70 Questions
Which type of fracture is the most common in post-menopausal women and is usually caused by a FOOSH injury?
Colles’ fracture
What is the common finding in a Colles’ fracture?
Dinner fork deformity
Which type of fracture occurs when there is a fall onto a flexed wrist or a direct blow to the back of the wrist?
Smith’s fracture
What is the treatment method appropriate for stable fractures, where muscular forces are not likely to displace the fracture?
Closed methods
What is the term for the restoration of a fractured bone to its normal anatomical position?
Reduction
What is the term for joint replacement surgery?
Arthroplasty
Which of the following is a treatment option for regaining wrist extension and forearm supination?
Orthosis use
What is the recommended treatment for scaphoid fractures?
Surgery
What type of orthosis is used to immobilize Boxer's fractures?
Ulnar gutter orthosis
What is the recommended treatment for Mallet finger injuries?
Immobilization
What causes flexion contracture of the MP and PIP joints?
Dupuytren's disease
How are TFCC injuries typically treated?
Surgery
Which treatment modality is recommended for individuals with Swan Neck Deformity?
Forearm-based thumb spica
Which condition is associated with Boutonniere Deformity?
Rheumatoid arthritis
What is the recommended treatment for Trigger Finger?
Orthosis with MCP joint in 0-15 degrees
What is the cardinal sign of Trigger Finger?
Both locking in flexion and pain with gripping
Which condition is associated with Swan Neck Deformity?
All of the above
What causes or exacerbates symptoms in Activity modification?
Modalities for pain
What is the recommended orthosis for Boutonniere Deformity?
Dorsal blocking orthosis
What is the recommended treatment for Boutonniere Deformity?
PIP immobilized in extension
Which joint is affected by Dupuytren's Disease?
Proximal interphalangeal (PIP) joint
What is the initial presentation of Dupuytren's Disease?
Enlarged nodule at the level of the distal palmar crease
Which digits are commonly involved in Dupuytren's Disease?
Ring and little finger
Which surgical procedure is indicated when functional status is affected in Dupuytren's Disease?
Open fasciectomy
What is the recommended orthosis for Skier's Thumb?
Short opponens orthosis
Which ligament is ruptured in Skier's Thumb?
Ulnar collateral ligament
What is the primary stabilizer of the distal radioulnar joint?
Intrinsic ligaments
What is the most common cause of TFCC injuries?
Fracture of the radius
What is the recommended treatment for deQuervain's Tenosynovitis?
Thumb spica orthosis
Which tendon sheaths are affected in deQuervain's Tenosynovitis?
Abductor pollicis longus and extensor pollicis brevis
Which condition is characterized by the lateral bands moving in an excessive dorsal position in relation to the PIP joint axis, resulting in hyperextension of the PIP joint and flexion of the DIP joint?
Swan Neck Deformity
What is the recommended orthosis for immobilizing the area affected by Swan Neck Deformity?
Oval 8
Which condition is characterized by the lateral bands falling volar to the PIP joint axis, resulting in excessive flexion of the PIP joint and hyperextension of the DIP joint?
Boutonniere Deformity
What is the recommended treatment for Boutonniere Deformity?
Orthosis positioning PIP in slight flexion
Which condition is characterized by the presence of a nodule or scarring of the tendon at the level of the A1 pulley, preventing the tendon from extending the finger?
Trigger Finger
What is the recommended orthosis for Trigger Finger?
Finger-based orthosis
What causes or exacerbates symptoms in Activity modification?
Excessive MCP flexion and activities that cause pain/triggering
What is the term for the condition where the lateral bands move in an excessive dorsal position in relation to the PIP joint axis, resulting in hyperextension of the PIP joint and flexion of the DIP joint?
Swan Neck Deformity
What is the term for the condition where the lateral bands fall volar to the PIP joint axis, resulting in excessive flexion of the PIP joint and hyperextension of the DIP joint?
Boutonniere Deformity
What is the term for the presence of a nodule or scarring of the tendon at the level of the A1 pulley, preventing the tendon from extending the finger?
Trigger Finger
Which type of shoulder instability is usually caused by a fall on an outstretched hand (FOOSH)?
Atraumatic instability
Which type of shoulder instability is typically bilateral and can be congenital?
Multidirectional instability
What is the primary treatment for atraumatic shoulder instability?
Rehabilitation
Which type of labral tear occurs when the labrum is torn away from the glenoid?
Bankart tear
Which surgical procedure involves sewing the joint capsule to the detached glenoid labrum using stitches or bone anchors?
Bankart procedure
What is the primary goal of the non-operative treatment phase for instability/dislocation?
Strengthen the shoulder in all planes
Which muscle weakness can lead to narrowing of the subacromial space and increased chance for impingement of RC and bicep tendons?
Weakness in serratus and traps
What is the most common treatment for calcific tendinitis?
