Conditions Of Wrist, Hand & Fingers Flashcards Preview

Conditions (2nd year) > Conditions Of Wrist, Hand & Fingers > Flashcards

Flashcards in Conditions Of Wrist, Hand & Fingers Deck (71)
0

Name all the Carpal Bones

Scaphoid Trapezium
Lunate Trapezoid
Triquetrum Capitate
Pisiform Hamate

1

What is the Triangular Fibrocartilage?

Disc overlying distal ulnar head
Disc binds end of distal radius & ulna together
Makes up a portion of TFCC complex which acts as a stabilizer of the distal radio-ulnar joint

2

What are the Joint of the Hand?

Carpo-metacarpal (CM)
Inter-metacarpal
Metacarpo-phalangeal (MCP)
Inter-phalangeal (IP)
- digits numbered 1-5 w/first being thumb
(Knuckles = MP joints)

3

Describe an Inter-phalangeal joint

Proximal (PIP) & distal (DIP) & IP are hinge joints
Reinforced by articulating capsule joined by volar & collateral ligaments

4

What is the Wrist Retinacula?

Very thick fascial tissue
Protective pathways through which tendons, nerves & blood vessels pass

5

What is the job of the Flexor Retinaculum?

Protects extrinsic flexor tendons & median nerve

6

What is the role of the Extensor Retinaculum?

Pasageway for extrinsic muscles on the dorsal side of the wrist

7

What are the 3 Nerves of the hand?

Median }
Ulnar } Brachial Plexus
Radial }

8

What does the Median Nerve Supply?

Supplies majority of flexor & intrinsic muscle on radial side of Palm
Cutaneous sensation lateral 2/3 of Palm

9

How does medial nerve entrapment happen?

Strenuous/repetitive elbow motion
Pronator Teres/FDS tightness

10

What does the Ulnar Nerve innervate?

Innervates FCU & ulnar FDP
Cutaneous sensation of 5th & 1/2 4th on dorsal & palmar sides

11

What does the Radial Nerve innervate?

Superficial- skin on dorsum of hand
Deep- Innervates extensor muscles of forearm

12

Wrist Sprain MOI

Axial loading (FOOSH)
Most common btwn scaphoid & lunate

13

Wrist Sprain S&Sx

TOP dorsum of hand of radio-carpal joint

14

Wrist Sprain Management

PIER
R/O #
Pain in 'snuff' box, scaphoid # indicator
Tape to prevent movement

15

What are the primary movements of the thumb?

Flexion
Extension
Opposition
Abduction
Circumduction

16

Game Keepers Thumb MOI

Tearing of UCL @ MP joint when MP near full ext & thumb forcefully abducted away from hand

17

Game Keepers Thumb S&Sx

Palmar aspect of thumb is swollen w/visible bruising & ⬆ ️pain or weakness w/pinching/opposition

18

Game Keepers Thumb Management

PIER
R/O #
Tape for instability
Valgus stress for MCP of thumb

19

Interphalangeal Collateral Ligament Sprain MOI

Excessive valgus/varus force/hyperextension

20

Interphalangeal Collateral Ligament Sprain S&Sx

Obvious deformity may or may not be present unless there is a # or a total rupture
Rapid swelling makes assessment difficult
Need to R/O dislocation or #

21

Interphalangeal Collateral Ligament Sprain Management

PIER
Valgus/varus stress test
Budding taping (2&3/4&5)

22

Dislocation of MC & phalanges MOI (MCP)

Rare injury
Hyperextension/shearing forces cause anterior capsule to tear allowing proximal phalanx to move backward

23

Dislocation of MC & phalanges MOI (PIP)

Hyperxtension & axial compression (ball hits tip of finger)

24

Dislocation of MC & phalanges MOI (DIP)

Usually occurs dorsally & may be associated w/an open wound
Individual often reduced their own dislocations

25

Dislocation of MC & phalanges S&Sx

Painful, swollen finger
Pain present at joint line
B/c of opportunity to entrap volar plates, no reduction it may lead to permanent disability

26

Dislocation of MC & phalanges Management

Immobilize in a wrist/finger splint in position found
When RTP, protect w/buddy taping

27

What is a STRAIN?

Occurs as a result of excessive overload against resistance/stretching of the tendon beyond its normal range

28

Jersey Finger MOI

Individual grips opponents jersey & opponent simultaneously twists to get away
Jerking motion forces individual finger to rapid to extend; rupturing FDP
Ring finger is most commonly involved

29

Jersey Finger S&Sx

Pain & swelling at DIP & report a popping sensation
Flex tendon disruption is indicated w/1finger lying in complete extension while others are in slight flexion
In avulsed tendon can be palpated at proximal aspect of involved finger

30

Jersey Finger Management

Standard acute care
Refer to physician
Tendon has retracted into Palm, surgical reattachment must happen 7-10 days post injury
Typical RTP is 6-12 weeks post op.

