Term
| Possible Flexor Tendon Injuries? |
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Definition
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Term
| Mechanism of Injury for flexor tendon injuries? |
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Definition
Laceration
Industrial Accident
Crushed |
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Term
| What are the Flexor Tendon Zones of the Hand? (range) |
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Definition
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Term
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Definition
| between insertions of FDS and FDP. |
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Term
| Between what pulleys does the FDP run under? |
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Definition
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Term
| What is Flexor Tendon Zone II called? |
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Definition
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Term
| Location of Flexor Tendon Zone II? |
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Definition
| From FDS insertion to distal palmar crease |
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Term
| What important structure begins in Zone II? |
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Definition
Flexor synovial sheath
(for index, middle and ring fingers) |
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Term
| What pulleys are found in zone II? |
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Definition
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Term
| What pulleys are considered most important? |
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Definition
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Term
| Distal to the MCP joint, Camper's chiasma teninum digitorum mannus is formed which allows? |
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Definition
| FDP to pass through FDS on its way to insertion at the distal phalanx |
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Term
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Definition
| Runs from A1 to distal transverse carpal ligament |
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Term
| What originates in Flexor Tendon Zone III? |
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Definition
| Lumbricals (from FDP tendons) |
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Term
| Where is Flexor Tendon Zone IV? |
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Definition
| area covered by the transverse carpal ligament |
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Term
| Where is Flexor Tendon Zone V? |
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Definition
| Proximal to transverse carpal ligament (distal 1/3 of forearm) |
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Term
| Contents of Flexor Tendon Zone V? |
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Definition
Radial Bursa- where FPL enters sheath
Ulnar Bursa- where FDS and FDP enter a sheath |
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Term
| Delayed primary flexor tendon repair results are equal to or better than immediate repair of the flexor tendon |
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Definition
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Term
| If a patient is referred to you to prepare them for secondary flexor tendon repair, what should you work on? |
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Definition
Joint has useful PROM
Tissue is free of scar tissue
Minimize swelling |
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Term
| What are the most frequent causes of failure of flexor tendon repairs? |
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Definition
scar tissue formation
rupture of repaired tendon |
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Term
| Flexor Tendon Injury protocol depends on? |
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Definition
Age of patient
Trauma
Pulley integrity
Timing of repair
Location of injury
Compliance of Patient
Surgical technique |
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Term
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Definition
| A painful snapping sound that occurs when the finger flexor tendon abruptly pulls through the A1 pulley |
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Term
| Another name for trigger finger? |
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Definition
| Stenosing Flexor Tenosynovitis |
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Term
| Mechanism of Injury for Trigger finger? |
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Definition
Stenosis of A1 pulley
Thickening of flexor tendon |
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Term
| What movements does the snapping occur through the A1 pulley? |
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Definition
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Term
| What digits is trigger finger most commonly found in? |
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Definition
Thumb
Middle finger
Ring Finger
1, 3, 4 |
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Term
| What are predisposing factors to trigger finger? |
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Definition
Post-menopausal women
Diabetes
RA
Duputyren's Contracture
Tendinitis in UE |
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Term
| Patient presentation for Trigger Finger? |
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Definition
Clicking/popping in finger
Pain with snap
Palpable nodule in A1 pulley |
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Term
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Definition
Splinting has been ABANDONED
Corticosteroids or surgery |
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Term
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Definition
| FDP avulsion off of distal phalanx |
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Term
| What digit is Jersey finger most common? |
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Definition
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Term
| Mechanism of Injury for Jersey Finger? |
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Definition
| Distal phalanx forcibly extended when trying to flex the finger (ie: grasp an object) |
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Term
| Patient Presentation in Jersey Finger? |
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Definition
Sudden pain at distal phalanx
Inability to flex DIP
Hold the DIP in extension
May be able to palpate avulsed section proximally |
