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Wrist
Orthopedics
| Question | Answer |
|---|---|
| Dorsal Wrist Compartment I | APL & EPB |
| Dorsal Wrist Compartment II | ECRL, ECRB |
| Dorsal Wrist Compartment III | EPL |
| Dorsal Wrist Compartment IV | extensor digitorum comunis (four tendons) & extensor indicis (EDC, EI) |
| Dorsal Wrist Compartment V | extensor digiti minimi (EDM) |
| Dorsal Wrist Compartment VI | extensor carpi ulnaris (ECU) |
| Median nerve: Motor | Wrist flexors, thumb opposition |
| Median nerve: Sensory | Volar thumb, radial 2 ½ digits |
| Ulna nerve: Motor | Intrinsics, Adductor Pollicis |
| Ulna nerve: Sensory | Ulnar 1 ½ digits volar & dorsal |
| Radial nerve: Motor | Wrist extensors, APL, EPB |
| Radial nerve: Sensory | Dorsal thumb & radial half of hand |
| Wrist Hx: includes: | Handedness; Occupation; trauma; location of pain; numbness, paresthesias |
| Wrist Exam: Inspect for: | swelling, scars, masses |
| Wrist Exam: Specific tests | Tinel, Phalen; Finkelstein; Foveal; Watson |
| 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 |
| Wrist ROM: radial deviation: | 20 degrees |
| Wrist ROM: ulnar deviation: | 55 degrees |
| Wrist ROM: flexion : | 90 degrees |
| Wrist ROM: extension: | 70 degrees |
| Wrist Radiographs | AP, Lateral, Oblique |
| Wrist Radiographs: clenched fist: | Scapholunate dissociation |
| Wrist Radiographs: Scaphoid | Ulnar deviation |
| Wrist Radiographs: Carpal Tunnel | Hamate, pisiform injuries |
| Wrist Radiographs: Comparison views | Growth plate injuries |
| 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 |
| 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; |
| Wrist Radiographs (PA): Impact fx may only show: | increased density at radial metaphysis |
| Wrist Radiographs: beak, bulge or density at fused epiphyseal line is: | not a fracture; IS a physeal scar |
| Gilula Arcs: articular surfaces of carpal bones s/b: | parallel, joint spaces similar width & parallel cortical margins |
| Gilula Arcs: any break in the lines or overlapping of normally parallel joint spaces suggestive of: | joint injury |
| De Quervain Tenosynovitis: Hx: | Radial wrist pain |
| De Quervain Tenosynovitis: Anatomy: | 1st Dorsal compartment; APL & EPB tendon moves over radial styloid |
| De Quervain Tenosynovitis: Dx: | Pos Finkelstein |
| De Quervain Tenosynovitis: Tx: | Ice, thumb spica, rest, ionto |
| De Quervain Tenosynovitis: Injection: | Marcaine/ Kenalog In 1st dorsal compartment; directed toward radial styloid |
| De Quervain Tenosynovitis: last intervention: | Surgical release |
| CTS: Hx: | Pain, numbness, paresthesia in median n. distn |
| CTS: Anatomy: | 10 structures pass through carpal tunnel (9 tendons, 1 (median) n.) |
| CTS: PE: | Positive Tinel’s and Phalen’s |
| CTS: Consider: | EMG, Neurometrics |
| CTS: Tx: | Splinting, ergonomics |
| CTS: Injection: | 1ml Marcaine/40mg Kenalog; ulnar to palmaris longus at proximal wrist crease at 30 degrees |
| CTS: Surgical release | cut transverse carpal ligament |
| Tinel Sign | Percuss over median n. carpal tunnel; tingling or pain in median n. distn = Pos |
| Phalen Test | Acute flexion of wrists for 60-90 sec => numbness & tingling over median n. distn |
| Ganglion Cysts: Sx: | Painful or painless |
| Ganglion Cysts: Distribution: | 65% Dorsal (SL joint), 25% radio-volar, 10% other flexor tendon sheaths (retinacular), occult |
| Ganglion Cysts: Aspiration: | 18 g needle & 10 cc syringe; instill 40 mg Kenalog; compressive bandage; surg excision for recurrence |
| Ganglion Cysts: recurrence | 10 % recurrence after excision |
| Scapholunate Dissociation = | Traumatic SL ligament tear; >2mm space at SL joint |
| Scapholunate Dissociation: S/S | Wrist pain & instability; Letterman sign; Watson Test |
| Scapholunate Dissociation: dorsal rotary subluxation leads to: | dorsal intercalated segment instability (DISI) & SL advanced collapse (SLAC) |
