Study sets, textbooks, questions
Upgrade to remove ads
Ortho Lecture 2 - Wrist/Hand
Terms in this set (80)
Where is the pain located at with a Scapholunate sprain/dissociation?
On the back of the wrist, radial side (near snuffbox)
What makes Scapholunate sprain hurt more?
loading the wrist
What clinical presentations does the scapholunate sprain has that is specific to this condition?
Hypermobility of carpals as the swelling goes down.
Tenderness @ scapholunate junction
What can appear on a X-ray for you to consider Scapholunate sprain/dissociation?
Terry Thomas Sign- abnormal distance of scapholunate ligament
What is the normal Scapholunate distance?
Normal is 2mm. 3mm is abnormal
If your patient has a grade 3 scapholunate sprain that is caught before it dissociates from each other. How would you treat it?
Grade 3 I would brace it for 6-8 weeks.
What's the MC way to sprain/dissociate your scapholunate ligament?
Falling on your hand with your wrist extended, ulnar deviated and carpals supinated. This can push your capitate between the scaphoid and lunate
Tearing of the scapholunate ligament and the radioscaphoid will lead to a complication known as DISI.
What does DISI stand for and what is it?
Dorsal Intercalated segmental Instability; it is when the scaphoid goes into flexion & the lunate into extension.
Besides DISI what is another complication that occurs with scapholunate grade 3 injuries.
SLAC wrist; Scapholunate Advanced Collapse.
it's when the capitate come between scaphoid and lunate and that can result in a degenerative disease If the disease progress on then DISI can occur.
What is the TFCC composed of?
What are the 2 types of TFCC tears?
Type 1 - traumatic
Type 2 - Degenerative chronic tears
How can I get a traumatic type 1 TFCC tear?
by falling on an extended wrist
especially if its pronated
How can I get a type 2 degenerative chronic tear?
Because of an Ulnocarpal impaction syndrome. basically my long ass ulna keep hitting my TFCC, triquetrium and lunate
With an Ulnocarpal impaction syndrome I most likely have what type of variance?
Postive ulna variance - long ass ulna
Where and what type of pain is associated with Triangular Fibrocartilage Complex Tears?
Dull aching pain on the pinky (ulnar) side of wrist that radiates to the back (dorsal) of my wrist
Would ulnar deviation hurt with a TFCC injury?
What actions would produce pain with a TFCC tear?
Forced Pronation & supination or
ulnar deviation & gripping
What clinical presentation is specific to TFCC tears?
Visible Ulnar carpal sag
Piano key sign
Extensor Carpi Ulnaris tendon out of place and can feel it on extension
How is conservative management in treating TFCC Tears?
ineffective in chronic tears
How would you immobilize a type 2 TFCC tear?
Short arm cast in slight flexion & ulnar deviation for 3-6 wks
How would you immobilize a type 1 TFCC tear?
Long arm cast for 4-6 weeks
Both TFCC tear & Scapholunate sprain present with tenderness. How can you tell them apart?
TFCC has tenderness on the back of the wrist past the head of the ulna, around the ulnar styloid process.
Scapholunate sprain has tenderness over the scapholunate junction
Both TFCC & Scapholunate present with decrease grip strength & clicking and catching but what's more specific with TFCC?
TFCC grip weakness has clicking that happens fr fr with pronation and supination activities
What is a ganglion cyst?
Soft tissue tumor from a tendon sheath or capsule
How would you describe a ganglion cyst?
Round, oval, jelly fluid filled that just came over some months or suddenly
What is the MC tumor of the hand & wrist?
If your patient has a ganglion cyst 50-70% of the time it's going to occur where?
back of the wrist (dorsal)
Your patient has a ganglion cyst & is complaining of aching & numbness/tingling, Why would that be happening?
Mass effect or compression of a nerve from the cyst.
Why would a patient have muscle weakness with a ganglion cyst?
The cyst connected to a tendon
How can you tell the difference between a solid mass & a ganglion cyst?
Ganglion cyst can transilluminate
Besides doing nothing & observation. what other strange therapies can be done for ganglion cyst?
Bible therapy - hit that sucker with a big ass book & pop that bad boy.
Aspiration but its 50/50 chance gone come back . damn
A white 50 year old man comes into your office complaining of thick palm nodules that doesn't hurt & nervous because he can't move his 4th and 5th finger as much as the others.. what condition does this match?
White 50yrs old men will have a hard time with what movement of the pinky and ring finger?
extension of the MCP and PIP.
What is the earliest sign of Dupuytren's Contracture?
Triangle puckering of skin over the flexor tendon proximal to flexor crease of fingers.
If my patient finger is stuck in flexion. What grade of Dupuytren's contracture is he experiencing?
Grade 1 of Dup. Contracture presents in what way?
Thick fascia, skin tethering & puckering
Grade 2 of Dup. Contracture presents in what way?
Bands & limited extension
With conservative treatment of Dup contracture there is little efficacy. But what's a cool way I can treat my patient?
Stretching exercises in warm water.
Ultrasound to prevent fibrosis
Fibroblastic proliferation & disordered Collagen deposit & fascial thickening is associated with that condition?
Continuing regional pain that doesn't match the injury, manifest distally with abnormal sensory, motor, trophic, autonomic changes correlates with what condition?
