Wrist And Hand

Front 1

Thumb extension

Back 1

EPL
Radial Nerve C7

Front 2

Finger flexion and thumb opposition

Back 2

FDS
Median Nerve
C7

Front 3

Finger Abduction

Back 3

interosseous
Ulnar nerve
T1

Front 4

FOOSH with sig. wrist pain
Exam:Appearance, Neurovascular and ROM Exam is normal. Palpation Tenderness over the Anatomic Snuff Box.
DDX?

Back 4

Scaphoid Fracture until proven otherwise

Front 5

Scaphoid Fractures put in _______ splint

Back 5

thumb spica splint

Front 6

Scaphoid Fractures
- 6 weeks of immobilization --> must re-evaluate for _____

Back 6

non-union

Front 7

Arise for the defect in capsule of a joint, filled with synovial fluid
- most common soft tissue tumor of the hand

Back 7

Ganglion Cyst

Front 8

where is a Ganglion Cyst common?

Back 8

•Common in 15-40 y/o patients on;
o Dorsum of the wrist
o Volar Radial Wrist
o Base of the Finger

Front 9

Sx of Ganglion Cyst

Back 9

oPain
oChanging Size
oIf it compresses nerve (ulnar or median) mat have weakness and paresthesia

Front 10

Tx of Ganglion Cyst

Back 10

oBible Cyst
oAspiration- High Rate of Recurrence
Proceed With caution(radial artery)
oSurgical Excision

Front 11

Compression of the median nerve in the carpal tunnel
- most common entrapment neuropathy

Back 11

carpal tunnel syndrome

Front 12

Carpal tunnel Syndrome
- associated with:
- diagnosis based on:

Back 12

- associated with: overuse and repetitive motion, pregnancy, diabetes, trauma, sarcoidosis, hypothyroidism

- Dx based on: history and exam

Front 13

Tx of Carpal Tunnel Syndrome

Back 13

oOMM
oSplinting in neutral, especially at night or cock up
oNSAIDS (nor for our patient)
oErgonomic Adjustments
These are all 1st line TX 6-12 weeks
oCorticosteroid Injection
Next line

oSurgical Release of carpal Tunnel
Last resort and for those with persistent neurologic sx

Front 14

De Quervains Tenosynovitis has to do with?

Back 14

1st extensor compartment

(most common in middle age women)

Front 15

What is in the first extensor compartment?

Back 15

Abductor Pollicis longus
Extensor Pollicis Bervis

Front 16

De Quervains Tenosynovitis occurs from

Back 16

repetitive use of the thumb

Front 17

De Quervains Tenosynovitis you have a + _____ test

Back 17

finkelstein

Front 18

De Quervains Tenosynovitis
- Tx

Back 18

NSAIDS, REST, THUMB SPICA SPLINT, CORTICOSTEROID INJECTION

Front 19

Osteoarthritis
- Palpation and ____ are positive
- most common joint

Back 19

- Grind tests
- wrist and carpometacarpal joints

Front 20

Distal Radius Fractures (Colles fracture)

Back 20

•Extraarticular
•Dorsal Displacement (Named for distal fragment)
•Dorsal Angulation
•“Dinner Fork Deformity”
•Reduce to anatomic alignment
•Immobilize 4-6 weeks
oShort arm cast

Front 21

Distal Radial fractures
- watch for :

Back 21

oCompartment Syndrome
oNeurovascular compromise -->surgery

Front 22

Mallet Finger
1. Disruption of the ______ of the ___

Back 22

Extensor Mechanism
DIP
- result in an extensor lag

Front 23

Mallet Finger
Tx:

Back 23

o6 weeks of continuous extension splinting
If you take off have to start 6 weeks over again
oPatient adherence is the biggest obstacle

Front 24

Jersey Finger

Back 24

•Forced extension of a flexed finger resulting in flexor digitorum profundus avulsion, with or without boney fragment.

Front 25

Jersey Finger Tx

Back 25

Immediate surgical tx

Front 26

Nodular thickening and contraction of palmar aponeurosis

Back 26

Dupuytren Contracture

-Progressive thickening and loss of extension, usually painless but sensitive

Front 27

Dupuytren Contracture
- most common in
- associated with

Back 27

- white male >50 y/o
- DM, Pulmonary Dz, repetitive trauma, alcoholism, smoking

Front 28

Dupuytren Contracture tx

Back 28

splinting can slow progression, surgery to release the contracture after the:

oPIP involvement-->dysfunction -->surgery

o30 degree or more flexion -->dysfunction -->surgery

Front 29

Pyogenic Flexor Tenosynovitis

Back 29

•Infection in the synovial sheath

•Poor vascularity and high synovial fluid-->will spread quickly

**IV Antibiotics & Early Surgical Intervention! **

Front 30

4 signs of Pyogenic Flexor Tenosynovitis

Back 30

1. pain on extension
2. fusiform swelling
3. slight flexion
4. tenderness along tendon sheath

Front 31

Stenosing Tenosynovitis (Trigger Finger)

Back 31

• Thickening or nodule of the flexor tendon that catches on the first annular pulley preventing smooth extension or flexion of the finger

Front 32

Stenosing Tenosynovitis (Trigger Finger) Tx

Back 32

NSAIDS or corticosteroid injection x2 --> surgical release

Front 33

DIP dislocation

Back 33

complicated by fracture and significant soft tissue injury
oSomething else going on as well
(hematoma or crushing of nail bed)

Front 34

PIP dislocation

Back 34

Most common
(buddy tape)

Front 35

MCP dislocation

Back 35

usually seen at the thumb
- skier's or game keepers thumb --> injury to the UCL

Front 36

Uncomplicated fractures of the MCP and phalanges can be treated with

Back 36

short period of protection with splinting followed by early ROM and buddy taping

Front 37

Complicated fractures of the MCP and phalanges

Back 37

Irreducible, malrotated, displaced intra-articular, multiple fractures

Front 38

Boxer's Fracture

Back 38

neck of the 5th MC

Front 39

splint for a boxer's fracture

Back 39

ulnar gutter splint 4-6 weeks