Term
| The patient can ____ SCAPHOLUNATE ligament and it may get better with splinting, time, and oral anti-inflammatories. However, if the ligament is ___ this can lead to a very unstable wrist joint and lead the patient to chronic pain and eventually ___ if not fixed surgically |
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Definition
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Term
| SCAPHOLUNATE DISSOCIATION Often times this injury is not that obvious on _____ |
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Definition
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Term
| What is secondary to a scapho-lunate dissociation |
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Definition
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Term
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Definition
| scapho-lunate advanced collapse |
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Term
| SLAC wrist can lead to ___ |
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Definition
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Term
| NEVER _____ pts w/ SLAC wrist / osteoarthristi, it will make it worse. |
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Definition
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Term
| If x-rays are negative of SCAPHOLUNATE DISSOCIATION you can ____ them, and if the patient has a sprain the patient should get better |
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Definition
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Term
| How do you get a difinitive diagnosis of scapholunate dissociation? |
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Definition
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Term
What do you do if If MRI for scapholunate dissociation is positive, or if you have a high suspicion for a scapho-lunate injury?
What If the patient has a fracture? |
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Definition
send the patient to the orthopedic specialist
send the patient to the orthopedic specialist after splinting/casting the fracture |
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Term
| checking for _____, can lead to a diagnosis of scapho-lunate dissociation |
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Definition
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Term
| This occurs when there is a tear to the ulnar collateral ligament (UCL) of the thumb’s MCP joint |
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Definition
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Term
| GAMEKEEPERS THUMB occurs when there is a tear to the ____ of the thumb’s ___ joint |
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Definition
ulnar collateral ligament (UCL)
MCP |
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Term
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Definition
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Term
| GAMEKEEPERS THUMB When the ulnar collateral ligament at the base of the thumb is torn there is instability with ___ stress of the MCP joint |
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Definition
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Term
With GAMEKEEPERS THUMB, The patient can have a ____. It should heal conservatively with a _____.
Rarely does this need surgery, but if there is a significant piece involving a large portion of the joint, surgery may be the option |
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Definition
bony avulsion
thumb spica cast |
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Term
GAMEKEEPERS THUMB can also have a soft tissue sprain/tear which x-rays will be ____
Most patients with no bony abnormality will heal conservatively in a ___ |
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Definition
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Term
| A stener lesion is when the ____ flips into the ___ joint and prevents the ligament from healing. THis happens in ___ |
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Definition
adductor aponeurosis
MCP
GAMEKEEPERS THUMB |
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Term
| how to treat a stener lesion in GAMEKEEPERS THUMB ? |
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Definition
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Term
| occurs due to valgus or varus stress to the MCP joints or IP joints |
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Definition
| COLLATERAL LIGAMENT SPRAINS |
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Term
COLLATERAL LIGAMENT SPRAINS
If there is ____ with valgus or varus stress of the joint involved you can buddy tape the involved finger with the finger next to it for several weeks until acute symptoms resolve
Patients only need surgery if there is ____ and significant laxity |
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Definition
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Term
| what is the only exception to getting 3 x ray views? |
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Definition
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Term
| Dorsal angulation of the distal radius metaphysis approximately 2-3 cm from the wrist joint with or without associated fracture of the ulna styloid |
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Definition
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Term
| COLLE’S FRACTURE: ____ angulation of the distal ___ metaphysis approximately 2-3 cm from the wrist joint with or without associated fracture of the ulna styloid |
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Definition
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Term
COLLE’S FRACTURE
Some of these fractures can be ___ and may not need surgery if they maintain good position
If you are comfortable with this in your clinic you want to do a ___ block first to numb the site as much as you can, because it definitely is a painful procedure
You need to x-ray the patients every week for at least the first __ weeks
X-ray through the cast on follow-up (you do not want to take a chance that the fracture will move) |
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Definition
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Term
COLLE’S FRACTURE
Initial treatment is _____, followed by a __, followed by an x-ray through the cast to confirm the ___ |
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Definition
reduction
sugar tong splint
reduction |
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Term
| Why sugar tong splint for colles fracture? |
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Definition
This splint allows for swelling
It prevents supination and pronation which can displace the fracture |
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Term
| After 4 wks in a sugar tong splint for colles fracture, transfer the patient into a ___ for another 2 weeks, at which time it should be healed |
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Definition
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Term
| will a scaphoid fx be seen on x ray? |
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Definition
| These fractures are not always seen on initial x-rays if the fracture is fresh |
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Term
| What imaging is needed for definitive dx of scaphoid fracture? |
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Definition
MRI
I will usually get an MRI in a patient that requires immediate use of their hand/wrist
Professional athletes or a patient who does manual labor are examples |
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Term
| where do you palpate scaphoid fx? |
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Definition
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Term
scaphoid fx tx?