Complex Regional Pain Syndrome
There are 4 types of CPRS
1. Reflex sympathetic dystrophy ( 90%)
3. Warm CRPS
4. Cold CRPS
Stage 1 (Acute) of CRPS last about 1 - 3 months & presents in what way?
-Severe burn, throb ,ache pain that worse w/ touch & breeze.
-DON'T FOLLOW A NERVE DISTRIBUTION
-Sensitive to cold/hot
-Shiny, red, purple, pale skin
- long nails & hair
- localized edema
Stage 2 (Dystrophic stage) last about 3-6 months & presents how?
- Worsen pain, Osteopenia, Slow hair growth, muscle stiffness, increasing edema, brawny skin
Stage 3 is the Atrophic stage of CRPS and is IRREVERSIBLE - aint no going back.. So now how would your patient present?
-Whole entire limb has pain now & can spread to other limbs
- Waxy, trophic skin
- Limites movements in limb
- Severe Osteopenia
To get the best prognosis with CRPS treatment should begin when
within 3 months of the first symptom
Your patient watch grey's anatomy and seen a patient came in with CRPS & now she's asking you how can she prevent getting CRPS.. what would suggest?
1. Take vitamin C after a trauma
2. Early movement after a stroke
3. Early movement after a limb injury
Cherialgia Paresthetica is also known as what?
Wartenberg Syndrome, Handcuff Neuropathy & Superfical radial neuropathy
Paresthesia, Pain & Dysthesia will occur where?
Following the Superficial Nerve. So the back of the hand, 1st - 3rd fingers area.
What can make the pain/ paresthesia of Cherialgia Paresthetica worse?
Tapping over the Superficial radial nerve - tinel's
& ulnar deviation
About how long would treatment take until handcuff neuropathy gets better?
To take the tension off of the superficial radial nerve how would you splint the wrist?
In extension & radial deviation
Your patient has completely cut their radial nerve & is experiencing complete anesthesia.. What's your next best move?
Refer they ass! URGENTLY
A member of the Harris County Jail is being transported to court. After the 30 min ride to court he is complaining of pain/paresthesia in his lower forearm area. What do you think is the cause of this?
Compression of the sensory branch (superficial radial nerve) in the wrist or distal forearm.
What is one unique thing about Cherialgia parenthetic to help you differentiate from something else?
It has NO MOTOR involvement.
JUST A SENSORY CHANGE
Intersection syndrome is also known as what other names?
What type of pain are you looking for with Intersection syndrome?
Pain on the back of the wrist, radial sided
that goes down to the thumb or up the edge of forearm.
A patient with Squeaker's wrist during active & passive wrist motions creates a crepitus sound. What is the unique name of this sound?
Wet Leather Crepitus
Scapholunate sprain has tenderness @ scapholunate junction,
TFCC has tenderness @ ulnar styloid process
Where would the tenderness be with Intersection Syndrome?
@ Lister's tubercle
what 2 ways could you immobilize for treatment of intersection syndrome?
Cockup splint; 20 degrees of extension
Thumb spica splint;
Dorsal Impaction Syndrome is also known as
Scaphoid Impaction syndrome
If a patient come into your office with a Dorsal impaction syndrome they most likely have a career as what?
Gymnast or Chiropractor
Dorsal Impaction Syndrome pain presents where?
Dorsoradial aspect of wrist
What would make the pain of scaphoid impaction syndrome worse?
By extending & loading the wrist
What is specific about point tenderness with dorsal impaction syndrome?
The point tenderness is over the rim of the scaphoid elicited with the wrist in little bit of flexion & ulnar deviation.
What new conditions of the wrist/hand has an increase of pain with ulnar deviation of the wrist.
TFCC, Cherialgia Paresthetica & Dorsal Impaction Syndrome
Mallet finger is an injury where?
Avulsion at DIP.
Boutinniere deformity is an injury where
injury at PIP
extensor digitorum tendon can be injured with which conditions?
Boutonniere Deformity & Mallet finger
You can not actively extend with both Mallet finger and Boutonniere. But what is the difference between the 2.
Mallet finger you can't actively extend the Dip (tip of finger)
Boutonniere you can't actively extended the PIP.
PIP flexed, Dip extended correlated with what condition?
What tendon is injured with Jersey finger? and what location
Flexor Digitorum Profundus tendon is injured at the DIP
What action is not able to occur with a jersey finger injury
No active flexion at DIP
Your patient can't make a fist with their right hand. The finger they just injured stays straight when they try to make a fist. Why? what condition is this?
They cant flex their Dip while PIP is flexed
No blood supply to Lunate can lead to what?
Avascular necrosis of lunate
AVN of lunate is commonly called what?
What is the goal of cast immobilization in Keinbock's Disease?
allow for revascularization
Gamekeeper's thumb and Bowler's thumb is a pain at the base of thumb. What's the difference?
Bowler's thumb has more of Numbness/tingling from compression of ulnar digital nerve
Gamekeepers is more pain because of the tear of Ulnar collateral ligament at MCP & has swelling
What motion causes pain with Bowler's thumb?
Bennett's fx is located where?
Boxer's/ Ballroom fx is located where?
Sets with similar terms
Upper Extremities Technique Midterm
PC 617 Exam 4
Other sets by this creator
Ortho Lecture 2 - Lumbar
Ortho Lecture 2- Hip/Thigh
Ortho Lecture 2 - Thorax
Other Quizlet sets
Spi study set
Week 1 Quiz
HY121 UAB midterm