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)
Loading flashcards...
0
Q

What is the Triangular Fibrocartilage?

A

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

1
Q

Name all the Carpal Bones

A

Scaphoid Trapezium
Lunate Trapezoid
Triquetrum Capitate
Pisiform Hamate

2
Q

What are the Joint of the Hand?

A
Carpo-metacarpal (CM)
Inter-metacarpal 
Metacarpo-phalangeal (MCP)
Inter-phalangeal (IP)
   - digits numbered 1-5 w/first being thumb 
(Knuckles = MP joints)
3
Q

Describe an Inter-phalangeal joint

A

Proximal (PIP) & distal (DIP) & IP are hinge joints

Reinforced by articulating capsule joined by volar & collateral ligaments

4
Q

What is the Wrist Retinacula?

A

Very thick fascial tissue

Protective pathways through which tendons, nerves & blood vessels pass

5
Q

What is the job of the Flexor Retinaculum?

A

Protects extrinsic flexor tendons & median nerve

6
Q

What is the role of the Extensor Retinaculum?

A

Pasageway for extrinsic muscles on the dorsal side of the wrist

7
Q

What are the 3 Nerves of the hand?

A

Median }
Ulnar } Brachial Plexus
Radial }

8
Q

What does the Median Nerve Supply?

A

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

9
Q

How does medial nerve entrapment happen?

A

Strenuous/repetitive elbow motion

Pronator Teres/FDS tightness

10
Q

What does the Ulnar Nerve innervate?

A

Innervates FCU & ulnar FDP

Cutaneous sensation of 5th & 1/2 4th on dorsal & palmar sides

11
Q

What does the Radial Nerve innervate?

A

Superficial- skin on dorsum of hand

Deep- Innervates extensor muscles of forearm

12
Q

Wrist Sprain MOI

A
Axial loading (FOOSH)
Most common btwn scaphoid & lunate
13
Q

Wrist Sprain S&Sx

A

TOP dorsum of hand of radio-carpal joint

14
Q

Wrist Sprain Management

A

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

15
Q

What are the primary movements of the thumb?

A
Flexion
Extension
Opposition 
Abduction 
Circumduction
16
Q

Game Keepers Thumb MOI

A

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

17
Q

Game Keepers Thumb S&Sx

A

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

18
Q

Game Keepers Thumb Management

A

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

19
Q

Interphalangeal Collateral Ligament Sprain MOI

A

Excessive valgus/varus force/hyperextension

20
Q

Interphalangeal Collateral Ligament Sprain S&Sx

A

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
Q

Interphalangeal Collateral Ligament Sprain Management

A
PIER
Valgus/varus stress test
Budding taping (2&3/4&5)
22
Q

Dislocation of MC & phalanges MOI (MCP)

A

Rare injury

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

23
Q

Dislocation of MC & phalanges MOI (PIP)

A

Hyperxtension & axial compression (ball hits tip of finger)

24
Q

Dislocation of MC & phalanges MOI (DIP)

A

Usually occurs dorsally & may be associated w/an open wound

Individual often reduced their own dislocations

25
Q

Dislocation of MC & phalanges S&Sx

A

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
Q

Dislocation of MC & phalanges Management

A

Immobilize in a wrist/finger splint in position found

When RTP, protect w/buddy taping

27
Q

What is a STRAIN?

A

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

28
Q

Jersey Finger MOI

A

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
Q

Jersey Finger S&Sx

A

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
Q

Jersey Finger Management

A

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
Q

Mallet Finger MOI

A

Object hits finger while extensor tendon is taut

Avulsed lateral bands of extensor mechanism the distal attachment

32
Q

Mallet Finger S&Sx

A

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

33
Q

Mallet Finger Management

A

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

34
Q

Boutonnière Deformity MOI

A

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
Q

Boutonnière Deformity S&Sx

A

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
Q

Boutonnière Deformity Management

A

Splint PIP in complete extension & refer

37
Q

What is a tendonopathy?

A

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
Q

Trigger Finger MOI

A

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
Q

Trigger Finger S&Sx

A

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

40
Q

Trigger Finger Management

A

Resisting splinting when necessary

Find cause, treat cause

41
Q

DeQuervain Tenosynovitus MOI

A

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
Q

DeQuervain Tenosynovitus S&Sx

A

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

43
Q

DeQuervain Tenosynovitus Management

A

Find cause, treat cause
Thumb spica
Surgery may be warranted

44
Q

Dupuytren Contracture MOI

A

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

45
Q

Dupuytren Contracture S&Sx

A

Fixed flexed deformity occurring on ring or 5th finger

Finger cannot be extended

46
Q

Dupuytren Contracture Management

A

Surgical removal of nodule

47
Q

Ganglion Cyst MOI

A

Benign tumor masses typically seen on dorsal aspect of wrist

48
Q

Ganglion Cyst S&Sx

A

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

49
Q

Ganglion Cyst Management

A

Rx is symptomatic

Surgical removal

50
Q

Fingertip Injuries (subungual hematoma) MOI

A

Direct trauma to nail bed can result in blood under nail

51
Q

Fingertip Injuries (subungual hematoma) S&Sx

A

⬆️ pressure under nail bed which can lead to throbbing pain

52
Q

Fingertip Injuries (subungual hematoma) Management

A

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

53
Q

Paronychia MOI

A

Infection along nail fold

Seen w/hangnail

54
Q

Paronychia S&Sx

A

Nail fold becomes red, swollen & painful

Can produce purulent drainage

55
Q

Paronychia Management

A

Warm water soaks

Severe cases, MD may recommend antibodies

56
Q

What is Carpal Tunnel Syndrome

A
  • 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
Q

Carpal Tunnel Syndrome S&Sx

A

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
Q

Carpal Tunnel Syndrome Management

A

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

59
Q

Ulnar Tunnel Syndrome MOI

A

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

60
Q

Ulnar Tunnel Syndrome S&Sx

A

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

61
Q

Ulnar Tunnel Syndrome Management

A

NSAIDs & avoidance of activity

62
Q

Cyclists Palsy MOI

A

Linked to ulnar nerve entrapment

Biker leans on handle bars for extended period of time

63
Q

Cyclists Palsy S&Sx

A

Swelling in hypothenar eminence

Sx mimic ulnar nerve entrapment but disappears after ride

64
Q

Cyclists Palsy Management

A

Properly padded handle bars
Wearing padded gloves
Varying hand positions

65
Q

Scaphoid # MOI

A

70% of carpal #

FOOSH

66
Q

Scaphoid # S&Sx

A

Pain in ‘snuff box’

Pain ⬆️ w/extension & radial deviation

67
Q

Scaphoid # Management

A

Standard acute care
Immobilize
Poor blood supply = ⬆️ healing time

68
Q

Boxer # MOI

A

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

69
Q

Boxer # S&Sx

A

Sudden pain, inability to grip

TOP over # site

70
Q

Boxer # Management

A

Standard acute care

Refer to MD