Treatment is a __________ cast if the pt is a poor candidate for Sx or in a rural practice. Otherwise, Sx is the Tx.
In an acute injury you will ___ the cast to allow for swelling |
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Definition
thumb spica long arm
bivalve
Now, you will see some providers who may suspect a scaphoid fracture and intially treat it in a thumb spica removable splint (to wear full-time), or in a short arm thumb spica cast
This is NOT CORRECT
You must go above the elbow to protect the patient from supinating and pronating so the fracture maintains position (does not move) and has a better chance to heal |
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Term
If the scaphoid fracture is ___ to the waist of the scaphoid the greater the chance for the fracture to heal
The more ___ the fracture is to the waist of the scaphoid the more likely there will be a non-union (did not heal)
Why? |
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Definition
distal
proximal
blood supply is better distally |
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Term
| It usually occurs due to making a fist and punching something |
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Definition
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Term
| Some patients sustain this injury if they fall onto a clenched fist, or sometimes someone stepped on the patient’s hand |
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Definition
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Term
| BOXER’S FRACTURE: The patient sustains a fracture of the ___ ____ _____ |
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Definition
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Term
| When examining a patient that you suspect has a boxer’s fracture (OR, really any patient with a suspected hand fracture), ALWAYS check their ______ |
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Definition
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Term
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Definition
seen on the volar aspect of the hand with the fingers flexed into the palm; and then on the dorsal aspect of a clenched fist at the MCP joints
You compare this to the uninvolved side
You are checking for any finger crossings on the volar aspect of the hand, and then shortening of the metacarpal head on the dorsal aspect with fist still clenched
If any fingers cross then the patient has a displaced fracture that needs surgery
If a metacarpal head is shortened the patient may need surgery depending on the x-ray findings (this is less so, however, in the fifth metacarpal)
I check the cascade on every hand trauma I see, so with any metacarpal fracture always check this |
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Term
If any fingers cross when checking cascade, then the patient has a ___ fracture that needs __
If a metacarpal head is ___ the patient may need surgery depending on the x-ray findings (this is less so, however, in the fifth metacarpal)
I check the cascade on every hand trauma I see, so with any metacarpal fracture always check this |
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Definition
displaced
surgeryshortened |
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Term
| cascade - flexed fingers should all point towards the ___ |
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Definition
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Term
boxer's fracture
These patient’s tend to heal quickly, especially if they have no co-morbidities and are non-smokers, rarely needing Sx.
Acutely, I put them in an ____, or splint. I finish these off with an ace wrap to hold the fiberglass mold in place. |
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Definition
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Term
| a very unstable proximal 1st metacarpal fracture |
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Definition
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Term
| BENNETT’S FRACTURE: occurs when the _____ tendon pulls on the ___ metacarpal long bone causing it to be pulled proximal and dorsal from its attachment |
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Definition
abductor pollicus longus tendon
1st |
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Term
| with BENNETT’S FRACTURE, it is important to.. |
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Definition
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Term
| If the bennett's fracture can maintain position, a ___ cast can be used for treatment |
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Definition
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Term
| If bennett's fx not stable then ___ |
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Definition
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Term
| Stable finger fractures do not need surgery as long as there are no significant ___ component |
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Definition
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Term
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Definition
These injuries DO NOT require Sx, and they DO NOT require Casting.
Treatment is buddy taping and treating symptoms
Do not immobilize these
Patients will get better with time |
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Term
| The Volar Plate can be defined as a very thick ligament that prevents hyperextension from occurring. If there is enough force during hyperextension, the disruption may cause a rupture of the Volar Plate at its insertion on the ___ ___ of a finger. This would result in ..... |
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Definition
middle phalanx
a small piece of bone being avulsed, (pulled off), by the ligament as it is hyperextending. |
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Term
| what sport is notoriously known for finger dislocations |
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Definition
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Term
| Just as in fractures, dislocations always require a good __ exam prior to reducing the joint. Dislocations that compromise __ status must be reduced immediately |
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Definition
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Term
KANAVEL’S SIGNS
The finger is in slight ___
Fusiform ___
Pain with ___
Tenderness along the ___ sheath |
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Definition
flexion
swelling
extension
tendon |
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Term
| KANAVEL’S SIGNS indicates what? |
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Definition
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Term
| ___ and ___ fractures tend to be unstable and generally need surgery to stabilize) |
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Definition
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