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64 Cards in this Set
- Front
- Back
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A fracture of the ulna. Named because of the injury that results when attempting to block the downward blow of a ________ with the raised forearm. Transverse
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nightstick fracture
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Fracture of the mid or proximal ulna associated with a radial head dislocation.
Unstable fracture-dislocation Requires surgical consultation for ORIF |
Montagia fracture
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Fracture of the mid or distal radius associated with a carpoulnar dislocation.
Unstable fracture-dislocation Requires surgical consultation for ORIF |
Galeazzi Fracture
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Also called a reverse Colles fracture
This fracture is a transverse fracture of the distal radial metaphysis with palmar (as opposed to dorsal) displacement of the distal fracture fragment If intraarticular, it is called a reverse Barton fracture Results from a fall onto the flexed outstretched hand. Volar displacement |
Smith's Fracture
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A Barton fracture involves the intraarticular compartment.
Which is considered a Barton and which is a reverse Barton between the two fractures: Colle's and Smith |
Colles: Barton
Smith: reverse-Barton |
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Distal radius fracture w/ dislocation of radiocarpal joint;
Most common frx dislocation of the wrist joint Comminuted frx of distal radius may involve either anterior or posterior cortex and may extend into the wrist joint It often occurs along with a radial styloid frx It differs from Colles' or Smith's Fracture in that the subluxation/dislocation is the most striking radiographic finding Almost always requires surgical fixation |
Barton Fracture
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Fracture to the Radial Styloid
Requires fixation Reduction is secured w/ either K wire or lag screw; |
Chauffeur's Fracture
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in the transverse palm crease, which is on the thumb side, the proximal transverse thumb crease or the distal transverse thumb crease?
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proximal transverse thumb crease is next to the thumb
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Most common carpal fracture, results from hyperextension injury
Blood supply is highly variable 55 –90% result in nonunion Exam = snuff box pain, radial deviation pain Xrays may look normal – when in doubt, treat as a fracture! Long-arm thumb spica cast x 6-12 weeks, serial xrays Surgical ORIF |
scaphoid fracture
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helps stabilize ulnar carpal joint
Twisting injury to wrist, usually hyperextension and ulnar deviation Pain and popping between ulna and carpals, pt unable to do a “push up” d/t ulnar pain Splint in flexion and ulnar deviation for 6 weeks Arthroscopy |
TFCC tear
Triangular Fibrocartilage Complex |
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Heberdens of DIP common
DIP and PIP OA or RA? |
OA: DIP and PIP
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Bouchard Nodes: PIP or DIP
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PIP
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MP joints:
OA or RA |
RA and MP joints
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What test is this?
The patient is asked to hold their wrist in complete and forced flexion (pushing the dorsal surfaces of both hands together) for 30–60 seconds. This maneuver moderately increases the pressure in the carpal tunnel and has the effect of pinching the median nerve between the proximal edge of the transverse carpal ligament and the anterior border of the distal end of the radius. By compressing the median nerve within the carpal tunnel, characteristic symptoms (such as burning, tingling or numb sensation over the thumb, index, middle and ring fingers) conveys a positive test result and confirms carpal tunnel. Technique One minute acute wrist flexion against resistance Inverse praying position Place each hand dorsum against each other Interpretation: Positive test suggests Median Neuropathy Wrist flexion reproduces carpal tunnel symptoms Most specific if symptoms occur by 30 seconds |
Phalen's test
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Median nerve entrapment, very common
Middle aged or pregnant women, workers’ comp Parathesia, pain, sometimes paralysis Starts with an aching into the greater thenar eminence, moves into thumb, index and long finger Often unable to open jars, lids; night pain/stiffness Phalen’s test, Tinel’s sign, EMG Splinting (24 hours/day), NSAID’s, ergonomic aids Surgical release |
carpal tunnel syndrome
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Compression of Median Nerve
Occurs between transverse carpal ligament Inflamed and enlarged synovial lining of flexor tendons bilateral 50% |
carpal tunnel syndrome
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Chronic, severe compression of the median nerve within the carpal tunnel may lead to
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thenar atrophy
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Efficacy
Test Sensitivity: 44-70% Test Specificity: 94% Technique Percuss Median Nerve at carpal tunnel in wrist Tap over volar carpal ligament Interpretation: Positive Test for Median Neuropathy Reproduces pain and tingling along Median Nerve course |
Tinnel's sign
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Epidemiology
Much less common than Median Nerve compression Etiology: ____ Nerve compression Soft tissue tumors Ganglion Cyst Constricting bands or muscles ______ artery thrombosis Symptoms and Signs ______ Nerve Neuropathy Affects ulnar 1.5 fingers on palmar surface Does not affect forearm or finger dorsum Treatment Activity modification Usually surgery |
ulnar nerve entrapment
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Cause
Osteonecrosis of the Lunate Men age 20-40 most commonly affected Loss of blood supply secondary to trauma, idiopathic Symptoms Pain over dorsum of wrist, hyperdensity on Xray, bone scan, CT helpful Treatment Splint x 3 weeks, NSAIDS Refer |
Kienbock's disease
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Carpal dislocations result from hyperdorsiflexion (hyperextension)
Severe ligament injury is necessary to tear the distal row from the ______ to produce ________ dislocation Look for associated scaphoid fracture May have associated radial styloid fracture Requires surgical repair. |
Lunate and Perilunate Dislocation
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Pain out of proportion, no evidence on film, what should you suspect before dx a sprain
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Lunate and Perilunate Dislocation
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which fracture?