| SL dissociation: Rx: | SL ligament repair, PRC, Arthrodesis |
| TFCC Tear = | Triangular Fibrocartilage Complex |
| TFCC fn: | Stabilizes distal radioulnar joint |
| TFCC Tear: MOA = | Acute or repetitive overuse |
| TFCC Tear: PE: | TTP over TFCC; (+) Foveal sign |
| TFCC Tear: dx tests | X-Ray (Look for ulnar variance); MRI / Arthrogram |
| TFCC Tear: Rx: | Splint, NSAIDs, PT; injection; arthroscopic repair |
| Ulna Impaction Syndrome S/S: | Ulnar wrist pain, swelling & weakness |
| Ulna Impaction Syndrome MOA: | Ulna head impinges carpi |
| Ulna Impaction Syndrome: X-ray shows: | cystic or sclerotic changes of the lunate &/ or triquetral |
| Ulna Impaction Syndrome: leads to: | lunotriquetral ligament attrition |
| Ulna Impaction Syndrome: Rx: | Ulna shortening |
| Kienbock Dz = | Lunatomalacia |
| Kienbock Dz: MOA | Repetitive microtrauma => lunate collapse secondary to vasc insuff & avascular necrosis |
| Kienbock Dz: S/S | Radiating wrist pain & swelling over lunate; pain on middle finger dorsiflexion |
| Kienbock Dz: Rx: | Surgical unloading, fusion, vascular implantation |
| Monteggia fx = | Ulna shaft fx; Proximal radius dislocation |
| Monteggia fx: tx | ORIF vs long arm cast for 6 weeks |
| Galeazzi fx = | Radial fracture; distal Ulna dislocation |
| Galeazzi fx: tx | ORIF vs long arm cast 6 weeks |
| MUGR = | monteggia = ulna; Galeazzi = radial |
| Greenstick fx = | Incomplete fx |
| Greenstick fx: MOA | thick periosteum in children prevents displacement; dorsal cortex intact |
| Greenstick fx: tx | Reduction (if needed) & short arm cast for 3-4 weeks |
| Night Stick fx = | Isolated Ulna fracture |
| Night Stick fx: tx = | Cast or splint for 4 wks; then functional splint for several wks |
| Both Bone Forearm Fx: MOA | Fall or direct hit |
| Both Bone Forearm Fx: Displacement or angulation > 10 degrees: | needs ORIF |
| Both Bone Forearm Fx: Non displaced, non-angulated fx: | may be put in long arm cast 6 wks |
| Colles Fx: MOA | FOOSH injury; dorsal angulation of distal fragment |
| Colles Fx : if < 15 degrees angulation: | acceptable; short arm cast for 4-6 wks |
| Colles Fx : if > 15 degrees or sig displaced: | reduction, CRPP, ORIF |
| Smith Fx: MOA | Fall on back of hand; Hyperflexion injury; volar angulation of distal fragment |
| Smith Fx: minor angulation = | acceptable; short arm cast 4-6 wk |
| Smith Fx: significant angulation = | Reduction, CRPP, ORIF |
| Barton Fx = | Intra-articular fracture; displaced radial articular fragment |
| Barton Fx: tx | ORIF |
| Chauffeur Fx: MOA | Oblique fx through the base of the radial styloid |
| Chauffeur Fx: Tx | Long arm cast for 1 mo. followed by short arm cast for 2 wks |
| Torus Fracture = | Buckle fracture with intact periosteum |
| Torus Fracture: Common in: | children |
| Torus Fracture: Tx | 3-4 weeks immobilization in a short arm cast; young kids need long arm cast (lest they take cast off) |
| Scaphoid Fx: MOA | FOOSH injuries |
| 80% of scaphoid fx occur at: | waist |
| Scaphoid Fx: 1/3 will develop: | osteonecrosis |
| Scaphoid Fx: Healing time: Distal | 6 weeks |
| Scaphoid Fx: Healing time: Waist | 3 months |
| Scaphoid Fx: Healing time: Proximal | 4 months |
| Scaphoid Fx: Healing time: RX: | Percutaneous screw fixation; ORIF w/ bone graft |
| Scaphoid Fx: Imaging: | AP, Lat, oblique, scaphoid views; MRI; Bone scan 72 hrs post injury |
| Scaphoid Fx: If initial imaging neg: | Immobilize in thumb spica or cast; repeat radiographs in 10-14 days |
| Both Bone Forearm Fx: Displacement or angulation > 10 degrees: tx | needs ORIF |
| 90% of distal radial fractures are: | Colles Fx; FOOSH injury; dorsal angulation of distal fragment |
| Most common carpal fx = | Scaphoid Fx (2/2 FOOSH) |
| Ganglion Cysts: Hx: | Swelling at wrist (usually dorsal); Leak of joint fluid |
Created by:
Abarnard
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