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Hand & Wrist Disorders
Part 1
98
Medical
Professional
10/16/2011

Additional Medical Flashcards

 


 

Cards

Term
Where is the most common site for a ganglion cyst?
Definition
dorsal wrist at the scapho-lunate joint
Term
What locations other than the scapho-lunate joint are common sites for ganglion cysts?
Definition
volar medial
volar lateral
Term
Where do ganglion cysts arise from?
Definition
capsule of the joint or the sheath of a tendon
Term
Ganglion cysts are usually __________ and _________ with palpation.
Definition
mobile; soft
Term
What is the treatment for ganglion cysts?
Definition
often resolve on their own

sometimes will continue to enlarge and sometimes can cause pain to the point that it needs to be removed

can aspirate or surgically excise

often recur with aspiration; sometimes recur with surgical excision
Term
What do you have to worry about if you are going to try to aspirate a ganglion cyst on the volar surface of the wrist?
Definition
arteries and nerves
Term
What is a hard, non-mobile mass commonly located at a proximal metacarpal?
Definition
carpal boss
Term
What is a carpal boss?
Definition
bone spur
Term
What is a problem with a carpal boss?
Definition
sometimes tendons can snap over the bony spur causing pain
Term
What is the treatment for a carpal boss?
Definition
surgical excision
Term
In a patient with DeQuervains's tendonitis, where will the swelling be?
Definition
along the extensor tendon of the thumb
Term
Where will a patient with DeQuervain's tendonitis be tender?
Definition
radial styloid (1st compartment of the wrist)
Term
What wrist disorder is common in new moms?
Definition
DeQuervain's tendonitis
Term
What is Finkelstein test?
Definition
apply an ulnar deviation to the wrist with the thumb in the fist

increased pain along the thumb extensor when compared to the opposite side is generally a positive test
Term
What condition would yield a positive Finkelstein test?
Definition
DeQuervain's tendonitis
Term
What are the treatment options for DeQuervain's tendonitis?
Definition
removable thumb spica splint
ice/heat
occupational therapy
steroid shot
Term
Where would a patient with trigger finger be tender?
Definition
over the A1 pulley of the flexor tendon of the digit
Term
What does a patient with trigger finger complain of?
Definition
snapping or triggering of the finger
Term
You can often feel a ________ or _________ with trigger finger.
Definition
nodule; crepitus
Term
What is the pathophysiology behind trigger finger?
Definition
flexor tendon on the flexor side of the digit at the base of the digit gets caught in the A1 pulley system

if the tendon is inflamed, it may swell and thicken and not be able to pull through this pulley system

therefore, catching, triggering, and snapping may result
Term
What are the possible causes of trigger finger?
Definition
not sure
sometimes trauma
sometimes overuse
Term
Where is the most common location of trigger finger in children?
Definition
thumb
Term
What is the treatment for trigger finger?
Definition
nothing, sometimes it will resolve on its own

longer it is present, the less the chance that it will resolve on its own

steroid shot may help

often surgery is needed to release the pulley so the tendon can glide without interruption
Term
What causes a Dupuytren's contracture?
Definition
spontaneous fibrous proliferation in the palmar fascia
Term
Who are Dupuytren's contractures most commonly seen in?
Definition
diabetics
Term
What is the treatment for Dupuytren's contractures?
Definition
observation as long as there is no pain and no significant contracture

steroid shot can help reduce pain, but does not prevent further progression of the contracture

never resolve on their own and generally worsen over time

surgical percutaneous fasciotomy or surgical removal is definitive treatment
Term
What symptoms would a patient with carpal tunnel syndrome complain of?
Definition
numbness/tingling along median nerve distribution of forearm and hand (1st 3 fingers and half of 4th, volar surface)

sometimes referred pain to shoulder on the same side

pain in forearm that wakes them up during the night with numbness/tingling into the hand

may complain of diffuse paresthesias that include all of the digits
Term
What do you need to rule out if a patient with suspected carpal tunnel syndrome complains of diffuse paresthesias that include all of the digits?
Definition
multiple nerve compressions like double crush syndrome
Term
What is double crush syndrome?
Definition
occurs when the patient has more than one nerve compressed--one in the periphery of a limb and one in the neck

ex: carpal tunnel syndrome caused by a pinched nerve in the neck
Term
What gives a definitive diagnosis of carpal tunnel syndrome?
Definition
EMG
Term
What is the treatment for carpal tunnel syndrome?
Definition
removable volar wrist splint (esp. while sleeping and during activities that cause symptoms)

steroid shot or oral anti-inflammatories (longer the symptoms have been present, more likely these meds will not help)

