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
|
|
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
|
|
Term
| What is a hard, non-mobile mass commonly located at a proximal metacarpal? |
|
Definition
|
|
Term
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
Term
| Keinboch's disease will sometimes present with ________ lesions in the _______ bone without collapse of the bone. |
|
Definition
|
|
Term
| What gives the definitive diagnosis for Keinboch's disease? |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
Term
| Some mallet fingers involve ______ ______ and some involve ________. |
|
Definition
|
|
Term
| X-rays with a soft tissue mallet finger are _________. |
|
Definition
|
|
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
|
|
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
|
|
Term
| What is the treatment for jersey finger if there is complete bony avulsion that is subluxed or a retracted tendon? |
|
Definition
|
|
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
|
Definition
DeQuervain's tendonitis
radial styloid |
|
|
Term
|
Definition
anatomical snuff box
scaphoid fracture |
|
|
Term
|
Definition
|
|
Term
|
Definition
scapho-lunate joint (3rd and 4th compartment)
ganglion cyst |
|
|
Term
|
Definition
luno-triquetral ligament
Keinboch's disease |
|
|
Term
|
Definition
|
|