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Term
| 3 Types of Jersey Fingers? |
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Definition
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Term
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Definition
Avulsed tendon retracts into palm (no bony frag)
Blood supply avulsed
Early reattachment necessary |
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Term
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Definition
| Avulsed tendon retract to where tendon is trapped by FDS and held by intact blood supply |
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Term
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Definition
| involves a large bone fragment from the distal phalanx which prevents retraction from A5 pulley |
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Term
| Surgery is needed for all types of Jersey fingers. Which type is most common? |
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Definition
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Term
| What are the extensor tendon zones of the hand? |
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Definition
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Term
| Odd number zones correspond to DIP, PIP, MCP, and Wrist Joint |
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Definition
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Term
| Injury in Extensor Tendon Zone I? |
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Definition
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Term
| Injury to Extensor Tendon Zone II= |
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Definition
| Middle phalanx injury secondary to crush or laceration |
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Term
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Definition
| Boutonniere Deformity= central band rupture |
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Term
| Boutonneire Deformity Tx? |
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Definition
Splinting for closed injury
Surgery for instability or displaced avulsion |
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Term
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Definition
| Broad extensor mechanism injury |
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Term
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Definition
MCP joint injury; almost always requires surgery
May be accompanied by a Boxer's Fracture |
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Term
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Definition
| Dorsal Hand; surgery almost always recommended |
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Term
| Extensor zone VII injury? |
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Definition
Wrist level
Injuries associated with retinaculum and lacerations resulting in scarring of tendon |
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Term
| Extensor Tendon Zone VIII injury? |
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Definition
| Musculo-tendinous junction/muscle bellies affected |
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Term
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Definition
Avulsion of extensor tendon distal to DIP joint
(Rupture of Lateral Bands) |
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Term
| Mechanism of injury for mallet finger? |
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Definition
Forced flexion of distal phalanx
Often the result of a finger being struck on the tip |
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Term
| Patient presentation of mallet finger? |
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Definition
DIP held in flexion
Inability to extend the DIP
Tenderness over distal phalanx |
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Term
|
Definition
Type I=Extensor tendon avulsed
Type II= lacerated extensor tendon
Type III= Deep avulsion injuring skin and tendon
Type IV= fracture |
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Term
| Tx for TYPE I mallet finger? |
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Definition
Continuous splinting of DIP in extension for 6-10 weeks. DIP should NOT fall into flexion at the time or treatment must start over!
Bedtime splinting after 6 weeks
Sports splinting for another 6 weeks |
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Term
| Treatment of Type II or III? |
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Definition
| Surgical repair then type I protocol |
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Term
Stable vs. Unstable Fractures?
List some fractures that commonly require surgery |
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Definition
Stable Fracture=fractures that will not displace if early digital motion is allowed
Unstable Fracture= fractures that displace an unacceptable amount if early digital motion is allowed
Fx Requiring Surgery:
Open
Comminuted displaced
Fracture with joint dislocation
Displaced spiral fx
Displaced intra-articular fx
Fx involving loss of bone
Multiple fx |
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Term
| What is a Boxer's Fracture? |
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Definition
| Fracture of the metacarpal neck of the 5th metacarpal |
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Term
| Mechanism of Injury for Boxer's Fracture? |
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Definition
| Glancing Punch with Main contact landing on the metacarpal head of the 5th metacarpal (CAN ALSO BE 3rd 4th MC) |
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Term
| Patient Presentation of Boxer's Fracture? |
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Definition
Swelling around 5th MCP
Loss of ROM of 5th MCP
Rotational deformity
EXTENSOR LAG OF INVOLVED FINGER
Distal fx segment displaced palmarly |
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Term
| Non-Displaced Metacrapal Fx treat with? |
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Definition
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Term
| Sprain of PIP presentation? |
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Definition
Stable Joint with ROM
Pain with ligament testing
Swelling |
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Term
|
Definition
Early ROM
Buddy Tape
Ice
NSAIDS |
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Term
Open PIP dislocation?
Tx? |
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Definition
Exposed joint with extensive soft tissue damage
Tx:Surgery |
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Term
Dorsal PIP dislocation tx?
