Shared Flashcard Set

Details

Forearm, Wrist and Hand
Orthopedics
138
Other
Graduate
02/16/2010

Additional Other Flashcards

 


 

Cards

Term
Fixed Arches of the Hand
Definition
Distal Carpal row, IF and MF metacarpals
Term
Mobile Arches of the Hand Unit 1
Definition
Thumb Metacarpal
Term
Mobile Arches of the Hand Unit 2 
Definition
IF Phalanges 
Term
Mobile Arches of the Unit 3 
Definition
MF, RF, SF phalanges, RF and SF metacarpals
Term
Causes of Ulnar Nerve palsy creates what condition of the Mobile Arches?
Definition
Mobile Arches are flattened because ulnar extensors overpower the intrinsics 
Term
What type of Joint is the Distal Radial Ulnar Joint 
Definition
Double Pivot Joint 
Term
The main Stabilizer of the Radial Ulnar Joint 
Definition
TFCC
Term
Resting Position of the Radial Ulnar Joint 
Definition
Neutral with Slight ulnar deviation 
Term
Close-packed position of Radial Ulnar Joint 
Definition
Forearm Supinated approx 5 deg
Term
Capsular Pattern of the Radial Ulnar Joint
Definition
Equal Restrictions of Flexion and extension
Term
Functions of the Radial Ulnar Joint
Definition
Transmits loads from hand to forearm
Term
Joint Surfaces of the Radial Carpal joint
Definition
Convex side: Lunate, scaphoid and TFCC. Concave Side: Radius
Term
Resting Position of the Radial Carpal Joint 
Definition
Neutral with slight ulnar deviation 
Term
Close-Packed Position of the radio-carpal joint 
Definition
extension with Radial Deviation
Term
Capsular Pattern of the Radio Carpal Joint 
Definition
Equal restriction in all directions
Term
What is the TFCC Complex
Definition
Fibrocartilaginous disk between medial and proximal row and ulna
Term
Functions of the TFCC Complex (3)
Definition

1. Enhances joint congruity

2. Cushions ag compressive F

3. Separates distal ulna from direct contact with the carpals but allows gliding betwen the carpals, disk and ulna during P/S

Term
Proximal Row of Midcarpal Joints is             Laterally and              medially
Definition

1. Convex

2. concave

Term
Approximately     % of wrist Flexion and 34% of wrist             occur at the midcarpal joint
Definition

1. 66%

2. Extension 

Term
What is Resting Position for the MCP and IP ?
Definition
Slight Flexion 
Term
What is the Close-Pack position of the MCP? 
Definition
Full Flexion 
Term
What is the Close Pack position of the IP?
Definition
Full Extension
Term
What is the capsular pattern of the MCP and IP? 
Definition
Greater Limitation of flexion than extension; restriction in all directions 
Term
No              motion of the MCP joints when the digits are                at the MCP joints because the collateral ligament are tight 
Definition

1. lateral 

2. Flexed

Term
The Trapezium is general                  from palmar to dorsal and                from medial to lateral 
Definition

1. concave

2. Convex

Term
What are the functions of Pulleys (2)
Definition

1. Prevent bowstringing 

2. Promote efficiency in flexion

Term
How many Transverse annular ligaments are there?
Definition
5
Term
There are 3              Ligaments in the IP
Definition
Cruciform 
Term
What Flexor tendon Zone is from A1 to to Flexor Digitorum Superficialis ? 
Definition
Zone 2 
Term
What are the land marks for Flexor tendon zone 1?
Definition
Between insertion of flexor digitorum superficials and flexor digitorum profundus
Term
What are the landmarks for flexor tendon zone 3? 
Definition
Flexor rentinaculum to the A1 pulley 
Term
What flexor tendon zone is from the Forearm to the distal wrist crease?
Definition
Zone 5 
Term
What zone is associated with the Carpal Tunnel?
Definition
Zone 4 
Term
What is the functional position of the hand? (2)
Definition

1. Extended 20 degrees

2. Ulnar Deviation 10 degrees

Term
What are the functional position of the (1) MP (2) PIP and (3) DIP 
Definition

1. flexed 45 degrees

2. flexed 30-45 degrees 

3. 10-20 degrees

Term
What are the Functional position of the thumb? (3)
Definition

1. 1st CMC partially abducted and Opposed 

2. MP joint flexed 10 degree

3. IP joint flexed 5 degree

Term
What are the 3 prehension grips ? 
Definition

1. Pinch 

2. Palmar (holding a Pencil)

3. Lateral (holding a key) 

Term
What are the 3 power grips? 
Definition

1. Cylindrical 

2. Spherical 

3. Hook 

Term
What is the most common compartment for compartment syndrome?
Definition
Volar Compartments
Term
What is the causes of compartment syndrome? (2)
Definition