surgery to release carpal ligament if conservative treatment does not help
Term
What can patients with carpal tunnel syndrome sometimes also have going on?
Definition
distal radius fracture
Term
What symptoms will a patient with ulnar nerve entrapment at the wrist have?
Definition
numbness/tingling in the ulnar nerve distribution of the hand (pinky and half of the ring finger)
Term
What nerve runs through the Guyon canal?
Definition
ulnar n.
Term
Who is ulnar nerve entrapment most commonly seen in?
Definition
RA
Charcot-Marie-Tooth
MS

pts. often complain of CTS symptoms too
Term
What are the causes of ulnar nerve entrapment?
Definition
sometimes overuse
sometimes insidious
fracture can cause symptoms
Term
How is ulnar nerve entrapment diagnosed?
Definition
EMG
Term
What is the treatment for ulnar nerve entrapment?
Definition
oral anti-inflammatories
steroid injection
sometimes surgical release of ligament
Term
What might a patient with long-standing ulnar nerve entrapment present with?
Definition
intrinsic atrophy
Term
What would your findings be in a patient with long-standing ulnar nerve entrapment if the motor exam was abnormal?
Definition
not only are the intrinsics weak, but often the flexor digitorum profundus of the small finger is weak against resistance

flexor carpi ulnaris is also weak in the small finger

pt. cannot bring pinky into a fist due to weakness of the small finger flexor
Term
Despite treatment, when there is entrapment of nerves and you measure motor weakness and observe atrophy, the atrophy generally remains as well as their motor weakness.
Definition
Term
Where will a patient with Keinboch's disease be tender?
Definition
over luno-triquetral ligament (next to finger extension tendons)
Term
What is Keinboch's disease?
Definition
avascular necrosis (AVN) of the lunate bone
Term
When is Keinboch's disease primarily diagnosed?
Definition
20-40 year olds
Term
What do the first stages of Keinboch's disease present with?
Definition
normal x-rays (typical with AVN)
Term
What can be used to pick up AVN before actually seeing on plain films?
Definition
MRI
Term
Keinboch's disease will sometimes present with ________ lesions in the _______ bone without collapse of the bone.
Definition
lytic; lunate
Term
What gives the definitive diagnosis for Keinboch's disease?
Definition
MRI
Term
What is the treatment for Keinboch's disease?
Definition
oral anti-inflammatories
steroid injections
splinting to help reduce the pain
surgery (fusion)

treatment is similar to that of OA
Term
Where does a patient with triangular fibrocartilage tear (TFCC) complain of pain?
Definition
distal ulna side of the wrist

hurts to pick up weighted objects and is made worse with twisting the wrist
Term
What anatomical variant does a triangular fibrocartilage tear occur more frequently with?
Definition
ulna plus sign (ulna is longer than radius)
Term
What two bones is the TFCC between?
Definition
ulna and lunate
Term
What can cause a TFCC tear in a patient with an ulna plus sign?
Definition
axial load or even a twist to the wrist joint (ulna can impact the lunate)
Term
What gives a definitive diagnosis of a TFCC tear?
Definition
MRI
Term
What is the treatment for triangular fibrocartilage tear?
Definition
time (if it improves, the pt probably sprained the wrist instead)

volar wrist splint for comfort
steroid injections
anti-inflammatories
surgery if no response to conservative treatments
Term
What causes osteoarthritis of the hand and wrist?
Definition
gradual degenerative wear and tear of the joints in the hand and wrist

sometimes trauma
Term
What joints are most commonly affected by osteoarthritis?
Definition
carpometacarpal joint
DIP
PIP
wrist
(hip, knee, spine)
Term
Does osteoarthritis occur more in women or men?
Definition
women
Term
What will you often feel in the CMC joint of a patient with OA?
Definition
crepitus when rotating the pt's thumb
Term
What wrist disorder can eventually cause osteoarthritis in the wrist and why?
Definition
Keinboch's disease