31

Mallet Finger MOI

Object hits finger while extensor tendon is taut
Avulsed lateral bands of extensor mechanism the distal attachment

32

Mallet Finger S&Sx

Tendon usually does not retract
Pain, swelling, lack of extensor at DIP
If left untreated, complete tears lead to permanent DIP extensor lag

33

Mallet Finger Management

Standard acute care
Refer to MD
Split DIP in complete extension for 6-8 weeks

34

Boutonnière Deformity MOI

Blunt trauma to dorsal PIP/rapid powerful flex of the joint against resistance
Central slip of extensor tendon ruptures at mid phalanx, leaving no active extensor mech. Intact over PIP

35

Boutonnière Deformity S&Sx

Not usually present immediately , develops over 2-3 weeks as the later slip moves in a palmar direction to cause hyperextension at MP flex at PIP & hyperextension of DIP

36

Boutonnière Deformity Management

Splint PIP in complete extension & refer

37

What is a tendonopathy?

Individual involved in strenuous/repetitive tasks often inflame tendon & tendon sheaths in wrist & hand
Tendon injury can be acute or chronic
Overuse can lead to derangement of both mechanical & physiological components of a normal tendon

38

Trigger Finger MOI

Snapping flexor tendon, multiple/severe traumas to palmar aspect of hand/indiv who perform repeated mov't/clenching of fingers
Repeated trauma & inflam'n lead to thickening of tendon sheath
Nodule can form & grow within thickened synovium

39

Trigger Finger S&Sx

Locking action
Painful popping when flexed PIP jt. is passively returned to extension
Palpable crepitus may indicate systemic disease

40

Trigger Finger Management

Resisting splinting when necessary
Find cause, treat cause

41

DeQuervain Tenosynovitus MOI

Indiv who uses forceful grasp, combined w/repetitive use of thumb k ulnar deviation
Motion places high demand on AbPL & EPB
These 2 tendons share a single sheath

42

DeQuervain Tenosynovitus S&Sx

Pain over radial styloid & ⬆️ w/wrist & thumb motion
TOP over tendons
Thumb motion & snapping
(+ve) Finklesteins test

43

DeQuervain Tenosynovitus Management

Find cause, treat cause
Thumb spica
Surgery may be warranted

44

Dupuytren Contracture MOI

Idiopathic
Nodules appear in palmar aponeurosis
Limited finger extension & eventually causes a flex deformity

45

Dupuytren Contracture S&Sx

Fixed flexed deformity occurring on ring or 5th finger
Finger cannot be extended

46

Dupuytren Contracture Management

Surgical removal of nodule

47

Ganglion Cyst MOI

Benign tumor masses typically seen on dorsal aspect of wrist

48

Ganglion Cyst S&Sx

Cyst contains jelly like colourless fluid & is freely mobile & palpable
Occurs spontaneously
Discomfort from pressure may occur as ganglion ⬆️ in size

49

Ganglion Cyst Management

Rx is symptomatic
Surgical removal

50

Fingertip Injuries (subungual hematoma) MOI

Direct trauma to nail bed can result in blood under nail

51

Fingertip Injuries (subungual hematoma) S&Sx

⬆️ pressure under nail bed which can lead to throbbing pain

52

Fingertip Injuries (subungual hematoma) Management

R/O #
Soak in ice water 10-15 mins to numb area
If throbbing persists, draining may help
MD for drainage

53

Paronychia MOI

Infection along nail fold
Seen w/hangnail

54

Paronychia S&Sx

Nail fold becomes red, swollen & painful
Can produce purulent drainage

55

Paronychia Management

Warm water soaks
Severe cases, MD may recommend antibodies

56

What is Carpal Tunnel Syndrome

- Formed by volar capsule w/roof formed by transverse retinacular lig't
- accommodates median nerve, finger flexors
- irritation of synovial sheath can produce swelling/edema that puts pressure on median nerve
- repetitive movements/positions

57

Carpal Tunnel Syndrome S&Sx

Pain awakens individual at night, relieved w/'shaking' out hands
Pain, numbness, burning sensation along median nerve distribution
Pinch & grip strength limited
(+ve) phalen, carpal tunnel compression & tinnel sign
Diminished sensitivity to pain & weak thumb abduction

58

Carpal Tunnel Syndrome Management

Refer to MD
Find cause, treat cause
Night splint/brace

59

Ulnar Tunnel Syndrome MOI

Compression of ulnar nerve as it passes around hook of hamate
Frequent w/Cyclist

60

Ulnar Tunnel Syndrome S&Sx

Motor sensory/mixed Sx
Numbness along ulnar nerve distribution
(+ve) pinch grip for thumb & index finger
(+ve) Tinel sign over pisiform

61

Ulnar Tunnel Syndrome Management

NSAIDs & avoidance of activity

62

Cyclists Palsy MOI

Linked to ulnar nerve entrapment
Biker leans on handle bars for extended period of time

63

Cyclists Palsy S&Sx

Swelling in hypothenar eminence
Sx mimic ulnar nerve entrapment but disappears after ride

64

Cyclists Palsy Management

Properly padded handle bars
Wearing padded gloves
Varying hand positions

65

Scaphoid # MOI

70% of carpal #
FOOSH

66

Scaphoid # S&Sx

Pain in 'snuff box'
Pain ⬆️ w/extension & radial deviation

67

Scaphoid # Management

Standard acute care
Immobilize
Poor blood supply = ⬆️ healing time

68

Boxer # MOI

# of distal metaphysis or neck of 4th & 5th MC

69

Boxer # S&Sx

Sudden pain, inability to grip
TOP over # site

70

Boxer # Management

Standard acute care
Refer to MD