Term
| Distal radius serves as support for the carpus and the distal radioulnar joint |
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Definition
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Term
| If a fracture of the distal radius heals with poor alignment problems such as what arise? |
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Definition
Altered load bearing
Altered articular surface pressure
Carpus malalignment
DRUJ incongruence
Premature degeneration |
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Term
| Malalignments of Distal Radius: Impaction |
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Definition
Radial Shortening.
Offset between ulnar head and lunate surface of distal radius |
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Term
| Normall the distal radius is level or 1-2 mm distal or proximal to distal articular surface of ulna |
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Definition
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Term
| Malalignments of the Distal Radius: Dorsal Angulation? |
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Definition
Loss of volar angulation
Remember that the distal radius usually has a volar angulation of 10 degrees |
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Term
| What kind of fracture will often reverse the volar inclination? |
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Definition
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Term
| a dorsal inclination of __ degrees or more significantly affects the DRUJ and carpals |
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Definition
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Term
| Malalignments of the Distal Radius: Dorsal Displacement? |
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Definition
Fractured segment displaced dorsally
Greater instability secondary to decreased contact area between segments |
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Term
| Malalignments of the Distal Radius: Radial Displacement |
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Definition
Distal radial fragment is displaced away from the ulna
DRUJ is unstable with ligamentous injury |
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Term
| Malalignments of the Distal Radius: Loss of Radial Inclination? |
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Definition
Frontal plane deformity. Normally has a radial to ulnar inclination of 22-25 degrees
This is measured from the tip of the radial styloid to ulnar corner or the radius |
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Term
Distal Radius Fracture Classifications:
Type I
Type II
Type III
Type IV
Type V |
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Definition
Type I= bending type fx
Type II= articular shearing fx
Type III= compression fx
Type IV= radiocarpal fx-dislocation
Type V= combined fx |
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Term
|
Definition
Distal radial metaphyseal fx with dorsal displacement of the fx segment and angulation
AKA extension fx of the radius |
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Term
| Another name for colles fx? |
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Definition
Silver fork deformity
Distal ulna may be prominent |
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Term
| A Colles Fx is the most common type ___ fracture |
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Definition
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Term
| Mechanisms for a Colles Fx? |
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Definition
| Backward fall on palm of outstretched hand causing pronation of UE while hand is fixed to the ground |
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Term
| Greater than ___ deg of dorsal angulation of the distal radial surface is indicitive of substantial fragmentation and impaction of distal metaphyseal bone and requires _____? |
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Definition
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Term
| Colle's Fracture Reduction involves? |
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Definition
Traction
Flexion
Ulnar deviation
Pronation |
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Term
| For a colles fx, you splint the wrist in ____. |
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Definition
| Ulnar deviation (NO wrist flexion) |
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Term
|
Definition
Reverse Colles Fracture or Garden Spade Deformity
Distal metaphyseal with volar displacement of fracture fragment and angulation |
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Term
| Mechanism of injury for Smith's Fx? |
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Definition
Backward fall on palm of outstretched hand causing pronation of UE while hand is fixed to ground
(same as Colles Fx) |
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Term
|
Definition
|
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Term
|
Definition
| Transverse fx through the distal radial shaft; extra articular |
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Term
|
Definition
| Oblique Fx through the distal shaft beginning at dorsal articular lip and crossing into dorsal articular surface |
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Term
|
Definition
Enters radiocarpal joint
Same as a Volar Barton's Fx |
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Term
| Type II: Articular Shearing Fx Examples |
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Definition
Barton's Fractures
Chauffeur's Fracture |
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Term
| Barton's Fracture involves? |
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Definition
| Intra-articular fx that involves either the volar or dorsal rim of the radius |
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Term
