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Upper Extremit #4

Monteggia’s Fx distal ulnar with associated radial head dislocation
Galeazzi’s Fx distal radius with an associated dislocation and/or subluxation of distal radial/ulnar joint
Smith’s Fx reverse collie’s fracture
Distal Radius/Ulna fxs Signs and Symptoms +edema, +ecchymosis, +deformity, Point tender, ROM, Circulation; TX, Referral, Casting
Scaphoid Fx common–70% carpal fx, FOOSH, X-Ray, Persistant pn in snuffbox, Non-union fx b/c poor blood supply, risk of avascular necrosis, casting depend on how bad, doesn’t work, need to pin, part dead, graph from illiac crest, remove entire scaphoid if graph fails
Scaphoid Fx Signs and Sx Point tender; Axial load of ROM; TX X-rays every 4 weeks to see if healing
Hamate Fx Direct blow – while grasping some sort of object, Hook is most common place to fracture, point tender at hypotheamareminense
Hamate Fx Signs and Sx TTP; Grip strength Abduction of 5th will increase pain, palpable crepitous over hook of hamate, ulnar nerve is under hook (tunnel of Gion) can cause compression or laceration of nerve
Hamate TX xray wrist in extension for better view, splint for 4-6 weeks, begine working on ROM and grip strength – may not be normal until 2-3 months post, Nonunion – b/c ligaments and tendons pull bony ends apart
Boxer’s Fx Axial loading Signs and SX, Severe pn, +edema, +deformity, Point tender, TX Referral, Conservative vs aggressive, if displaced, pin it, nondisplaced- cast and conservative
Phalangeal Fx Very common, Mistake for dislocation, Direct blow to actual bone or axial load, Impingement, caught in facemask, netting, Hyperextension, Can look the same b/c bones so small, don’t reduce b/c could be a fx, Shortened finger appearance, overlapping
Phalangeal Fx Signs and Sx +edema, +percussion, Point tender, +deformity, Overlapping, deformity, TX Referral, Immobilization, Buddy taping Make a fist, fingertips do not align properly (malalignment), external pins
Dislocations Distal Radioulnar Joint Isolated or can occur in association with radial fx, Common damage in TFCC, Hyperextension = MOI, Ulnar Dorsal Dislocation = hyperpronated, Ulnar Volar Dislocation = hypersupination
Distal Radioulnar Joint Dislocation Signs and SX +deformity, +edema, TTP, ROM; TX, Referral, Internal fixation, Immobilization, ROM, PRE 6 weeks after, ROM exercised
Lunate Dislocation common Median nerve, could compress into carpal tunnel, Axial load, Volar displacement–most common will move (palm side), S/S, +deformity, TTP, ROM, Possible neuro TX; Refer, Reduce, Immob in slight flexion, Taping, Chronic dis - kienbox disease risk
MP Dislocation Rare, Hyperextension, Anterior capsule; Signs and SX 90° angle
PIP Dislocation Most common dislocation, Hyperextension & axial loading, Possible neuro involvement b/c of compression; Coach’s Finger– fixed flexion of PIP (chronic dislocations), Signs and SX, +edema, TTP, Reproduction of mechanism; TX, Referral, Reduction, Splint, ROM
DIP Dislocation Open fx, Volar plate, Signs and SX, +deformity, TTP, +edema, Ath usually relocates, TX, Referral, Reduction, Immobilization PIP left free
TFCC Injury Triangular Fibrocartilage Complex -Forced hyperextension of wrist Compression Radioulnar joint and carpal bones become compressed together, pain aong ulnar aspect
TFCC Injury Signs and Sx Pn along ulnar aspect, inbetween carpal bones, ROM, +edema, TX Referral, Improper tx; permanent disability
Wrist Sprain Axial loading, FOOSH, Gymnasts, Hyperextension, ulnar deviation; Signs and Sx, TTP radiocarpal joint, ROM, Glide test, excessive movement or pain with movement in carpals = bad; TX, Referral, Cryotherapy, Decrease activity, NSAIDs, Taping, PRE
Gamekeeper’s Thumb Tearing UCL at thumb – stabilizing and pinching and grasping, Forceful, Football; Signs and Sx +edema; palmar aspect, +ecchymosis, +stress test, c/o instability, TX, PRICE, Referral, Cast, Taping, Surgery
Interphalangeal Collateral Ligament Sprains Exc valgus/varus, Hyperextension, Prox phalanx, Volar plate, IP Sprain; S/Sx –deformity, +edema, Quickly; TX Referral, Buddy taping-Not immediately after injury, Extension splint, Flexion contracture, Medial = radial collateral, lateral = ulnar collateral