Are dorsal PIP dislocations more or less common than volar PIP dislocations? |
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Definition
Closed reduction and splinting
MORE COMMON THAN VOLAR |
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Term
| Type I dorsal PIP dislocation? |
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Definition
Hyperextension injury
Volar plate avulsed
Minor collateral lig damage |
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Term
| Type II dorsal PIP dislocation? |
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Definition
Hyperextension injury
Volar plate avulsed
MAJOR collateral ligament damage |
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Term
| Type 3A dorsal PIP dislocation? |
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Definition
| Stable fx-dorsal dislocation |
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Term
| Type 3B dorsal PIP dislocation? |
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Definition
| Unstable fx dorsal dislocation |
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Term
| Lateral PIP dislocation mechanism of injury? |
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Definition
| secondary to collateral ligament injury |
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Term
| With lateral PIP dislocations may have avulsion and or rupture of the volar plate |
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Definition
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Term
| Treatment for Lateral PIP dislocation? |
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Definition
Closed reduction
1 week of immobilization
Buddy taping after 1 week |
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Term
| Volar PIP Dislocation: Types? |
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Definition
Straight volar dislocation
Ulnar or radial volar displacement |
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Term
| Volar PIP Dislocation: Straight volar dislocation |
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Definition
| Proximal condyle causes damage to central extensor slip |
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Term
| Volar PIP Dislocation: ulnar or radial volar displacement? |
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Definition
| condyle buttonholes through central slip and lateral band |
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Term
| Tx of volar PIP dislocations? |
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Definition
Closed reduction
PIP immobilized in full extension |
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Term
|
Definition
| Intraarticular fx at the base of the 1st metacarpal. A single volar ulnar fragment fractured |
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Term
| What is a Rolando Fracture? |
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Definition
T-condylar fx to base of the 1st metacarpal
POOR PROGNOSIS |
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Term
| What is Gamekeeper's Thumb? |
|
Definition
| Instability of MCP joint due to insufficent UCL of thumb |
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Term
| Mechanism of injury for Gamekeepers thumb? |
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Definition
| Valgus stress/force across the thumb joint |
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Term
| Gamekeeper's thumb is also called? |
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Definition
| Skiiers thumb due to high incidence in skiiers who had fallen and ski pole had torn UCL |
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Term
| UCL resists ____ applied forces.(direction) |
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Definition
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Term
| Ex of radially applied forces? |
|
Definition
pinching
holding large objects |
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Term
|
Definition
Weakening of key pinch grip
Volar subluxation of proximal phalanx |
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Term
| Patient Presentation of UCL tear? |
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Definition
Pain swelling and ecchymosis on ulnar side of thumb
Small lump over ulnar side (steener lesion)
Hx of valgus injury |
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Term
|
Definition
| entrapment of torn UCL by adductor aponeurosis |
|
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Term
|
Definition
If stable= immobilization in a short arm cast with a tumb spica for 4 weeks
Unstable= operative tx |
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Term
|
Definition
| Digital Nerve Compression Injury (compression neuropathy) of ulnar digital nerve of the thumb |
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Term
| Mechanism of Injury for Bowler's Thumb? |
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Definition
| perineural or neuroma-type formation on the ulnar digital nerve secondary to repeated pressure from thumbhole of bowling ball |
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Term
| Patient presentation of Bowler's Thumb? |
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Definition
Painful mass at base of the thumb
Paresthesias in the thumb
Positive Tinel's sign |
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Term
| Treatment for Bowler's thumb? |
|
Definition
PRICE
Thumbshell splint
Backsetting of thumb hole to increase thumb extension and ABD
Full insertion of thumb into thumbhole |
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Term
|
Definition
Contracture secondary to Dupuytren's disease
Can be confined to a single digit or involve multiple digits |
|
|
Term
| Palmar and digital contractures of the ring and little finger are the most common in Dupuytren's |
|
Definition
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|
Term
| Surgical intervention is necessary if the contracture has reached ____ MCP contracture and ____ PIP contracture |
|
Definition
|
|
Term
| When is a PIP joint arthroplasty indicated? |
|
Definition
|
|
Term
| When is a MCP joint arthroplasty indicated? |
|
Definition
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