| Barton's Fx is accompanied by dislocation/subluxation of the carpus in what direction? |
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Definition
| In direction of fx segment |
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Term
| Directions of Barton's Fx dislocation? |
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Definition
Volar and Dorsal
Bartons= Fx-dislocation injury |
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Term
| How does Barton's Fx vary from Colle's or Smith's? |
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Definition
| Dislocation is most striking x-ray finding |
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Term
| Is a dorsal or volar Barton's fx most common? |
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Definition
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Term
| Mechanism of Injury for Dorsal/Volar Barton's Fx? |
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Definition
FOOSH
Volar radiocarpal ligaments avulse volar lip of the radius |
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Term
| Volar Barton's Fx requires what tx? |
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Definition
ORIF with Volar T-plate
Although recurrence of palmar subluxation is common |
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Term
|
Definition
| Fracture of the dorsal lip of the radius and dislocation of the carpus dorsally |
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Term
| Tx for Dorsal Barton's Fx? |
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Definition
Non-Operative: manipulation reduction and immobilization in extension
Operative: closed reduction, external fixation applied and percutaneous pinning |
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Term
|
Definition
| Shearing of the radial styloid |
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|
Term
Summary: Type I Fx=
Type II= |
|
Definition
Type I= Colle's Fx, Smith's (although can be a type II or III too)
Type II= Barton's and Chaffeur's Fx |
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Term
| Type IV fx classification involves? |
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Definition
Dislocation
Dislocation of the radiocarpal joint with small ligamentous avulsion fx |
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Term
| Type V in the fx classification involves? Involves what else additionally? |
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Definition
Combination of Types I-IV fx
Forearm compartment syndrome, open wound or associated injury to carpus, forearm or elbow |
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Term
| What is the highest occuring fx at the wrist? |
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Definition
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Term
| Scaphoid fx has a ____ healing process (short/lengthy) |
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Definition
LENGTHY
Especially lengthy with proximal pole fractures of the scaphoid |
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Term
| You must approach any suspected scaphoid fx as though it is a fx |
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Definition
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Term
| What does the scaphoid articulate with proximally? |
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Definition
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Term
| What does the scaphoid articulate with medially? |
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Definition
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Term
| What joint does the scaphoid form distally? |
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Definition
| Scaphotrapexialtrapezoid joint |
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Term
| Strong Volar Ligaments holds the scaphoid in ___ degrees of ____ in relation to lunate |
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Definition
| 30-60 degrees of flexion in relation to lunate |
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Term
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Definition
| 3 dorsal and volar arches from radial and ulnar arteries |
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Term
| However 70-80% of intraosseous blood supply is from branches of what artery? |
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Definition
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Term
| Branches of the _____ artery supply 20-30% of the blood supply to the region of the distal tuberosity of the scaphoid |
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Definition
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Term
| However, ___% of the middle 1/3 of scaphoid and ____% of proximal 1/5 scaphoid fractures will develop avascular necrosis |
|
Definition
30% of middle 1/3
100% of proximal 1/5
will develop AVN |
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Term
| Mechanism of Injury for Scaphoid Fx? |
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Definition
Wrist loaded in extended position
Load on articular surface between the radius and scaphoid is 4x the load on the palm |
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Term
| Wrist loaded in extended position causes the proximal pole of the scaphoid to become trapped between the ___ and ___. This = ___ fracture of scaphoid |
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Definition
trapped between radius and capitate
=waist fx of scaphoid |
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Term
| What are the signs of a scaphoid fx |
|
Definition
tender over dorsoradial wrist and in snuffbox
Swelling in snuffbox |
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Term
| Middle third Scaphoid fx is also called ___ fx |
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Definition
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Term
| What is the most common subtype of scaphoid fx? |
