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MS of the Hand.
Clinical Medicine II
| Question | Answer |
|---|---|
| Name the four main joints of the hand | CMC: carpometacarpal joint of thumb, MP joint: metacarpophalangeal, PIP proximal interphalangeal, DIP: Distal interphalangeal joint |
| What side is the flexor side? Extensor side? | Flex: volar-stronger Extensor: dorsal side |
| Thenar and hypothenar muscles | Thenar: thumb, hypothenar: along lateral pinky finger |
| Name the three bones that connect in the wrist joint | radius, scaphoid and lunate |
| Nerve innervation of Thenar, Hypothenar, Lumbricals, Interosseous | T: median, H: ulnar, L: 1,2median, 3,4Ulnar, I: ulnar |
| Origination of the flexor muscles of the forearm, Extensor? Supination? | medial epicondyle of humerous, lateral epicondyle, lateral |
| Infection of the cuticle | paronychia |
| Causes of paronychia | poor hygiene, biting nails, hang nails, |
| Typical pathogens of paronychia | staph, strep, MRSA for resistant paronychia |
| Bacterial superinfection with fungal onychomycosis usually indicates what with paronychia | pseudomonas infections, often w/ green discharge |
| Tx paronychia | oral abx, I&D marsupialization if large abscess |
| Packing an abscess to heal inside out | marsupialization |
| Infections “locked in” bw fibrous septae of distal phalanx | felon |
| Tx of a felon | Refer to ortho, very nerve sensitive, near bone don’t mess! |
| Cause of a felon | puncture, foreign body wound harvests infx |
| What must we be aware of with human “fight bites” | Extensor tendon injury at MCP joint |
| Tx of infected human bites | I&D, XRay for foreign bodies, leave open, marsupilization if needed |
| Common organisms in animal bites | pasteurella Multocida: GI track dogs/cats |
| What is a common side effect/sign w/ animal bites | rapid onset lymphangitis |
| Ascending lymphangitis Check what? | cellulitis in finger/infx that ascends thru lymph sys up arm. Check epicondular nodes |
| Two most common areas for ganglion cysts | Scaphoid-lunate joint on dorsum, Volar ganglion |
| Tx of ganglion cysts? Why? | Usually leave alone, surgery if problematic, connects to joint, infx can cause arthritis |
| How can tell bw tumor and cyst? | Cyst changes w/ activity (^w/activity) and tumor usually slow growing |
| Cysts commonly found in pt’s with arthritis on dorsum of hand | Digital mucous cyst, still connected to joints |
| Issue with palmer fascia that causes palmer deformity | Dupuytren’s Contracture |
| Diagnosis of Dupuytren’s Contracture | H & P, R/O tendon by making a fist |
| Where is Dupuytren’s seen most commonly | Ring finger in pt’s w/diabetes, epilepsy and alcoholism |
| Cause of Dupuytren’s | Genetic: Autosomal-Dominant |
| Tx of Dupuytren’s | Conservative, surgery if can’t flatten hand, more problematic usually cuz tethered to skin->necrosis |
| What does the ulnar nerve supply in the hand | 5th and lateral ½ of 4th digit palmer, lateral ½ of dorsum |
| What does median n. supply in the hand | medial ½ 4th digit, 3,2,1st of palmer, tips of medial ½ 4th, 3,2,1st dorsal |
| What does the radial n. supply in the hand | lateral 1st digit, dorsal 1st,2nd, medial 1/2 3rd digit |
| Cubital Tunnel Syndrome | “Truck driver’s elbow” chronic compression of the ulnar N. of elbow, Ganglion may grow and compress it |
| End result sxs of Cubital Tunnel syndrome | atrophy/weakness of intrinsic hand muscles (small and ring finger ulnar side of hand) |
| Ulnar N. compression signs | Froment’s sign, Pope’s blessing: lateee sign |
| Froment’s sign | Sign of cubital tunnel syndrome, can’t grab paper, or with 1st and 2nd digit |
| Tx of Cubital Tunnel Syndrome | leave until weakness, cut elbow fascia, let ulnar n. be free in Soft tissue |
| Cause of Carpal Tunnel Syndrome | Hypertrophy of flexor tendons, dec. room for median N.->median N. sxs,congenital: some ppl’s tunnel is smaller than others |
| Most workers that develop Carpal Tunnel? | assembly line work, not data entry ppl |
| CTS tests | Tinel’s Test, Phalen’sTest, CTS nerve compression test |
| Holding two hands dorsum to dorsum for 60-90s | phalen’s test: pinching median nerve causes sxs |
| Tapping on the median n. under the Transverse carpal ligament | causes a shock in median n. fingers “Tinel’s test” |
| Saturday Night palsy | Radial n. palsy from prolong compression of nerve, lose radial n. hand fxs: may take weeks to return |
