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Orthopedics

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Question
Answer
Dorsal Wrist Compartment I   APL & EPB  
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Dorsal Wrist Compartment II   ECRL, ECRB  
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Dorsal Wrist Compartment III   EPL  
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Dorsal Wrist Compartment IV   extensor digitorum comunis (four tendons) & extensor indicis (EDC, EI)  
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Dorsal Wrist Compartment V   extensor digiti minimi (EDM)  
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Dorsal Wrist Compartment VI   extensor carpi ulnaris (ECU)  
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Median nerve: Motor   Wrist flexors, thumb opposition  
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Median nerve: Sensory   Volar thumb, radial 2 ½ digits  
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Ulna nerve: Motor   Intrinsics, Adductor Pollicis  
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Ulna nerve: Sensory   Ulnar 1 ½ digits volar & dorsal  
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Radial nerve: Motor   Wrist extensors, APL, EPB  
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Radial nerve: Sensory   Dorsal thumb & radial half of hand  
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Wrist Hx: includes:   Handedness; Occupation; trauma; location of pain; numbness, paresthesias  
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Wrist Exam: Inspect for:   swelling, scars, masses  
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Wrist Exam: Specific tests   Tinel, Phalen; Finkelstein; Foveal; Watson  
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Watson Test for S-L dissociation:   Stabilize volar scaphoid w/ thumb & bring wrist from ulnar to radial deviation; there will be a clunk or pain  
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Wrist ROM: radial deviation:   20 degrees  
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Wrist ROM: ulnar deviation:   55 degrees  
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Wrist ROM: flexion :   90 degrees  
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Wrist ROM: extension:   70 degrees  
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Wrist Radiographs   AP, Lateral, Oblique  
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Wrist Radiographs: clenched fist:   Scapholunate dissociation  
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Wrist Radiographs: Scaphoid   Ulnar deviation  
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Wrist Radiographs: Carpal Tunnel   Hamate, pisiform injuries  
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Wrist Radiographs: Comparison views   Growth plate injuries  
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Wrist Radiographs: Lateral View:   Check 2-20 degree palmar tilt of articular surface of radius; dorsal aspect of distal radius is smooth; capitate sits in lunate  
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Wrist Radiographs: PA View:   Check radius lies distal to ulna; radial border of Scaphoid is intact; No more than 2mm of intercarpal joint space; no abnormalities of radius or ulna cortex;  
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Wrist Radiographs (PA): Impact fx may only show:   increased density at radial metaphysis  
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Wrist Radiographs: beak, bulge or density at fused epiphyseal line is:   not a fracture; IS a physeal scar  
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Gilula Arcs: articular surfaces of carpal bones s/b:   parallel, joint spaces similar width & parallel cortical margins  
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Gilula Arcs: any break in the lines or overlapping of normally parallel joint spaces suggestive of:   joint injury  
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De Quervain Tenosynovitis: Hx:   Radial wrist pain  
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De Quervain Tenosynovitis: Anatomy:   1st Dorsal compartment; APL & EPB tendon moves over radial styloid  
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De Quervain Tenosynovitis: Dx:   Pos Finkelstein  
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De Quervain Tenosynovitis: Tx:   Ice, thumb spica, rest, ionto  
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De Quervain Tenosynovitis: Injection:   Marcaine/ Kenalog In 1st dorsal compartment; directed toward radial styloid  
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De Quervain Tenosynovitis: last intervention:   Surgical release  
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CTS: Hx:   Pain, numbness, paresthesia in median n. distn  
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CTS: Anatomy:   10 structures pass through carpal tunnel (9 tendons, 1 (median) n.)  