pain over base of 1st metacarpal. Oblique fracture of the first metacarpal base separating a small triangular volar fragment from the proximally displaced metacarpal shaft. Treatment typically requires Open or closed reduction with internal fixation |
Bennet's fracture
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Fracture of 5th metacarpal. tx: ulnar gutter splint
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Boxer's fracture
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Pathophysiology
Inflammation of thumb extensor tendons Extensor pollicis brevis Abductor pollicis longus Occurs where tendons cross radial styloid Variations: Extensor Carpi Radialis Tenosynovitis Affects radial wrist extensors Seen in heavy laborers Same signs, symptoms and management as de Quervain's |
DeQuervain’s tenosynovitis
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Signs and symptoms
First dorsal extensor compartment (snuff box) symptoms Crepitation with extensor tendon movement Local thickening of tendon sheath Radiation of pain Ascending up forearm Descending down into thumb Provocative maneuver eliciting pain Finkelstein Test Active and passive range of motion of thumb |
DeQuervain’s tenosynovitis
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what test is this?
Pain with passive stretching of the tendons : Direct the patient to place the thumb in their palm. Have them cover the thumb with the fingers of the same hand, forming a fist. Gently deviate the wrist towards the ulna. This stretches the inflamed tendons over the radial styloid, reproducing the patient's pain. |
Finklestein test used in DeQuervain's tenosynovitis
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Viking disease or Palmar fibromatosis
Nodular thickening and contraction of palmar fascia Men >50, northern European descent Nodules in palm, mild discomfort only Flexion of finger at MCP then PIP, usually ring finger Night splints may slow disease, but it is always progressive Surgical release |
Dupuytren’s contracture
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Central slip extensor tendon rupture
Proximal insertion of middle phalanx (PIP) Forced flexion of finger Splint in PIP extension 6 weeks – MUST catch early, may not get full extension after 1-2 weeks! DIP free motion |
Boutonniere Deformity
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Baseball finger
Extensor tendon injury at DIP joint, or avulsion fx Pain and inability to straighten distal phalanx Continuous splinting for 6 weeks (stack splint) pinning |
Mallet finger
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Clinical Manifestations:
Most often in long or ring fingers (occassionally in thumb) Produces a painful clicking as inflammed tendon passes thru constricted sheath as finger is flexed and extended; May lock in flexion, extension, or may be arrested in the middle range; There should be locking as the digit is passively taken thru a ROM With chronic triggering, a PIP flexion contracture (or IP flexion joint contracture) may develop; Palpation may reveal tender nodule over metacarpal head (which may imply a better prognosis w/ nonoperative treatment); Determine if the patient can flex and extend the digit past the triggering point w/o assistance; |
Trigger Finger
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What are these disorders associated with:
RA gout diabetes amyloidosis |
trigger finger
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in trigger finger, Results from localized tenosynovitis of superficial and deep flexor tendons adjacent to ___ pulley at a metacarpal head;
Inflammation causes nodular enlargement of tedon distal to pulley; Occurs most often in middle or ring fingers (occassionally in thumb); Rheumatoic trigger finger may involve several fingers; |
A1
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Gamekeeper’s thumb, “ski pole” injury
Rupture of ulnar collateral ligament of 1st MCP joint May be associated with Avulsion fracture at base of proximal phalanx Swelling, discoloration, pain with gripping, unable to pinch Stress radiographs with local anesthetic, compare to normal side may be helpful Thumb spica cast 4-6 weeks Ligament repair, percutaneous pinning to stabilize MP joint |
Ulnar collateral ligament sprain
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“Jersey” finger
FDS – Flexor digitorum sublimis FDP – Flexor digitorum profundus Spontaneous ( RA ) or Traumatic Check active flexion ability, strength of each joint (MP, PIP, DIP) Splint in wrist, finger flexion Refer for surgical repair ASAP > best results within 2 weeks of injury |
Flexor Tendon Injury (Jersey Finger)
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Mechanism
Ring finger most commonly affected (75% of cases) Protrudes further than other fingers on grasping Forced extension of actively flexed DIP joint Example Football player grabs a player's jersey on tackle Lifting latch on car door Signs/Symptoms Pain and swelling at volar aspect of DIP Localized tenderness and fullness if tendon retraction Affected finger more extended at DIP when hand at rest Inability to flex at affected DIP joint Caveat Do not passively force finger into extension Avulsed tendon retracts with avascular risk |
Flexor Tendon Injury (Jersey Finger)
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Radiology: XRay digit (AP, Lateral, Oblique)
Assess for bony avulsion of volar distal phalanx Management: Early surgical repair in all cases Temporize by splinting finger in current position Hand surgeon or orthopedics referral Best recovery if repaired within 7-10 days of injury Complications Fibrosis and scarring of tendon sheath Associated with delayed surgical repair Follow-Up No sports participation until fully recovered |
Flexor Tendon Injury (Jersey Finger)
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infection around nailbed
parnychia or felon |
paronychia
S. aureus usual pathogen > Keflex, etc I & D for both if severe Partial nail removal for paronychia |
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infection of pulp
paronychia or felon |
felon