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Definition
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Term
If an immediate diagnosis and reduction/immobilization for waist fracture, the patient has a good chance of healing in 3 months
Displaced or unstable fx requires ORIF (>1mm displacement) |
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Definition
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Term
| Scaphoid surgery the patient might be immobilized in a below elbow thumb Spica Cast. The cast stops at the thumb IP joint and is immobilizing what joint? |
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Definition
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Term
| What kinds of things can we work on with a person in a spica cast? |
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Definition
Finger ROM
Shoulder ROM
Elbow ROM |
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Term
| Carpal Tunnel Syndrome (CTS) affects 1% of general population. What subtype populations is it most common in? |
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Definition
Middle aged to advanced age
More common in women than in men |
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Term
| What is the carpal tunnel? |
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Definition
| Fibro-osseous ring that forms a closed compartment housing flexor tendons and median nerve |
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Term
| Causes of Carpal Tunnel Syndrome |
|
Definition
Repetitive wrist flexion/extension
Prolonged positioning in wrist flexion/extension
Forceful Gripping
Excessive Vibration
Poor Ergonomics
Trauma induced swelling
Conditions affecting fluid balance
Constrictive bandage, cast, handcuff
Anatomic Abnormalities |
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|
Term
|
Definition
1. Pain, numbness, tingling in median nerve distribution
2. Night pain/parathesias
3. Prolonged use of hand aggrevates
4. Massaging hands may releive
5. Weakness/atrophy of thenar muscles |
|
|
Term
| Differential Diagnosis of CTS? |
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Definition
Thoracic outlet
Cervical Radiculopathy
Brachial plexopathy
Pronator teres syndrome
Digital Nerve Compression (Bowler's Thumb)
Systemic neuropathy |
|
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Term
|
Definition
Wrist splints
Activity Modification
Ergonomic Evaluation
Stretching, ROM, strengthening
Cortisone |
|
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Term
| When should a patient with CTS have surgery? |
|
Definition
Thenar atrophy or weakness
Sensation absent
EMG displays fibrillation potentials
Symptoms over 1 year |
|
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Term
|
Definition
Open carpal tunnel release
Endoscopic carpal tunnel release |
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Term
| Pathology: Intersection Syndrome. What is it? |
|
Definition
| Tendonitis or tenosynovitis of 1st and 2nd dorsal compartments of the wrist |
|
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Term
| what are the tendons of the 1st dorsal compartment? 2nd dorsal compartment? |
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Definition
1st= EPB, ABPL
2nd= ECRB, ECRL |
|
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Term
| Mechanisms of Injury for Intersection Syndrome? |
|
Definition
Extensive use of radial extensors of the wrist
Muscles intersect each other at a 60 degree angle, three finger widths proximal to wrist joint |
|
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Term
| Patient Population of Intersection Syndrome? |
|
Definition
Skiers
Rowers
Racquet
Sports
Canoeing
Weightlifting
ADL/job requiring excessive use of radial extensors
Sudden change in activity level |
|
|
Term
| Patient presentation in intersection syndrome? |
|
Definition
Palpation tenderness of dorsal wrist 3 fingertips proximal to wrist joint
Swelling of first 2 compartments
Crepitation over compartments with AROM/PROM
Pain with wrist flexion/extension |
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Term
| Treatment for intersection syndrome |
|
Definition
Thumb Spica splint
Activity avoidance
Ice/NSAIDs
Ace wrap
AAROM-AROM as tolerated
Strengthening progression
ADL/sport activity modifications
Injections |
|
|
Term
| differential dx for Intersection syndrome? |
|
Definition
Wartenberg's syndrome
De Quervain syndrome |
|
|
Term
| Dorsal and Volar Ganglion Cysts: Dorsal may orignate/compress? |
|
Definition
Dorsal originates: scapholunate interval
Compress EPL or common extensor tendon sheaths |
|
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Term
| Dorsal and Volar Ganglion Cysts: Volar Cysts originate from? |
|
Definition
FCR tendon sheath
Radius and Scaphoid
Scaphoid and trapezium
Scaphoid and lunate |
|
|
Term
| Patient Presentation with Ganglion Cyst? |
|
Definition
Wrist flexion improves visualizaiton of dorsal cysts
Palpation painful
Soft/firm palpable mass will be found
Flexion/ext of wrist will increase pain |
|
|
Term
| Tx of Ganglion Cyst: conservative |
|
Definition
Immobilization
Steroid Injection
Home remedy |
|
|
Term
| differential dx of ganglion cysts? |
|
Definition
non-neoplastic masses
Neoplastic masses |
|
|
Term
| What is pronator syndrome? |
|
Definition
| Median nerve entrapment in proximal forearm |
|
|
Term
| What could compress the median nerve in proximal forearm? |
|
Definition
Pronator teres
Flexor digitorum superficialis (FDS) arch
Lacertus fibrosis |
|
|
Term
| Patient presentation of Pronator syndrome? |
|
Definition
Dysthesias in median nerve distribution
Sensory disturbance in volar base of thenar eminence
Palpation tenderness over proximal forearm
Weakness through median nerve distribution
Pain with stretch of involved tissues |
|
|
Term
| Treatment for Pronator Syndrome? |
|
Definition
Long arm splint with elbow at 90 and neutral
Activity modification
NSAIDs
STM
Stretching and strengthening |
|
|
Term
What is ulnar tunnel syndrome?