1. an increase in tissue pressure with in a closed osteofascial compartment which compromises blood flow to the muscles and nerves with in the compartment 

2. begins when tissue pressure is greater than venous pressure and impair s blood outflow

Term
What problems are associated with compartment syndrome?
Definition

1) lack of oxygenated blood and lack of waste removal leading to pain and decresed nerve sensation 

2) absence of distal pulse 

3) hypoesthesia

4) extremity paresis

Term
What are some possible etiologies of compartment syndrome? (7) 
Definition

1)External Compartment resriction

2) Tight splints, casts, dressings

3) Burns 

4) Tight fascial closure during ORIF 

5) Malfunctioning sequential pressure devices 

6) Postoperative hematoma /muscle edema

7) Trauma producing hematoma/edema

Term
What are signs and sx of compartment Syndrome? (6)
Definition

1)Crescendo pain

2) Pain with passive stretch of fingers (most reliable sign)

3) Paresthesia (not Reliable)

4) diminished or absent pulse

5) pallor

6) Porkiness

Term
What are possible treatments of compartment syndrome? (2) 
Definition

1) Bivalve or removal of casts, dressings, ect

2) early faciotomy if pressure remains

 

Term
What are the causes of a Volkmann's Ischemic Contracture? 
Definition

1) Untreated compartment syndrome

 

Term
What are the main symptoms of Volkmann's Ischemic Contracture? (3)
Definition

1)Prolonged muscle ischemia results in necrosis which leads to scarring and contracture 

2) Rhabdomyolysis 

3) Renal Failure

Term
What are signs for Chronic Forearm Compartment Syndrome?
Definition

1) Bilateral Sypmtoms

2) Pain may be reproduced at specific workload or time interval 

3) Swollen and tender compartments shortly after activity 

4) Symptoms tend to resolve after an hour of ceasing activity 

Term
What is anatomical problem causing carpal tunnel syndrome? 
Definition
Ischemic compression of median n. with in the carpal tunnel 
Term
What are signs and symptoms of carpal tunnel syndrome? (5)
Definition

1) Spontaneous onset

2) Gradually increasing pain at night

3) Pain radiating to forearm, elbow and shoulder

4) Numbness/tingle along median n. distribution

4) Sense of weakness of hand

5) Thenar atrophy 

 

Term
What are treatments of Carpal Tunnel Syndrome? (7)
Definition

1) Eliminate Cause

2) NSAIDS

3) Injections

4) Splinting 

5) Stretching 

6) Neural Glides

7) Surgical Release

Term
 Cause of ulnar tunnel syndrome? (2)
Definition

1)Entrapment at Guyon's canal 

2) resulting from pressure of tumor, ganglia, constricting bands of muscle or thrombosis of ulnar artery


Term
What are signs and features of ulnar tunnel syndrome? (2)
Definition

1) pain or numbness along ulnar border 

2) Claw Hand

Term
Who has a high incidence of ulnar tunnel syndrome? 
Definition
cyclists
Term
What test can be used for ulnar tunnel syndrome? (2)
Definition

1)Allen test 

2) NCV

Term
What are treatments for Ulnar Tunnel Syndrome? 
Definition

1) Splinting 

2) avoidance 

3) Neural Glides

4) surgical 

Term
What is the Mechanism of Injury for a TFCC lesion? (2)
Definition

1) Fall on out stretched hand (supinated)

2) chronic or repetitive rotational loading

Term
What is the main complaint of a pt with a TFCC lesion? 
Definition

Medial wrist pain just distal to ulna, with an increase at end range pronation/supination and forceful gripping

 

Term
What are signs of TFCC lesions? (4)
Definition

1) Painful Clicking

2) Tenderness localized to dorsal anatomical depression

3) Painful crepitus in posterior mobilization of carpal condyle against head of ulna in ulnar deviation

4) Pain in passive supination combined with ulnar deviation 

Term
What are treatments of TFCC lesions? (2)
Definition

1) Conservative 

2) Surgical 

Term
What is game keepers Thumb? 
Definition
Instability of the thumb due to injury of the UCL 
Term
What are the causes of game Keepers thumb? (2) 
Definition

1) valgus force on an abducted thumb 

2) RA can cause ligament laxity 

Term
Who is susceptible to gamekeepers thumb?
Definition
Snow Skiers. Caused by the Ski pole
Term
What are signs of gamekeepers thumb? 
Definition

1)pain and swelling in the ulnar aspect of the thumb

2) Laxity on the valgus stress test

3) Decreased ROM

Term
What is the treatment for Gamekeepers thumb? 
Definition

1) Grade 1 and 2 are non surgical 

2) Grade 3 are surgical 

Term
What is the most Common joint disease? 
Definition
OA of the Wrist/Hand
Term
Where is primary OA commonly found?
Definition
1st CMC and scaphotrapeziotrapezoid joint 
Term
In what population does primary OA affect? 
Definition
postmenopausal women 
Term
Where is the Heberden's node found?
Definition
DIP 
Term
What node is usually found in the PIP 
Definition
Bouchard node
Term
What are the Characteristics of RA? (5)
Definition

