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hand/wrist - last 91 slides
n/a
53
Medical
Graduate
10/17/2011

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Term
The patient can ____ SCAPHOLUNATE ligament and it may get better with splinting, time, and oral anti-inflammatories. However, if the ligament is ___ this can lead to a very unstable wrist joint and lead the patient to chronic pain and eventually ___ if not fixed surgically
Definition
sprain
torn
arthritis
Term
SCAPHOLUNATE DISSOCIATION Often times this injury is not that obvious on _____
Definition
x-rays
Term
What is secondary to a scapho-lunate dissociation
Definition
osteoarthritis
Term
SLAC wrist means ...
Definition
scapho-lunate advanced collapse
Term
SLAC wrist can lead to ___
Definition
osteoarthritis
Term
NEVER _____ pts w/ SLAC wrist / osteoarthristi, it will make it worse.
Definition
immobilize
Term
If x-rays are negative of SCAPHOLUNATE DISSOCIATION you can ____ them, and if the patient has a sprain the patient should get better
Definition
splint
Term
How do you get a difinitive diagnosis of scapholunate dissociation?
Definition
MRI
Term
What do you do if If MRI for scapholunate dissociation is positive, or if you have a high suspicion for a scapho-lunate injury?

What If the patient has a fracture?
Definition
send the patient to the orthopedic specialist


send the patient to the orthopedic specialist after splinting/casting the fracture
Term
checking for _____, can lead to a diagnosis of scapho-lunate dissociation
Definition
intercarpal instability
Term
This occurs when there is a tear to the ulnar collateral ligament (UCL) of the thumb’s MCP joint
Definition
GAMEKEEPERS THUMB
Term
GAMEKEEPERS THUMB occurs when there is a tear to the ____ of the thumb’s ___ joint
Definition
ulnar collateral ligament (UCL)
MCP
Term
‘skiers thumb’
Definition
GAMEKEEPERS THUMB
Term
GAMEKEEPERS THUMB When the ulnar collateral ligament at the base of the thumb is torn there is instability with ___ stress of the MCP joint
Definition

[image]

valgus

Term
With GAMEKEEPERS THUMB, The patient can have a ____. It should heal conservatively with a _____.
Rarely does this need surgery, but if there is a significant piece involving a large portion of the joint, surgery may be the option
Definition
bony avulsion
thumb spica cast
Term
GAMEKEEPERS THUMB can also have a soft tissue sprain/tear which x-rays will be ____
Most patients with no bony abnormality will heal conservatively in a ___
Definition
normal
thumb spica cast
Term
A stener lesion is when the ____ flips into the ___ joint and prevents the ligament from healing. THis happens in ___
Definition
adductor aponeurosis
MCP
GAMEKEEPERS THUMB
Term
how to treat a stener lesion in GAMEKEEPERS THUMB ?
Definition
surgery
Term
occurs due to valgus or varus stress to the MCP joints or IP joints
Definition
COLLATERAL LIGAMENT SPRAINS
Term
COLLATERAL LIGAMENT SPRAINS

If there is ____ with valgus or varus stress of the joint involved you can buddy tape the involved finger with the finger next to it for several weeks until acute symptoms resolve
Patients only need surgery if there is ____ and significant laxity
Definition
stability
instability
Term
what is the only exception to getting 3 x ray views?
Definition
the fingers - only get 2
Term
Dorsal angulation of the distal radius metaphysis approximately 2-3 cm from the wrist joint with or without associated fracture of the ulna styloid
Definition
COLLE’S FRACTURE
Term
COLLE’S FRACTURE: ____ angulation of the distal ___ metaphysis approximately 2-3 cm from the wrist joint with or without associated fracture of the ulna styloid
Definition
Dorsal
radius
Term
COLLE’S FRACTURE
Some of these fractures can be ___ and may not need surgery if they maintain good position
If you are comfortable with this in your clinic you want to do a ___ block first to numb the site as much as you can, because it definitely is a painful procedure
You need to x-ray the patients every week for at least the first __ weeks
X-ray through the cast on follow-up (you do not want to take a chance that the fracture will move)
Definition
reduced
hematoma
3
Term
COLLE’S FRACTURE
Initial treatment is _____, followed by a __, followed by an x-ray through the cast to confirm the ___
Definition
reduction
sugar tong splint
reduction
Term
Why sugar tong splint for colles fracture?
Definition
This splint allows for swelling
It prevents supination and pronation which can displace the fracture
Term
After 4 wks in a sugar tong splint for colles fracture, transfer the patient into a ___ for another 2 weeks, at which time it should be healed
Definition
short arm cast
Term
will a scaphoid fx be seen on x ray?
Definition
These fractures are not always seen on initial x-rays if the fracture is fresh
Term
What imaging is needed for definitive dx of scaphoid fracture?
Definition
MRI