Mechanism of Injury? |
|
Definition
Compression of ulnar nerve within Guyon's canal
Mechanism of Injury: compression [bicylcing/weightlifting/crutches], excessive gripping and rotating |
|
|
Term
| What are the 2 types of compression in ulnar tunnel syndrome? |
|
Definition
Internal and External Compression
Internal= ulnar aneurysm, thrombosis, ganglia, anomalous muscle belly/lig
External= fascial thickening, repetitive trauma, palmaris brevis hypertrophy |
|
|
Term
| Patient Presenation for Ulnar Tunnel Syndrome? |
|
Definition
Pain with palpation over Guyon's Canal
Weakness in ulnar nerve distribution
Ulnar artery may be occluded |
|
|
Term
| Radial Tunnel Syndrome vs. Posterior Interosseous Syndrome is? |
|
Definition
Radial tunnel syndrome= entrapment of deep branch of radial nerve
PINS= entrapment of the posterior interosseous nerve |
|
|
Term
| What can entrap the posterior interosseous nerve? |
|
Definition
Fibrous band over radiocapitellar
Synovitis of radio capitellar joint
Vascular leash of Henry
Proximal fascial edge of ECRB
Arcade of Froshe
Distal Edge of Supinator |
|
|
Term
Patient Presentation of PINS--Posterior Interosseous Nerve Syndrome
RTS? |
|
Definition
PINS= motor deficits in extrinsic finger extensors, pain with stretch on tissues, tenderness over lateral elbow
RTS= more forearm pain without muscular weakness; radial tunnel= 5cm distal to lateral epicondyle, just anterior to radial neck |
|
|
Term
|
Definition
Meniscus like structure that cushions between the ulna and proximal carpal row (mainly triquetrum)
Helps to stabilize the distal radioulnar joint |
|
|
Term
| TFCC is a bi_____ disc with attachments ? (concave/convex) |
|
Definition
TFCC= biconcave
Attachments: Articular cartilage of radius
Base of ulnar styloid
A& P radioulnar capsule forming the palmar and dorsal radioulnar ligaments |
|
|
Term
| Where is the blood supply the worst to the TFCC? |
|
Definition
|
|
Term
| Peripheral ___ to __ % demonstrates enough blood inflow to support healing |
|
Definition
|
|
Term
| Does the TFCC get a vascular supply from the radial base of the TFCC? |
|
Definition
|
|
Term
| TFCC ___ tears heal poorly, ____ tears have the potential to heal |
|
Definition
Central tears heal poorly
Peripheral tears have the potential to heal |
|
|
Term
|
Definition
1. Shock Absorber
2. Stabilizes distal radioulnar joint |
|
|
Term
| When does tension in the TFCC increase? |
|
Definition
| As the forearm pronates and supinates |
|
|
Term
| TFCC patient presentation? |
|
Definition
Ulnar sided wrist pain
Clicking/crepitus present with forearm rotation, gripping, or UD
Decreased ROM/strength in forearm pronation/supination and UD |
|
|
Term
| Classification of TFCC injury? |
|
Definition
|
|
Term
| Treatment ideas for TFCC? |
|
Definition
| Splinting to protect from pronation with UD, soft tissue to reduce swelling/increase blood flow, release tension in muscles, ice, immobilize for 2-4 weeks, JM |
|
|
Term
| What is the most common overuse injury for the wrist? |
|
Definition
| DeQuervain's Tenosynovitis |
|
|
Term
| Mechanism of Injry with DeQuervain's Tenosynovitis? |
|
Definition
| Forceful grasp with UD (throwing/striking) |
|
|
Term
| what muscles are involved with DeQuervain's Tenosynovitis? |
|
Definition
Muscles of 1st dorsal compartment:
Abductor pollicis longus
Extensor pollicis brevis |
|
|
Term
| Patient presentation with DeQuervain's Tenosynovitis? |
|
Definition
Pain on palpation over 1st dorsal compartment
Crepitus over 1st dorsal compartment with active or passive thumb flexion, extension, abduction, adduction
Pain with resisted thumb MCP joint extension
Swelling over 1st dorsal compartment |
|
|
Term
| Treatment for DeQuervain's Tenosynovitis? |
|
Definition
Splint
PT
Injections
Surgical Decompression |
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|