1) Pain 

2) stiffness

3) Joint damage

4) Instability 

5) deformity 

Term
What are common hand deformities caused by RA?
Definition

1) Ulnar Drift 

2) Boutonnier Deformity

3) Swan Neck 

Term
What are treatments for RA? (5) 
Definition

1) Control Inflamation

2) Exercise to maintain strength 

3) Joint protection 

4) Splinting 

5) Pain Management 

Term
What is Dupreytren's Contracture?
Definition
Palmer disease, causing contractures leading to flexion deformities of hand and fingers
Term
Dupreytren's Contracture usually affect              side of hand.
Definition
1) Ulnar
Term
What is the most common treatment of Dupreytren's?
Definition
Surgical Release
Term
What are associated risk factors for Dupreytren's Contracture? (4)
Definition

1) race 

2) Sex (males 7-15x higher incidence)

3) Alcohol consumption

4) Smoking

Term
Where can a ganglion ST lesion be found? (2)
Definition

1) Adjacent to a joint or tendon sheath.

2) on dorsum of wrist in radiocarpal region  

Term
What are the symptoms of a Ganglion?
Definition
Pain and feeling of weakness
Term
What causes Posterior Interosseous Nerve Compression?
Definition
Dorsal Ganglions arising from the scapholunate ligament places pressure on the nerve. 
Term
What is Dequervain's Disease?
Definition
Stenosing tenosynovitis of abductor policisis longus and extensor policisis brevis 
Term
What are symptoms of Dequervain's Disease? (4)
Definition

1) Pain over APL/EPB with ulnar deviation and flexion and adduction of the thumb

2) crepitation and triggering

3) Palpable thickening of extensor sheath

4) Positive Finkelstein's test 

Term
What are treatments foe dequervain's disease? (3)
Definition

1) NSAIDS/ Steroid Injection

2) Immobilization for 3 weeks

3) Surgical Release

 

Term
What is Trigger finger? 
Definition
Painful Snapping of fingers or thumbs due to disproportion between flexor tendon and tendon sheath 
Term
Where does trigger finger occur? (2) 
Definition

1) metacarpal head

2) A1 pulley 

Term
What are the treatments for trigger finger? (4) 
Definition

1) Injection

2) MP flexion block splint for involved digit

3) Surgical release

Term
What is the common mechanism of injury for flexor tendon injury? 
Definition
Laceration 
Term
     % of Flexor tendon injuries occur in ______ __.
Definition

1) 50 

2) zone 

3) 2 

Term
What can failure of repair of a partial flexor tendon injury cause? (2)
Definition

1) triggering 

2) delayed rupture

Term
What is Mallet Finger? 
Definition
Flexion deformity DIP 
Term
What is the Mechanism of injury for mallet finger? 
Definition
Longitudinal Fracture
Term
What is the MOI of Jersey finger? 
Definition
Forceful extension leading to Flexor digitorum profundus rupture
Term
What finger is most involved in Jersey finger? 
Definition
Ring finger
Term
What is a symptom of jersey finger? 
Definition
unable to perform flexion at affected DIP
Term
What is the treatment for jersey finger? 
Definition
Surgery within 10 day of rupture
Term
What is the MOI for volar plate injuries?
Definition
Landing on outstretched hand with the wrist extended, forces finger into hyper extension 
Term
What are the signs and symptoms of volar plate injuries? (5)
Definition

1) pain 

2) Swelling

3) volar bruising under the IP 

4) LOM

5) Weakness

Term
What are the treatments for Volar plate injuries? (3) 
Definition

1) Price 

2) Splinting 

3) Surgery if avulsed 

Term
What are common causes of infections of the hand? (6) 
Definition

1) human bites

2) Anima Bites

3) IV drug use

4) Myobacterial 

5) viruses

6) pyogenic granuloma

Term
What are types of hand infections? (4)
Definition

1) Superficial spreading 

2) Subcutaneous abcess

3) synovial sheath 

4) Fascial space

Term
What is Kienbock's disease?
Definition
Aseptic necrosis of the lunate 
Term
What are symptoms of Kienbock's disease? 
Definition

1) Pain on central dorsal aspect of wrist esp after activity

2) stiffness

3) LOM

4) decreased strength 

Term
What joint is most commonly associated with  intercarpal instability? 
Definition
scapholunate
Term
What is the MOI of Intercarpal Instability? 
Definition
FOOSH 
Term
What are the problems associated with Intercarpal Instability? 
Definition