Interphalangeal Collateral Ligament Sprains MCP most commonly affected, when tears, tears commonly at proximal phalanx, avulsion fx may be associated, see gaping if stress joint; Will swell quickly; Don’t want flexor contracture (too much collagen lays down, if in flexed position, stay in it)
Jersey Finger Flex Digitorum Profundus Tendon Rupture; 4th digit, Forc extension, Avulsion Fx Pulls chunk of distal phalanx off; S/Sx Window shading, +ecchymosis Inability to flex DIP against resistance TX Refer; Surgery, 7-10 days, late perm flexor contract, 3 mo RTP
Mallet Finger Poss avulsion fx, sep from jersey finger by seeing if can extend/flex against resistance (can with mallet, cannot with jersey) no window shade effect, timeline will restart if take splint off before done and flexes back (DIP) can be permanent deformity
Baseball finger Direct blow while in extended position, Forced flexion, Ruptured distal extensor tendon Mallet Finger Signs and Proximal phalanx head can protrude through (can palpate)
Boutonniere Deformity Signs and Sx +deformity, Proximal phalanx head protrudes through extensor hood, +edema; TX Referral, Splint PIP Not DIP
Trigger Finger Thickening of tendoness sheath, nodule cannot move under sheaths, force extension, in morning, feel pop w/pass into exten, tendon feel crunchy, can palp nodule, immob in extension, no flexor contracture; Flexor tendons, trauma, Rep motion, 3rd & 4th digit
Trigger Finger Signs and Sx Noted upon waking, Pop, Inability to actively extend, +crepitus, Palpable nodule; TX Referral, Immobilization, NSAIDs, US, Steroid Injections into nodule, Release of annular ligament – surgery if nothing works
De Quervain’s Sheath surrounding tendon, tendonitis is inflammation of tendon, tensoynovitis is build up of fluid b/w tendon and sheath, pn over radial styloid process, pain with extension and abduction of thumb, pn with ulnar deviation of wrist
De Quervain’s Extensor pollicis brevis, Abductor pollicis longus, Sports w/grasping; Signs and Sx, c/o radial styloid pn, Pn w/ AROM, TTP, +crepitus, ROM
Ganglion Cysts Benign, Dorsal aspect, Mobile, Jelly-like fluid, Occurs spontaneously, Tissue sheath degeneration, can move, not pn, ROM not affected unless continues to grow, complain of pressure, drain and inject with corticosteroid, if keeps coming back needs surgery
Ganglion Cyst Signs and SX Palpable, No pn, ROM, Pressure as it increases in size, TX, Aspiration, Steriod injection, Removal, Rupture, Neuro Pathologies
Median Nerve Entrapment Carpal Tunnel Syndrome, Compression, Direct trauma, chronic, Flexion/extension of wrist, 9
Carpal Tunnel Syndrome S/Sx Carpal Tunnel Syndrome, Nocturnal pn, +neuro, Dec grip, +phalen’s test, start grad, freq burn, ting, or itch numb in palm of hand & fingers, thumb index middle, TX, Immob: slight extension, Avoid comp, NSAIDs, stretch & strength, Steroid decompress
Ulnar Nerve Entrapment Ulnar Tunnel Syndrome, Compression, Repetitive compressive forces, Hook of hamate fx usual cause
Ulnar Tunnel Syndrome Signs and Sx Motor grad decrease, Weak & increasing numbness sensory, Median nerve involvement, +neuro, Atrophy of hypothenar emminance, +Tinel’s; TX, Splint, NSAIDS, Decompress of Guyon’s tunnel, progresses, more diff to open jars, hold, coordinate fine func
Posterodistal Interosseous Syndrome Wartenberg syndrome Repetitive, forced wrist flexion, s/s decrease sens, paresthesia, tingling in area nerve, +position Tinel, +compression, sx provoked by extreme pron of the wrist; tx splint in neutral, surgery resection of brachioradialis tendon
Superficial Radial Nerve Entrapment Repetitive pronation/supination, Compression around wrist, Signs and Sx, Posterodistal Interosseous Syndrome, Dull, achy pn, reproduction of pn, +neuro Superficial Radial Nerve Entrapment
Subungual Hematomas Blood deep to nail bed, r/o fx; Signs and Sx Throbbing pn, Visual evidance of blood; TX, Soak in ice water, Drain, Drill, Blade, Sterilized pin, Clean, Watch for signs of infection
Paronychia Infection, Hang nail, Swimmers, divers, Signs and Sx
De Quervain’s TTP along affected tendons (lateral aspect of thumb)with tenosynovitis – crepitous, Finklesteins – special test – fold thumb, ulnar deviate, if pain, positive (everyone) Repetitive ulnar deviation, thumb
De Quervain’s S/SX TX Conservative, Wrist immobilizer with separate thumb compartment, PRICE, NSAIDs, Steroid injection, Immobilization; Aggressive, Decompress – cut the sheath
Created by: adalmadge
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