NSAIDs and therapy, including iontophoresis and ultrasound
Which factor can cause problems with the length/tension relationship in the shoulder?
Structural asymmetry
Which age group is most commonly affected by stage two impingement?
25-40 years
What is the normal translation of the head of the humerus during midrange elevation of the shoulder?
3mm superiorly
What is the primary cause of secondary extrinsic impingement?
Scap dyskinesia
Which of the following is a treatment option for regaining wrist extension and forearm supination?
Low load prolonged stretch
Which ligament is ruptured in Skier's Thumb?
Ulnar collateral ligament
What is the recommended treatment for deQuervain's Tenosynovitis?
Corticosteroid injections
Which of the following is a common mechanism of injury for a SLAP lesion?
Repetitive overhead activity
Which of the following is a characteristic of AC joint sprain/separation type III and greater?
Pain and limited active range of motion (ROM)
Which of the following is a potential complication of AC joint repairs?
Distal clavicle osteolysis
Which special test can help diagnose rotator cuff impingement?
Hawkins/Kennedy
What is the recommended treatment for rotator cuff tendonitis?
Rest and ROM exercises
What is the primary indication for surgery in rotator cuff tears?
Failed conservative treatment
Which condition is characterized by pain in the neck at rest, pain with neck motion, and pain with overpressure on the neck?
Neck sprain
Which condition is associated with pain aggravated by postural positions and pain past the shoulder?
AC separation
Which condition is characterized by altered peripheral sensation and guarded cervical spine motion?
Tumor
Which condition is associated with pain mainly on the dominant side and pain relief with local injections?
Degenerative joint disease
Which condition is associated with pain into the deltoid area and a painful arc of motion?
RC tear
Which condition is characterized by a feeling of instability and local palpable tenderness in the shoulder?
AC separation
Which condition is associated with pain when working overhead and a history of FOOSH (fall on outstretched hand)?
Rotator cuff tear
Which condition is characterized by weakness with no pain and no trauma?
Muscle disease
Which condition is associated with severe pain and no history of trauma?
Shingles
Study Notes
Common Hand Conditions and Treatment Options
- Extensor digitorum should not be relied upon for extension.
- Regaining wrist extension and forearm supination can be challenging.
- Forearm rotation may be affected.
- The goals in the middle phase of treatment (6-8 weeks) include increasing range of motion, gentle strengthening, scar control, and functional use.
- Dynamic orthosis may be used to promote wrist and forearm strength.
- Early referral to an orthopedic specialist is recommended for scaphoid fractures.
- Finger fractures may require splinting or immobilization depending on the location of the injury.
- Boxer's fractures, which occur at the neck of the 5th metacarpal, can be immobilized with an ulnar gutter orthosis.
- Mallet finger injuries require immobilization of the DIP joint.
- Dupuytren's disease causes flexion contracture of the MP and PIP joints and may require surgery for treatment.
- Postoperative care for Dupuytren's disease includes wound care, edema control, scar management, and orthosis use.
- Skier's thumb, a rupture of the ulnar collateral ligament of the thumb, can be treated conservatively with an orthosis or surgically with ORIF.
- TFCC injuries, which affect the cartilage and ligaments in the wrist, may be treated conservatively with anti-inflammatory medications or surgically with arthroscopic evaluation and repair.
Rotator Cuff Pathologies and Treatment
- Special tests such as Hawkins/Kennedy and Yocum test can help diagnose rotator cuff impingement.
- A cluster of signs including Hawkins/Kennedy, painful arc, and infraspinatus test yield a 95% probability for impingement syndrome.
- Conservative treatment for impingement includes pain control, scapular stability restoration, RC strength restoration, and posture corrections.
- Surgical correction may be necessary for secondary instability or primary acromioplasty/decompression.
- Rotator cuff tendonitis presents with shoulder ache, fatigue, and pain with repetitive movement.
- Rotator cuff tears can be traumatic or due to overuse, commonly involving the supraspinatus tendon.
- Tears can be small, medium, large, or massive, and may cause decreased AROM and weakness.
- Diagnosis of tears involves examination, palpation, special tests, and imaging such as radiographs, MRI, arthrogram, or ultrasonogram.
- Conservative treatment for tears includes rest, ROM exercises, resistance exercises below 90 degrees, and modalities to decrease pain.
- Surgery may be appropriate for failed conservative treatment or full rotator cuff tears, usually in individuals over the age of 40.
- Post-surgical rehabilitation for rotator cuff repair involves different phases with specific goals and exercises.
- Rehab approaches for different tear types vary in the duration of sling use and progression of ROM exercises.
Test your knowledge on common hand conditions and their treatment options with this quiz. Learn about conditions like Dupuytren's disease, skier's thumb, and TFCC injuries, and discover the recommended treatments, including orthosis use and surgical interventions.
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