1) weakness with grasping 

2) Chronic wrist pain 

Term
What is a common nondissociative problem associated with Intercarpal Instability? 
Definition
Dynamic Wrist Instability 
Term
What is the most common wrist injury? 
Definition
Distal Radial Fracture
Term
What is the MOI of Distal Radial fracture
Definition
FOOSH
Term
Younger pt tend to sustain                radial fracture, older pt tend to             radial fracture
Definition

1) intrarticular 

2) extraarticular 

Term
What is a Colle's Fracture
Definition
Complete fracture of the distal radius with dorsal displacement of distal fragment 
Term
What is the MOI of Colle's Fracture
Definition
FOOSH
Term
What type of deformity is associated with Colle's Fracture?
Definition
DF or silverfork
Term
What is a Smith Fracture? 
Definition
Complete fracture of distal radius with palmar displacement of distal fragment 
Term
What is the MOI for a Smith Fracture? 
Definition
Fall on the back of flexed hand
Term
What is the treatment for a Smith fracture? 
Definition

1) closed reduction 

2) casting in supination for 3 wks 

Term
What is a Chauffer's Fracture? 
Definition
Strong radiocarpal ligament avulse radial styloid from metaphysis of radius. 
Term
What is the MOI of a Chauffer's Fracture 
Definition
Tension forces sustained during ulnar deviation and supination 
Term
What is the MOI of a Scaphoid fracture? 
Definition
FOOSH with wrist pronated
Term
What does the pt usually complain of with a scaphoid fracture? (2) 
Definition

1) Dorsal Wrist Pain 

2) tenderness over anatomical snuff box

Term
What is a clinical test for Scaphoid Fracture? 
Definition
axial compression of thumb 
Term
What is a Bennett's Fracture? 
Definition
Intraarticular Fracture of the base of the 1st metacarpal with involvement of the CMC joint 
Term
What is the MOI of a Bennett's Fracture
Definition
Axial loading of partially flexed thumb 
Term
What are symptoms of a Bennett's Fracture? (3)
Definition

1) extreme pain at base of thumb

2) tenderness 

3) swelling 

Term
What are the treatments of a Bennett's Fracture? (3) 
Definition

1) Closed Reduction 

2) Thumb Spica

3) internal fixation

Term
What are the indications of Proximal Row Carpectomy? (5)
Definition

1) Advance scapholunate dissociation 

2) Extension instability 

3) Nonunion of scaphoid with carpal instability 

4) Failed silicone lunate implant arthroplasty 

5) Keinbock's Disease

Term
What are the symptoms of Complex Regional Pain Syndrome Type 1? 
Definition

1) Pain triggered by noxious event , not limited to a single peripheral nerve

2) edema

3) stiffness

4) skin temperature change

5) sweating

Term

What are the symptoms of Complex Regional Pain Syndrome Type 2? (5)

 

Definition

1) Pain syndrome that involves direct partial or complete injury to a nerve or its major branches

2) Edema

3) Stiffness

4) Skin temperature change 

5) sweating 

Term
What are the symptoms of Complex Regional Pain syndrome type 1 at stage 1? (5)
Definition

1) Limb is flushed 

2) warm and dry

3) Stimulation of sweat glands is reduced

4) Edema

5) increased nail and hair growth 

Term
What is the starting symptom of Complex Regional Pain Syndrome Type 1 Stage 1? 
Definition
Acute inflammatory Phase ( 10 day to 3 mos) 
Term
Describe the pain associated with CRPS 1 Stage 1. (4) 
Definition

1) Diffuse

2) throbbing 

3) Burning 

4) Aching 

Term
What symptoms are associated with the end of CRPS 1 Stage 1? 
Definition

1) limb turns cold 

2) Sweaty

3) cyanotic from vasoconstriction caused by paradoxical sympathetic stimulation 

Term
How long does CRPS 1 stage 2 last for? 
Definition
3-6 mos
Term
How is the limb temperature affected in CRPS 1 Stage 2 ? 
Definition
Decreases by 10 degrees
Term
What are the signs of the integumentary system with CRPS 1 stage 2? (4)
Definition

1) pale 

2)Mottled

3) edematous

4) sweaty 

Term
what type of pain is associated with CRPS 1 stage 2? (3) 
Definition

1) Continuous 

2) Burning

3) throbbing 

Term
In CRPS 1 Stage 2 why is limb movement limited? (2)
Definition

1) Muscle Wasting 

2) Joint Stiffness

Term
CRPS 1 Stage 3 is characterized by              damage to muscle and         .
Definition

1) Irreversible 

2) joints

Term
CRPS 1 Stage 3 causes the bones to become             and joints become             and         
Definition

1) atrophy 

2) weak 

3) Stiff

Term
How is the skin affected by CRPS 1 stage 3? (4)
Definition

1) cool

2) glossy

3) pale

4) cyanotic

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