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CTS: PE:   Positive Tinel’s and Phalen’s  
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CTS: Consider:   EMG, Neurometrics  
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CTS: Tx:   Splinting, ergonomics  
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CTS: Injection:   1ml Marcaine/40mg Kenalog; ulnar to palmaris longus at proximal wrist crease at 30 degrees  
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CTS: Surgical release   cut transverse carpal ligament  
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Tinel Sign   Percuss over median n. carpal tunnel; tingling or pain in median n. distn = Pos  
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Phalen Test   Acute flexion of wrists for 60-90 sec => numbness & tingling over median n. distn  
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Ganglion Cysts: Sx:   Painful or painless  
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Ganglion Cysts: Distribution:   65% Dorsal (SL joint), 25% radio-volar, 10% other flexor tendon sheaths (retinacular), occult  
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Ganglion Cysts: Aspiration:   18 g needle & 10 cc syringe; instill 40 mg Kenalog; compressive bandage; surg excision for recurrence  
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Ganglion Cysts: recurrence   10 % recurrence after excision  
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Scapholunate Dissociation =   Traumatic SL ligament tear; >2mm space at SL joint  
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Scapholunate Dissociation: S/S   Wrist pain & instability; Letterman sign; Watson Test  
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Scapholunate Dissociation: dorsal rotary subluxation leads to:   dorsal intercalated segment instability (DISI) & SL advanced collapse (SLAC)  
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SL dissociation: Rx:   SL ligament repair, PRC, Arthrodesis  
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TFCC Tear =   Triangular Fibrocartilage Complex  
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TFCC fn:   Stabilizes distal radioulnar joint  
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TFCC Tear: MOA =   Acute or repetitive overuse  
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TFCC Tear: PE:   TTP over TFCC; (+) Foveal sign  
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TFCC Tear: dx tests   X-Ray (Look for ulnar variance); MRI / Arthrogram  
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TFCC Tear: Rx:   Splint, NSAIDs, PT; injection; arthroscopic repair  
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Ulna Impaction Syndrome S/S:   Ulnar wrist pain, swelling & weakness  
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Ulna Impaction Syndrome MOA:   Ulna head impinges carpi  
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Ulna Impaction Syndrome: X-ray shows:   cystic or sclerotic changes of the lunate &/ or triquetral  
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Ulna Impaction Syndrome: leads to:   lunotriquetral ligament attrition  
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Ulna Impaction Syndrome: Rx:   Ulna shortening  
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Kienbock Dz =   Lunatomalacia  
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Kienbock Dz: MOA   Repetitive microtrauma => lunate collapse secondary to vasc insuff & avascular necrosis  
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Kienbock Dz: S/S   Radiating wrist pain & swelling over lunate; pain on middle finger dorsiflexion  
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Kienbock Dz: Rx:   Surgical unloading, fusion, vascular implantation  
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Monteggia fx =   Ulna shaft fx; Proximal radius dislocation  
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Monteggia fx: tx   ORIF vs long arm cast for 6 weeks  
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Galeazzi fx =   Radial fracture; distal Ulna dislocation  
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Galeazzi fx: tx   ORIF vs long arm cast 6 weeks  
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MUGR =   monteggia = ulna; Galeazzi = radial  
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Greenstick fx =   Incomplete fx  
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Greenstick fx: MOA   thick periosteum in children prevents displacement; dorsal cortex intact  
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Greenstick fx: tx   Reduction (if needed) & short arm cast for 3-4 weeks  
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Night Stick fx =   Isolated Ulna fracture  
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Night Stick fx: tx =   Cast or splint for 4 wks; then functional splint for several wks  
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Both Bone Forearm Fx: MOA   Fall or direct hit  
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Both Bone Forearm Fx: Displacement or angulation > 10 degrees:   needs ORIF  
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Both Bone Forearm Fx: Non displaced, non-angulated fx:   may be put in long arm cast 6 wks  
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Colles Fx: MOA   FOOSH injury; dorsal angulation of distal fragment  
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Colles Fx : if < 15 degrees angulation:   acceptable; short arm cast for 4-6 wks  
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Colles Fx : if > 15 degrees or sig displaced:   reduction, CRPP, ORIF  
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Smith Fx: MOA   Fall on back of hand; Hyperflexion injury; volar angulation of distal fragment  
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Smith Fx: minor angulation =   acceptable; short arm cast 4-6 wk  
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Smith Fx: significant angulation =   Reduction, CRPP, ORIF  
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Barton Fx =   Intra-articular fracture; displaced radial articular fragment  
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Barton Fx: tx   ORIF  
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Chauffeur Fx: MOA   Oblique fx through the base of the radial styloid  
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Chauffeur Fx: Tx   Long arm cast for 1 mo. followed by short arm cast for 2 wks  
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Torus Fracture =   Buckle fracture with intact periosteum  
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Torus Fracture: Common in:   children  
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Torus Fracture: Tx   3-4 weeks immobilization in a short arm cast; young kids need long arm cast (lest they take cast off)  
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Scaphoid Fx: MOA   FOOSH injuries  
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80% of scaphoid fx occur at:   waist  
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Scaphoid Fx: 1/3 will develop:   osteonecrosis  
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Scaphoid Fx: Healing time: Distal   6 weeks  
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Scaphoid Fx: Healing time: Waist   3 months  
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Scaphoid Fx: Healing time: Proximal   4 months  
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Scaphoid Fx: Healing time: RX:   Percutaneous screw fixation; ORIF w/ bone graft  
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Scaphoid Fx: Imaging:   AP, Lat, oblique, scaphoid views; MRI; Bone scan 72 hrs post injury  
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Scaphoid Fx: If initial imaging neg:   Immobilize in thumb spica or cast; repeat radiographs in 10-14 days  
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Both Bone Forearm Fx: Displacement or angulation > 10 degrees: tx   needs ORIF  
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90% of distal radial fractures are:   Colles Fx; FOOSH injury; dorsal angulation of distal fragment  
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Most common carpal fx =   Scaphoid Fx (2/2 FOOSH)  
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Ganglion Cysts: Hx:   Swelling at wrist (usually dorsal); Leak of joint fluid  
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