S. aureus usual pathogen > Keflex, etc I & D for both if severe |
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Symptoms
Uniform, symmetric digit swelling; At rest, digit is held in partial flexion Excessive tenderness along the entire course of the flexor tendon sheath Pain along the tendon sheath with passive digit extension Pain with passive extension has been reported as the most clinically reproducible of these four signs |
Flexor Tenosynovitis
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Causative agents:
Typically include Staphylococcus (MRSA) and Streptococcus species. Mixed infections should be suspected in patients who have diabetes or are immunocompromised Disseminated gonorrhea and Candida albicans infection have been reported in immunocompromised patients. Treatment: IV antibiotics Hand surgery referral for possible emergent I&D |
Flexor Tenosynovitis
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the most common fractured bone of the wrist:
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scaphoid
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in general:
which nerve account for extension: which nerve allows fine control of pincer grip |
radial
median |
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the ulner nerve runs through this canal
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Guyon's canal
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this is the most common closed tendon injury of the finger:
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mallet finger
pt compliance is the most important factor in the success of splint tx |
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flexion of the PIP coupled with hyperextension of the DIP and MCP
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boutonniere's
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this test is perfomed by holding the affected finger's MCP and PIP jts in extension and having pt flex the DIP
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profundus test
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this test is performed by holding the unaffected fingers in extention and asking the pt to flex the injured finger
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superficialis test
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in this test the arm is first externally rotated and then passively elevated to a level alongside the ear
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impingement test
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in this test the thumb is pointed toward the floor and pt resists examiner's effort to push arm downward
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supraspinatus weakness
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what are the best predictors of rotator cuff injury:
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age older than 65
night pain weakness in ext rotation |
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the "painful arc sign" has high sensitivity as a single finding and is helpful in ruling out:
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rotator cuff tears
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the most common dislocated joint in the body is the ____ jt of the finger "coaches finger"
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PIP
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the MCP joint most commonly dislocated is that of the :
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thumb
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UCL injuries may cause _______ lesions, where the UCL becomes trapped outside of the adductor aponeurosis
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Stener
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"empty can" test is for:
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supraspinatus examination
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this test is for impingement of the rotator cuff tendons under the coracoacromial arch and is performed with the arm in full pronation and placed in forced flexion
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Neer's test
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This test is for subacromial impingement or rotator cuff tendonitis and the arm is forward elevated to 90 degrees and forcibly internally rotated
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Hawkin's test
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in this test, the arm is started in full flexion and constant valgus torque to the elbow and elbow is quickly extended
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moving valgus stress test to check the collateral ligaments of the elbow
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This test is used to check for ant shoulder instability and the pts arm is abducted to 90 degrees while examiner ext rotates the arm and applies ant pressure to the humerus
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apprehension test
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this test is for biceps tendon instability or tendonitis and is performed w/pt elbow flexed to 90 and examiner resists pt, attempts to supinate the arm and flex the elbow
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Yergason test
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this test is used to check glenohumeral instability by placing downward traction on humerus and examiner watches for depression lateral or inf to acromion
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Sulcus test
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this test is for cervical root disorder and the neck is extended and rotated toward the affected shoulder while an axial load is placed on the spine
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Spurling's test
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this sign is performed by rotating the loaded shoulder from extension to forward flexion to check for labral disorder
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"clunk" sign
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