous ligament
  • FOOSH
  • Less common
  • May be associated with TFCC tear
20
Q

What is intercalated segmental instability?

A

When carpals don’t all move in perfect synchrony
VISI: Bowl shape of lunate points down
DISI: Bowl shape of lunate points up

21
Q

What occurs is DRUJ injuries?

A
  • Separation of DRUJ possibly involving interosseous membrane
  • Piano key sign
  • Associated tendinopathies (ECU)
22
Q

What are some of the problems associated with soft tissue wrist injuries?

A
  • Instability (damaged ligaments)
  • Swelling
  • Weakness
  • Pain
  • Progressive OA
23
Q

What are three chronic wrist conditions?

A
  • de Quervain’s
  • Carpal tunnel syndrome
  • Carpal joint OA
24
Q

What is de Quervain’s tenosynovitis?

A

Inflammation of synovium of abductor pollicis longus, due to lots of abduction & radial devation

25
Q

What are some of the problems associated with de Quervain’s?

A
  • Pain/inflammation
  • ADL impairments
  • Weakness
  • Impaired ROM
26
Q

What occurs in carpal tunnel syndrome?

A
  • Median nerve compression/impingement
  • Causes thenar wasting (FBB, OP)
  • Decreases pinch strength
  • Causes referred pain/altered sensation
  • Occurs in excessive flexion (e.g. breastfeeding mothers)
27
Q

What are some of the management options for CTS?

A
  • NCS (nerve conduction study) to assess severity
  • Splintage
  • Neural mobilisation
  • Strengthening exercises
  • Surgical release
28
Q

What are the early healing timeframes for tissues (movement without stress)

A 
Skin: 1 week
T-T: 3 weeks
T-B: 3 weeks
Ligament: 3 weeks
Nerve: 3 weeks
Bone: 3 weeks
29
Q

What are the consolidated healing timeframes for tissues (movement with full stress)

A 
Skin: 3 weeks
T-T: 6-12 weeks
T-B: 6-12 weeks
Ligament: 6-12 weeks
Nerve: 6 weeks
Bone: 6-12 weeks
30
Q

What are the NTBM conditions of the wrist?

A

Acute:

  • Carpal dislocation
  • Anterior dislocation of lunate
  • Perilunar dislocation
  • Ulnar artery thrombosis/aneurysm

Chronic:
- Carpal joint OA

MI1 (18 decks)

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