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What is tardy ulnar palsy? What is it associated with?
Ulnar n. symptoms that occur years after original injury d/t injury to cubital tunnel area. It can be but is NOT always caused by "double crush" phenomena.
What forms the cubital tunnel?
Ulnar collateral ligament (anterior, posterios, oblique portions) AND flexor carpi ulnaris
What is an intrinsic overuse injury to the elbow?
force from muscular contraction; leads to tendinitis or muscular injury
What is an extrinsic overuse injury to the elbow?
tensile overload caused by excessive joint torque forces stressing soft tissue
What two conditions must you use differential diagnoses to separate from medial epicondylitis?
- -overuse of common flexor origin
- -UCL instability
What is Panner's disease? What is it associated with?
necrosis of the capitulum; associated with Little League Elbow
Name four sites of potential median nerve compression.
- 1. distal 1/3 of humerus at ligament of Struthers
- 2. at the lacertus fibrosis (biceps aponeurosis)
- 3. between head of pronator teres
- 4. at tendinous arch of FDS
What is anterior interosseus nerve syndrome? What muscles are impaired?
- Nerve entrapped between two heads of pronator teres. Causes pinch deformity and can be caused with Monteggia fracture. Impairment of:
- 1. FPL
- 2. lateral half of FDP
- 3. pronator quadratus
What is a Monteggia fracture? What is is associated with?
fracture of the proximal 1/3 of ulna with dislocation of radial head;associated with anterior interosseous n. syndrome
T/F: If swelling exists in the elbow, all three joints of the complex are involved.
TRUE; b/c they have a common capsule
In what position is the elbow held in with swelling to allow maximum volume in the joint?
resting position, 70 degrees of flexion
What happens to the triangle sign when there is fracture, dislocation, or fracture?
The distance between the apex and base decreases and the isosceles triangle no longer exists
What is Preiser's disease?
avascular necrosis of the scaphoid; a rare condition where ischemia and necrosis of the scaphoid bone occurs without previous fracture
What is Kienbock's disease?
loss of circulation to the lunate; a predisposing factor may be negative ulnar variance
What is a Colles fracture?
- dorsal angulation
- shortening of distal radius fragment
What is a Smith's fracture?
- reverse Colles fracture
- distal radius is angulated and displace volarly
What is Barton's fracture?
dorsal or volar intra-articular SHEAR fx
What is a Chauffeur's fracture?
fracture of radial styloid
What is extensor tenolysis?
the process of freeing an extensor tendon from adhesions
Name four types of close tendon injuries of the wrist and hand.
- Mallet injuries "baseball finger"
- Boutenniere injuries or deformities
- Swan-neck deformity
- Rupture of FDP tendon (Jersey finger)
What causes a volar PIP dislocation and how do you treat immobilize it?
- central slip
- immobilize in full PIP extension (buddy taping could result in Boutenneire deformity
What causes a dorsal PIP dislocation and how do you treat immobilize it?
- joint hyperextension causing volar plate injury
- use buddy taping for 3-6 weeks
What makes a PIP joint Fx/dislocation unstable? How do you immobilize?
- If >40% of articular surface is involved
- PIP pinned in 30 degrees of flexion
What is disrupted with an MCP joint dislocation? Is it reducible?
- Hyperextension injury disrupting MCP volar plate at MC attachment
- Irreducible by closed means
What is a Stener lesion?
- When the UCL is trapped outside the aponeurosis
- Occurs with complete tear of UCL
What does the healing of a hand fracture depend on? When is it the slowest?
- Depends on cortical thickness (ratio of cortical to cancellous bone)
- Slowest: when ratio of cortical to cancellous is the highest
What is the position of function? When is it used?
- 30 degrees wrist extension
- 60-80 degrees MCP flexion
- Full IP extension
- Used for nondisplaced MC fractures
What is de Quervain's tenosynovitis?
- Inflammation around tendon sheath of APL and EPB
- In 1st dorsal compartment
- Caused by chronic repetitive wrist motion
What is a Boxer's knuckle?
Longitudinal tear in the dorsal capsule of the MP joint
Name three median n. compression syndromes.
- Carpal tunnel
- Anterior interosseous syndrome
- Pronator syndrome
Name two ulnar n. compression syndromes.
- Handlebar palsy
- Cubital tunnel syndrome
Name two radial n. compression syndromes.
- Wartenberg's disease
- Radial tunnel syndrome
What is Wartenberg's disease?
- Superficial radial n. entrapment
- SENSORY ONLY
- Compressed under brachioradialis
- Night pain along dorsum of hand, thumb, and wrist
What is Bowler's thumb?
- Neuropathy of ulnar digital nerve
- Numbness and pain over distal medial aspect of thumb
- Caused by repeated friction
- Formation of perineural fibrosis (mass)
What are three sites of compression of ulnar n. entrapment (cubital tunnel syndrome)?
- Ligament of Struthers
- 2 heads of FCU
- Cubital tunnel
What muscles are affected by ulnar n. entrapment (cubital tunnel syndrome)?
- 3rd and 4th lumbricals
- hypothenar muscles
- ulnar 1/2 FDP
What are 4 sites for compression of the radial n. (radial tunnel syndrome)?
- Lease of Henry
- Arcade of Frohse (proximal edge of supinator)
- Tendinous margin of ECRB
- Fibrous bands lying anterior to the radial head at the entrance to radial tunnel