the bone can collapse and change the mechanics of the wrist, which puts stress on other joints and can cause wear and tear over time-->OA
Term
What might you see on physical exam in a patient with osteoarthritis of the hand?
Definition
Heberden's (DIP) and Bouchard's (PIP) nodes
Term
What is the treatment for osteoarthritis?
Definition
observation
oral anti-inflammatories
steroid injections
surgery (fusion vs. replacement)
Term
What do you always need to check in a patient with any kind of wrist or hand injury?
Definition
neurovascular status
Term
How do you treat a finger tip amputation?
Definition
-reduce bleeding with elevation
-give pt. a digital block
-when pt. is numb, tourniquet finger to stop bleeding and really expose the wound to make sure no bone involvement
-if bone exposed-->immediate referral
-if no bone exposed-->cauterize injury to stop the bleeding
-release tourniquet and re-evaluate extent of bleeding, continue cauterization until bleeding stops
-apply Xeroform once bleeding has stopped, followed by dressing and splint
Term
What do you need to be careful about when treating a finger tip amputation?
Definition
do not over-cauterize!
can damage surrounding healthy tissue
Term
What injection do you need to make sure is up to date in a patient with a finger tip amputation?
Definition
tetanus
Term
You should give a patient a tetanus shot with a finger tip amputation if they haven't had one in the last ___ years.
Definition
5
Term
What medication do you always need to make sure you give a patient with a finger tip amputation?
Definition
antibiotic (oral or shot)
Term
What happens with mallet finger?
Definition
rupture of the extensor tendon
Term
What patients is mallet finger common in?
Definition
those that do housekeeping
Term
How does mallet finger occur?
Definition
when finger jams into something when the finger is in extension
Term
What finger most commonly is affected by mallet finger?
Definition
middle (long) finger
Term
Some mallet fingers involve ______ ______ and some involve ________.
Definition
soft tissues; bone
Term
X-rays with a soft tissue mallet finger are _________.
Definition
negative
Term
X-rays with a bony tissue mallet finger are _________.
Definition
positive for bony avulsion findings
Term
What is the treatment for bony avulsion mallet finger with subluxation of the joint?
Definition
surgery (percutaneous pinning)
Term
What is the treatment for soft tissue mallet finger and small bony avulsion mallet finger?
Definition
conservative

6 weeks in a dorsal extension splint of the DIP joint (aluminum splint or Stax splint)

DO NOT ALLOW THE DIP JOINT TO FLEX AT ALL DURING TREATMENT

if finger flexes, treatment must start all over

once the pt. has had 6 weeks of constant extension splinting, you can splint just at night for 2 more weeks
Term
What can a patient with mallet finger have?
Definition
extension lag

10 degrees is usually still functional and complete
Term
What causes a Boutonniere deformity?
Definition
central slip of the PIP joint tears or is cut

lateral bands become taught and cause PIP to flex dorsally through these bands

lateral bands insert distally at the distal phalynx, pulling the distal phalynx more proximal and into extension which increases the flexion of the PIP joint
Term
What is the central slip?
Definition
ligament that helps guide the extensor tendon of the fingers at the PIP joints as flexion/extension occurs at the PIP joints
Term
What does a Boutonniere deformity look like?
Definition
hyperextension of DIP and flexion of PIP
Term
What is the mechanism of injury that causes Boutonniere deformities?
Definition
laceration of central slip
forceful blow to the bent finger
Term
What are the causes of swan neck deformity?
Definition
rheumatoid arthritis (most common cause)
long-standing mallet finger
cerebral palsy due to muscle imbalance
congenital joint laxity
Term
What happens with swan neck deformity?
Definition
lateral bands no longer function, which causes distal phalynx to flex

central slip then begins to over-function in which it continues to try and extend the DIP joint without functioning lateral bands

leads to excessive extension of the PIP joint
Term
What happens with jersey finger?
Definition
avulsion of flexor digitorum profundus from the base of the distal phalynx
Term
What is the mechanism of injury for jersey finger?
Definition
tip of the finger is forced into extension (DIP) and proximal finger (PIP) is forced into flexion
Term
Jersey finger can be a ______ injury or a _________ _______ injury.
Definition
bony; soft tissue
Term
What is the treatment for jersey finger if there is just a partial tear of the FDP or a bony avulsion without subluxation?
Definition
conservative (splint)
Term
What is the treatment for jersey finger if there is complete bony avulsion that is subluxed or a retracted tendon?
Definition
surgery
Term
What can you sometimes feel with jersey finger if the retraction is significant?
Definition
bulge at the volar proximal finger
Term
How do you splint a patient with jersey finger if conservative treatment is warranted?
Definition
similar to mallet finger, but include MCP, PIP, and DIP

splint in slight flexion to bring the ends of the rupture/avulsion together

done for 6 weeks
Term
What do you always need to do with a patient with jersey finger?
Definition
send them to orthopedic specialist
Term
[image]
Definition

DeQuervain's tendonitis

 

radial styloid

Term
[image]
Definition

anatomical snuff box

scaphoid fracture

Term
[image]
Definition

CMC

osteoarthritis

Term
[image]
Definition

scapho-lunate joint (3rd and 4th compartment)

ganglion cyst

Term
[image]
Definition

luno-triquetral ligament

Keinboch's disease

Term
[image]
Definition

distal ulna

TFCC tear

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