| When do you refer someone to a surgeon with sat. night palsy? | 4-6 wks doesn’t resolve |
| Tendinitis of Thumb extensor compartment | DeQuervain’s Tenosynovitis |
| Causes of DeQuervain’s | over use of thumb ab/adduction, ^ulnar/radial deviation, RA |
| Tx DeQuervain’s | Corticosteroid injections, decrease inflammation and irritation |
| Diagnostic teset of DeQuervain’s | Finkelstein’s Maneuver: thumb in fist, ulnar deviation causes pain in abductor thumb compartment |
| Forced flexion of the DIP joint whilte it is in extension | Mallet Finger: caused by jamming that finger |
| Tx of mallet finger | strict splinting in full extension of DIP 8-10wks |
| Potential complication of mallet finger | swan neck deformity: flexed DIP, hyperextended PIP |
| Two types of mallet finger | osseous and non-osseous: ligiment tear: takes longer to heal |
| Traumatic rupture of the central extensor tendon in PIP joint | Boutonniere finger: hyperextension DIP, flexion PIP |
| Tx of Boutonniere finger, complication | tx: 8-10 wk full PIP extension, stiffness often remains Refer to hand surgeon |
| Flexor tendon controlling the DIP, PIP joints | DIP: Flexor digitorum profundum, PIP: Flexor digitorum superficialis |
| Swelling of flexor tendon unit in fingers, causes “stuck” flexor position | Trigger Finger: often passively reduced |
| Cause of trigger finger, tx | Routinely griping in flexing fashion, hypertrophy of synovial tissue,will slide back and forth tx: corticosteroid injections, or surgical release of the “pulley” |
| Acute traumatic rupture of the FDP tendon from DIP joint, MC? | Jersey finger, MC is ring finger of dominant hand, longest finger |
| Test for jersey finger | make a fist, the DIP won’t be able to bend on command |
| Tx for jersey finger | surgical repair within a week |
| FOOSH injury, don’t miss what? | fall on outstretched hand, don’t miss lunate dislocation into carpal tunnel,must fix d/t loss of median n. fxn |
| Fracture of the distal head of radius in the forearm with dorsal (posterior) displacement of the wrist and hand. | Colles’ fracture-FOOSH |
| Fracture of distal head of radius w/ volar deviation-toward palm | smith’s fracture, landing hand in flexed position |
| Fracture of distal radium down the center of head w/ either dorsal or volar deviations | Dorsal Barton’s for Volar Barton’s fractures |
| Buckleing of either the radius or ulna, happens in who? | Torus fracture, kids only |
| Hand fracture need to be careful off with FOOSH fall | scaphoid fracture, in anatomical snuff box, radial a. there |
| How do we check for a scaphoid fracture | palpation in anatomical snuff box, compare to unaffected side |
| No fracture seen on plain film, pain in wrist 2wks later, next step | advanced imaging looking for scaphoid fracture |
| The UCL is torn at (or in some cases even avulsed from) its insertion site into the proximal phalanx of the thumb | gamekeeper’s thumb |
| Stener lesion | osseous fracture at proximal phalanx d/t UCL tear-gamekeeper’s thumb |
| Test for gamekeeper’s thumb | bend thumb laterally, no solid endpoint |
| Intra-articular thumb fracture in first CMC joint usually w/ dislocation of CMC joint | Bennet’s fracture-avulsion: surgical mngmt |
| Type of fracture causes high risk of malrotation of the digits | metacarpal spiral fractures |
| Transverse fracture of the distal 5th metacarpal | boxer’s fracture: commonly open |
| Tx for proximal phalanx fracture | long ulnar gutter splint |
| Distal phalangeal fracture characteristic | “tuft”: very thing, usually smashed, septae are there, extremely painful, mights lose sensation for months |
| What is common w/ a PIP dislocation | middle phalanx fracture, numb w/lidocain and reduce |
| Chronic inflammation of synovial fluid, swelling | Rheumatoid arthritis: autoimmune |
| Joints affected by RA, dx? | MCP, PIP joints, fingers spared dx: ESR, CRP, FANA, and Rheumatoid factor all elevated |
| ANA | ananuclear antibodies, FANA same thing |
| Swelling and cartilage loss of the PIP and DIP joints in the hand | osteoarthritis |
| Causes of osteoarthritis | old age, cartilage loss, osteophyte formation at edges of articular surfaces (bone spur) inflammation |
| Visible enlargements and lumps of PIP joints | Bouchard’s nodes |
| Visible enlargements and lumps of DIP joints | Heberden’s nodes |
Created by:
streetsmarts
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