I will usually get an MRI in a patient that requires immediate use of their hand/wrist
Professional athletes or a patient who does manual labor are examples
Term
where do you palpate scaphoid fx?
Definition
ANATOMICAL SNUFF BOX
Term
scaphoid fx tx?
Treatment is a __________ cast if the pt is a poor candidate for Sx or in a rural practice. Otherwise, Sx is the Tx.
In an acute injury you will ___ the cast to allow for swelling
Definition
thumb spica long arm
bivalve

Now, you will see some providers who may suspect a scaphoid fracture and intially treat it in a thumb spica removable splint (to wear full-time), or in a short arm thumb spica cast
This is NOT CORRECT
You must go above the elbow to protect the patient from supinating and pronating so the fracture maintains position (does not move) and has a better chance to heal
Term
If the scaphoid fracture is ___ to the waist of the scaphoid the greater the chance for the fracture to heal
The more ___ the fracture is to the waist of the scaphoid the more likely there will be a non-union (did not heal)
Why?
Definition
distal
proximal

blood supply is better distally
Term
It usually occurs due to making a fist and punching something
Definition
BOXER’S FRACTURE
Term
Some patients sustain this injury if they fall onto a clenched fist, or sometimes someone stepped on the patient’s hand
Definition
BOXER’S FRACTURE
Term
BOXER’S FRACTURE: The patient sustains a fracture of the ___ ____ _____
Definition
distal fifth metacarpal
Term
When examining a patient that you suspect has a boxer’s fracture (OR, really any patient with a suspected hand fracture), ALWAYS check their ______
Definition
cascade
Term
what is the cascade?
Definition
seen on the volar aspect of the hand with the fingers flexed into the palm; and then on the dorsal aspect of a clenched fist at the MCP joints
You compare this to the uninvolved side
You are checking for any finger crossings on the volar aspect of the hand, and then shortening of the metacarpal head on the dorsal aspect with fist still clenched
If any fingers cross then the patient has a displaced fracture that needs surgery
If a metacarpal head is shortened the patient may need surgery depending on the x-ray findings (this is less so, however, in the fifth metacarpal)
I check the cascade on every hand trauma I see, so with any metacarpal fracture always check this
Term
If any fingers cross when checking cascade, then the patient has a ___ fracture that needs __
If a metacarpal head is ___ the patient may need surgery depending on the x-ray findings (this is less so, however, in the fifth metacarpal)
I check the cascade on every hand trauma I see, so with any metacarpal fracture always check this
Definition
displaced
surgeryshortened
Term
cascade - flexed fingers should all point towards the ___
Definition
scaphoid
Term
boxer's fracture
These patient’s tend to heal quickly, especially if they have no co-morbidities and are non-smokers, rarely needing Sx.
Acutely, I put them in an ____, or splint. I finish these off with an ace wrap to hold the fiberglass mold in place.
Definition
ulnar gutter cast
Term
a very unstable proximal 1st metacarpal fracture
Definition
BENNETT’S FRACTURE
Term
BENNETT’S FRACTURE: occurs when the _____ tendon pulls on the ___ metacarpal long bone causing it to be pulled proximal and dorsal from its attachment
Definition
abductor pollicus longus tendon
1st
Term
with BENNETT’S FRACTURE, it is important to..
Definition
refer to a specialist!!
Term
If the bennett's fracture can maintain position, a ___ cast can be used for treatment
Definition
short arm thumb spica
Term
If bennett's fx not stable then ___
Definition
surgery
Term
Stable finger fractures do not need surgery as long as there are no significant ___ component
Definition
intra-articular
Term
volar plate injury tx?
Definition
These injuries DO NOT require Sx, and they DO NOT require Casting.
Treatment is buddy taping and treating symptoms
Do not immobilize these
Patients will get better with time
Term
The Volar Plate can be defined as a very thick ligament that prevents hyperextension from occurring. If there is enough force during hyperextension, the disruption may cause a rupture of the Volar Plate at its insertion on the ___ ___ of a finger. This would result in .....
Definition
middle phalanx
a small piece of bone being avulsed, (pulled off), by the ligament as it is hyperextending.
Term
what sport is notoriously known for finger dislocations
Definition
Wrestling
Term
Just as in fractures, dislocations always require a good __ exam prior to reducing the joint. Dislocations that compromise __ status must be reduced immediately
Definition
NV
NV
Term
KANAVEL’S SIGNS
The finger is in slight ___
Fusiform ___
Pain with ___
Tenderness along the ___ sheath
Definition
flexion
swelling
extension
tendon
Term
KANAVEL’S SIGNS indicates what?
Definition
infection
Term
___ and ___ fractures tend to be unstable and generally need surgery to stabilize)
Definition
oblique
spiral
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