How does a Lunate and Perilunate Dislocation occur?
Carpal dislocations result from hyperdorsiflexion (hyperextension)
What must occur in order for a perilunate dislocation to occur?
Severe ligament injury necessary to tear the distal row from the lunate to produce perilunate dislocation
What are the 2 fractures associated w/ Lunate and Perilunate dislocation?
- Scaphoid fracture
- Radial styloid fracture
Tx for lunate and perilunate dislocation?
Surgical repair
What condition?
Lunate and Perilunate dislocation
Patho behind what condition?
- Inflammation of the sheath that surrounds the abductor pollicus longus and extensor pollicus brevis tendons
- Tendon sheath thickens and constricts the tendons
DeQuervain’s tenosynovitis
Which condition?
- Pain and tenderness in the first dorsal extensor compartment (anatomic snuffbox) aggravated by attempts to move thumb or make a fist
- +/- swelling
- Crepitation as patient flexes and extends thumb may be noted
DeQuervain’s tenosynovitis
Which special test? For what condition?
- Place the thumb in palm.
- Form a fist.
- Passive ulnar deviation
–>This stretches the inflamed tendons over the radial styloid, reproducing the patient’s pain.
Finklestein test
Pain= DeQuervain’s tenosynovitis
Tx for DeQuervain’s tenosynovitis?
- NSAIDs
- Thumb spica splint
- Avoid offending activity
- Steroid injection
What type of splint is used for DeQuervain’s tenosynovitis?
Thumb spica splint
What is also known as:
•“Gamekeeper’s thumb” or “Skier’s thumb”
Ulnar Collateral Ligament Sprain
Ulnar Collateral Ligament sprain= UCL injury at what joint
1st MCP joint
How does an Ulnar Collateral Ligament sprain occur?
acute or chronic valgus stress of the 1st MCP joint
(Acute MC)
What condition?
Ulnar Collateral Ligament Sprain
Where is pain localized in an Ulnar Collateral Ligament Sprain?
To ulnar aspect of thumb
What indicates a mild vs moderate sprain vs complete tear of an Ulnar Collateral Ligament sprain?
Mild sprain= pain but no laxity
Moderate sprain= pain with partial laxity
Complete tear= Pain and significant laxity
How do you treat a mild to moderate Ulnar Collateral Ligament Sprain?
brace
Ulnar Collateral Ligament Sprain tx:
How do you treat a c_omplete tear_ or _avulsion fractur_e involving >25% of the articular surface
Surgical consult
What is the MOI of a collateral ligament injury (“jammed fingers”)?
Forced lateral deviation of the IP joints, usually PIP
How do you test for Collateral ligament injury (jammed finger). Where will they have pain?
•Exam – pain over ligament, valgus/varus stress with PIP at 30 deg
How do you tx Collateral ligament injuries (“jammed fingers”)
•Buddy Tape, continue participation
•Refer children (growth plate often involved)
What is the etiology of an IP joint dislocation?
•Forced hyperextension of the PIP or DIP joint.
Pathology of what?
- Rupture of the volar plate +/- avulsion fracture of the base of the middle phalanx (PIP joint) or distal phalanx (DIP joint)
- Dorsal displacement of middle phalanx on proximal phalanx (PIP joint) or distal phalanx on middle phalanx (DIP joint);
- Possible interposition of volar plate in IP join (complex dislocation).
Dislocation of the IP joints
What is Trigger Finger?
Where is it MC?
MC etiology?
- Nodular thickening of the flexor tendon
- MC at the MCP joint
MC idiopathic (inc risk with RA/DM)
What 2 conditions put you at increased risk for Trigger finger?
- DM
- RA
What are the 2 tx options for Trigger Finger?
- Steroid injections x2 only
- Surgical release if persistent despite injection
Which condition?
- Palmar fibromatosis
- “Viking disease”
- Nodular thickening and contraction of palmar fascia
- Minimal discomfort
- Flexion of finger at MCP then PIP
Dupuytren’s Contracture
Dupuytren’s Contracture is MC in which finger?
Ring finger
Who is Dupuytren’s Contracture MC in?
Men >50
Northern European Descent
Distinguish b/w Stage 1, 2 and 3 of Dupuytren’s Contracture
1- Small lump/nodule in the palm on palmer crease
2- Spreads up fascia and into fingers (cord develops)
3- Spreads up fingers. Creates tight cord- causes fingers to bend and unable to straighten
What is the tx for Dupuytren’s Contracture? How does it work?
Xiaflex injection
- Breaks down collagen adhesion
- Injected into contracted cord
•Manipulation the following day
Which condition?
- Cystic swelling overlying a tendon sheath
- Herniation of synovial tissue from a tendon sheath
Ganglia of Wrist and hand
What ages are generally affected by ganglia of wrist and hand?
What is the cause?
15-40y/o
Cause- Idiopathic or repetitive activities that load the wrist (tumbling, diving, rowing)
What are the 2 common and 1 less common locations of Ganglia of wrist and hand?
•Common locations
- Dorsum of the wrist
- Volar radial aspect of wrist
•Less common locations
- Base of finger
If a person has Ganglia of Wrist and Hand and is asymptomatic how do you tx?
provide reassurance
If a person has acute, severe sxs associated w/ Ganglia of Wrist and Hand how do you tx? (3)
- immobilization (though rarely a permanent solution) will relieve symptoms and may cause a decrease in sz
- Needle aspiration (may need to be repeated)
- Surgical excision- if reoccurrence w/ repeated aspiration)
What are the 2 MC causes of arthritis of the hand
- OA
- Secondary degenerative joint dz
What 2 joints are most often involved in OA? What occurs?
- DIP and PIP joints
- Stiffness and loss of motion in the fingers
What is the name of the 2 nodes seen in OA and where are they located?
•Heberden nodes = nodules at the DIPs
•Bouchard nodes = bony nodules at the PIPs