Chp. 15 Eval. Ortho

Description:	Chapter 15- Wrist, Hand, and Fingers
Category:	Sports Medicine
Created by:	gunrock on 2009-02-28

Question	Answer
What are the 4 carpal bones of the proximal row (from radial to ulnar)?	scaphoid, lunate, triquetrium, and pisiform
What are the 4 carpal bones of the distal row (from radial to ulnar)?	trapezium, trapezoid, capitate, and hamate
What are the superficial extensor muscles of the forearm?	extensor carpi radialis longus and brevis, extensor carpi ulnaris, extensor digitorum communis, brachioradialis
What are the deep extensor muscles of the forearm?	extensor pollicis longus, extensor pollicis brevis, abductor pollicis longus, extensor indicus, supinator
Define Plane synovial joint.	A synovial joint formed by the gliding between two or more bones.
What are the muscles of the anteromedial superficial compartment?	flexor carpi radialis, palmaris longus, flexor carpi ulnaris, flexor digitorum superficialis, and pronator teres.
What are the muscles of the anteromedial deep compartment?	flexor digitorum profundus, flexor policis longus, and pronator quadratus.
The thenar eminence is made up of what muscles?	abductor pollicis brevis, flexor policis brevis, and opponens pollicis.
The hypothenar eminence is made up of what muscles?	Abductor digiti minimi, flexor digiti minimi brevis, and opponens digiti minimi
What covers the entire central area of the palm?	palmar aponeurosis
What muscles fills in the webspace of between the thumb and index finger?	Adductor pollicis
What runs through the carpal tunnel?	Flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus, and median nerve.
What history should be taken in account of injures of the hand and wrist?	location of pain, MOI, relevant sounds, relevant sensation, duration of symptoms, description of symptoms, previous history, general medical health.
What are general things that can be inspected?	posture of the hand, gross deformity, palmar creases, and areas of cuts or scars
What can be inspected on the hand and wrist?	continuity of the distal radius and ulna, continuity of the carpals and metacarpals, alignment of the MCP joints, posture of the wrist and hands, ganglion cyst
What can be inspected on the thumb and fingers?	Skin and fingernails (subungual hematomoa, felon, paronychia), alignment of fingernails, and finger deformities.
Define Peripheral vascular disease?	A syndrom involving an insufficiency of arteries or veins in maintaining proper circulation.
What is ape hand?	Inhibition of the median nerve results in atrophy of the muscles within the thenar eminence. The extensor muscles draw the thumb parallel with the fingers and the patient's ability to flex or oppose the thumb is lost.
What is Bishop's deformity?	Inhibition of the ulnar nerve results in atrophy of the hypothenar, interossei, and medial two lumbrical muscles. the finger assumes a posture of flexion in the PIP and DIP joints that is more pronounced in the 4th and 5th fingers.
What is claw hand?	Extension of the MCP joint and flexion of the PIP and DIP joints as the result of pathology of the ulnar and median nerve.
What is Dupuytern's Contracture?	Flexion contracture of the MCP and PIP joints is caused by a shortening or adhesion (or both) of the palmar fascia. This condition most commonly affects the 4th and 5th fingers.
What is Swan-Neck Deformity?	Characterized by flexion of the MCP and DIP joints and hyperextension of the PIP joint, swan-neck deformity can be caused by a wide range of pathologies, including volar plate injuries, malunion fractures of the middle phalanx, etc.
What is Volkmann's Ischemic Contracture?	A decrease in the blood supply to the forearm muscles can result in a flexion contracture of the wrist and fingers. Volkmann's contracture can occur after a forearm fracture, fracture or dislocation of the elbow, or forearm compartment syndrome.
What is Lumina?	The growth plate of a fingernail or toenail.
What is the pathology and posture of Jersey finger?	Avulsion of the flexor digitorum profundus tendon. Inability to actively flex the DIP joint.
What is the pathology and posture of Mallet finger?	Avulsion of the extensor digitorum longus tendon. Inability to actively extend the distal phalanx, which assumes the posture of 25 degrees to 35 degrees of flexion.
What is the pathology and posture of Boutonniere deformity?	A rupture of the central expansion tendon. Extension of the MCP and DIP joints and flexion of the PIP joint; acutely, the PIP joint can be actively extended in those with boutonniere deformities.
What is psuedo-butonniere deformity and how is different from Butonniere deformity?	A rupture of the volar plate. PIP cannot be actively extended.
What should be palpated on the hand excluding the carpals?	Metacarpals, collateral lig. of the MCP, phalanges, collateral lig. of the PIP, thenar compartment, thenar webspace, central compartment, hypothenar compartment, ulna, ulnar styloid process, UCL, distal radius and styloid process, lister's tubercle, RCL
Where is the fulcrum, stationary arm, and movement arm located when measuring wrist flexion and extension?	Fulcrum: over the lateral joint line of the wrist. SA: centered on the midline of the ulnar shaft. MA: centered on the midline of the fifth metacarpal.
Where is the fulcrum, stationary arm, and movement arm located when measuring radial and ulnar deviation of the wrist?	Fulcrum: aligned with the center of the distal radioulnar joint, just proximal to the capitate. SA: centered over the midline of the forearm. MA: centered over the third metacarpal.
Where is the fulcrum, stationary arm, and movement arm located when measuring finger flexion and extension?	Fulcrum: positioned over the dorsal aspect of the joint being tested SA: centered on the midline of the bone proximal to the joint being tested. MA: centered on the midline of the bone distal to the joint being tested.
Where is the fulcrum, stationary arm, and movement arm located when measuring finger abduction and adduction?	Fulcrum: The hand is in its neutral position with the fingers slightly spread. SA: centered over the MCP joint being tested. MA: centered over the proximal phalange of the joint being treated.
What is normal for active flexion and extension?	Extension: 75 to 85 degrees. Flexion: 80 to 90 degrees.
What is normal for active ulnar and radial deviation?	Ulnar deviation: 35 degrees. Radial Deviation: 20 degrees.
What constitutes a positive grip dynamometry test?	Injured nondominant hand: more than 10% bilateral strength deficit compared with the dominant hand. Injured dominant hand: more than 5% bilateral strength deficit compared with the nondominant hand.
What does a positive grip dynamometry test implicate?	Pathology that inhibits grip strength, the underlying cause of the weakness must be determined.
What constitutes a positive valgus and varus stress testing of the wrist?	Pain or laxity (or both) compared with the same ligament on the opposite wrist
What does a positive valgus and varus stress test implicate?	Stretching or tearing of the UCL or RCL.
What constitutes a positive wrist glide test?	Pain or significant change in glide compared with the opposite side.
What does a positive wrist glide test implicate?	Tear or stretching of the collateral or intercarpal ligaments or trauma to the triangular fibrocartilage. Decreased glide may indicate adhesions and capsular stiffness after injury or surgery.
What constitutes a positive valgus and varus stress testing of the interphalangeal joints?	Increased gaping, compared with the same motion on the same finger of the opposite hand. Pain.
What does a positive valgus varus stress test of the IP joints implicate?	Collateral ligament sprain.
What constitutes a positive test for laxity of the thumb collateral ligaments?	The ulnar side of the first MCP joint gaps farther than the uninjured side or the patient describes pain (or both).
What does a positive test for laxity of the thumb implicate?	Stretching or tearing of the ulnar collateral ligament.
What are the pain characteristics of wrist sprains?	Pain emanating from the palmar and dorsal aspects of the wrist near the joint line.
What is the MOI of wrist sprains?	Tensile forces placed on the ligaments as the joint is forced past its normal ROM.
What would you find on inspection of wrist sprains?	Swelling localized to the joint line.
What are the pain characteristics of an injury to the TFCC?	Distal to the ulna along the medial one half of the wrist; the UCL of the wrist may also be tender.
What is the MOI of an injury to the TFCC?	Forced hyperextension of the wrist, compressing the triangular fibrocartilage.
What would you find on inspection of an injury to the TFCC?	Diffuse swelling around the wrist is possible, although acutely, no swelling may be visible.
What are the pain characteristics of carpal tunnel syndrome?	Paresthesia or pain in the hand, wrist, and fingers (median nerve distribution), possibly radiating up the length of the arm and worsening during sleep secondary to a flexed posture of the elbow, wrist, and fingers.
What is the MOI of carpal tunnel syndrome?	Repetitive wrist movement involving flexion and extension or finger flexion and extension.
What would you find on inspection of carpal tunnel syndrome?	Palmar aspect of the wrist possibly appearing thickened.
What constitutes a positive Phalen's test?	Tingling in the distribution of the medial nerve distal to the carpal tunnel.
What does a positive Phalen's test constitute?	Median nerve compression.
What are the pain characteristics of a wrist and distal forearm fracture?	Distal forearm, proximal wrist; the patient may describe hearing and feeling a cracking sensation.
What is the MOI of a wrist and distal forearm fracture?	A hyperextension mechanism, possibly combined with a rotatory component, placing tensile, compressive, or shear forces on the radius, ulna, or both (e.g. landing on an outstretched arm)
What woudl you find on inspection of a wrist and distal forearm fracture?	Gross deformity of the long bones possible; rapid onset of swelling.
Define Preiser's disease?	Osteoporosis of the scaphoid, resulting from a fracture or repeated trauma.
Define Kienbock's disease?	Osteochondritis or slow degeneration of the lunate bone.
What are the pain characteristics of a scaphoid fracture?	Proximal portion of the lateral wrist in the anatomical snuffbox.
What is the MOI of a scaphoid fracture?	Forceful hyperextension of the wrist that compresses the scaphoid.
What would you find on inspection of a scaphoid fracture?	Swelling possible in the anatomical snuffbox.
What are the pain characteristics of a perilunate or lunate dislocation?	Lateral wrist and hand. Paresthesia along the median nerve distribution.
What is the MOI of a perilunate or lunate dislocation?	Forced hyperextension of the wrist and hand.
What would you find on inspection of a perilunate or lunate dislocation?	A bulge caused by the displacement of the lunate may be seen on the palmar or dorsal aspect of the hand.
What three tendons make up the anatomical snuff box?	Extensor pollicis longus (medial border), extensor pollicis brevis and abductor pollicis longus (lateral border).
What are the pain characteristics of a metacarpal fracture?	Along the shaft of one or more metacarpals.
What is the MOI of a metacarpal fracture?	Longitudinal compression of the bone (direct contact), a crushing force (being stepped on), or a shear force (hyperextension of the finger).
What would you find on inspection of a metacarpal fracture?	Gross deformity of the bone may be visible.Localized swelling over the involved metacarpals,and MCP joints, which may spread to the entire dorsum of the hand.Fractures of the 5th or 4th, metacarpals may result in depression or shortening of the knuckles
What are the pain characteristics of DeQuervain's syndrome?	Over the length of the extensor pollicis brevisand abductor pollicis longus, the radial styloid process and thenar eminence, possibly extending into the distal forearm; complaints of pain increased during radial and ulnar deviation.
What is the MOI of DeQuervain's syndrome?	Repetitive stress often involving radial deviation.
What would you find on inspection of DeQuervain's syndrome?	Swelling over the styloid process and in the involved tendons.
What constitutes a positive Finkelstein's test?	Increased pain in the area of the radial styloid process and along the length of the extensor pollicis brevis and abductor pollicis longus tendons.
What does a positive Finkelstein's test implicate?	DeQuervain's syndrome (tenosynovitis of the extensor pollicis brevis and abductor pollicis longus tendons).
What are the pain characteristics of UCL sprains?	Along the ulnar aspect of the first MCP joint.
What is the MOI of a UCL sprain?	Acute: hyperextension or hyperabduction (or both) of the first MCP joint. Chronic: repetitive flexion or adduction (or both) of the joint.
What would you find on inspection of a UCL sprain?	Localized swelling in the adductor compartment and thenar eminence. Possible ecchymosis.
How would you splint a Jersey finger?	DIP joint in flexion.
How would you splint a Mallet finger?	DIP joint in extension.
How would you splint a Boutonniere deformity?	PIP and DIP joints in extension.
What constitutes a positive Tinel's sign?	Complaints of tingling, paresthesia, or pain by the subject in the area of the first three fingers and part of the 4th.
What does a positive Tinel's sign implicate?	Compression of the median nerve in the carpel tunnel.
What constitutes a positive Froment's sign?	1. Flexion of the subject's distal interphalangeal joint of the thumb. 2. Simultaneous hyperextension of the MCP joint of the thumb.
What does a positive Froment's sign implicate?	1. Adductor pollicis muscle paralysis due to ulnar nerve damage. 2. Ulnar nerve compromise.
What constitutes a positive Wrinkle test?	When the finger shows no signs of wrinkling.
What does a positive Wrinkle test implicate?	Denervated tissue.
What constitutes a positive digital Allen's test?	A delay in or absence of flushing of the radial or ulnar half of the hand and fingers.
What does a positive digital Allen's test implicate?	Partial or complete occlusion of the radial or ulnar arteries.
What constitutes a positive Bunnel Littler test?	PIP joint does not flex while the MCP joint is in an extended position.
What does a positive Bunnel Littler test implicate?	If the PIP joint does fully flex once the MCP joint is slightly flexed, intrinsic muscle tightness can be assumed. By contrast, if flexion of the PIP joint remains limited once the MCP joint is slightly flexed, capsular tightness can be assumed.
What constitutes a positive Murphy's sign?	The subject's third metacarpal is level with the second and fourth metacarpals.
What does a positive Murphy's sign implicate?	Dislocated lunate.
What constitutes a positive Watson test?	Palpable subluxation and reduction of the scaphoid.
What does a positive Watson test implicate?	Underlying carpal ligament tear.