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Mallet Finger
- Disruption of extensor digitorum tendon
- Finger is jammed (sudden hyperextension of DIP)
- Inability to extend DIP jt once flexed
- Want to keep it splinted in extension (6-8 weeks)
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Trigger Finger
- Sudden catching/snapping/locking of flexor tendon
- Painful
- Commonly occurs at A1 pulley
- Idiopathic but suspected to be related to thickening (due to initial bout of tenosynovitis)
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Boutonniere Deformity
- PIP flexion w/ DIP extension
- Injury or RA → interruption of central slip of extensor tendon
- Lateral slips separate
- Inability to extend PIP
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Swan Neck Deformity
- Volar plate loosens from disease or tears due to injury → creates tension imbalance
- Flexed DIP joint
- Hyperextended PIP joint
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DeQuervian's Tenosynovitis
- Pain, tenderness, and swelling over radial aspect of the wrist w/ difficulty grasping
- EPB and/or abd pollicis longs and synovial sheaths
- Idiopathic but considered an overuse injury
- OVERDIAGNOSED! (r/o CMC joint dysfunction)
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Dupuytren's Contracture (Palmar Fibromatosis)
- Painless inherited proliferative connective tissue disorder
- Involves palmar fascia → fascia contracts over time and tendons unable to move freely
- 4th and 5th digits most commonly affected (1st and 2nd almost always spared)
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Gout
- Hyperuricemia = a prerequisite
- "Diseases of excess"
- Monosodium Urate (MSU) crystals in the joint
- Initially presents as brief twinges of pain
- Attacks of gouty arthritis last 3-10 days
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OA Deformities
- Heberden's Nodes (DIP)
- Bouchard's Nodes (PIP)
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Triangular Fibrocartilage Complex (TFCC) Injury
- Articular disc that covers distal end of ulna
- Helps transmit weight up the ulna (increases ulnar WB)
- Inhibited grip strength w/ local pain
- Increased wrist girth @ USP w/ gripping
- Falsely positive STTT due to TFCC compression
- Decreased pain and increased grip strength when DRUJ is approximated
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Epicondylosis
- Results from activities involving forceful/repetitive grasping
- Observation: elbow seems normal, no swelling or redness
- Full AROM
- Tenderness at medial/lateral epicondyles
- Pain w/ resisted wrist flexion (w/ elbow straight) and pronation OR passive wrist extension w/ forearm supinated and elbow extended and ulnar deviation
- Musculotendinous junction of ECRB most commonly involved
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Carpal Tunnel Syndrome
- Compression of median nerve in carpal tunnel → tingling, numbness, pain, weakness, and muscle atrophy
- Results from repetitive stress (OVERDIAGNOSED!)
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Peripheral Nerve Entrapment: Median Nerve
5 nerve sites:
- 1) Ligament of Struthers
- 2) Lacertus fibrosis (bicipital aponeurosis)
- 3) Pronator Teres hypertrophy
- 4) Anterior Interosseous N
- 5) Carpal tunnel (most common)
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Hand of Benediction
- Median n. injury at level of elbow or upper arm
- Loss of lateral 2 lumbricals and lateral half of FDP → Inability to flex 2nd and 3rd digits
- Seen when pt. instructed to make a fist
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Peripheral Nerve Entrapment: Ulnar Nerve
2 ulnar nerve sites:
- 1) Cubital tunnel
- 2) Guyon's canal
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Cubital Tunnel and Syndrome
- Cubital tunnel: fibro-osseous canal that contains the ulnar nerve
- Borders: MCL (floor), aponeurosis/arcuate ligament (roof), med. head of triceps (post. border), medial epicondyle (anterior border), and olecranon (lateral border)
- Volume of cubital tunnel greatest w/ elbow in extension
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Cubital Fossa
Triangular space over anterior surface of elbow joint
- Contents:
- Biceps tendon
- Median n
- Radial n
- Brachial artery
- Median cubital (intermediate cubital) cutaneous vein
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Ulnar Claw/"Claw Hand"
- Abnormal resting position of the hand
- Most commonly due to ulnar n. entrapment (cubital tunnel syndrome at the elbow) → denervation of medial two lumbricals
- 4th and 5th MCP joints extended
- 4th and 5TH IP joints flexed
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Peripheral Nerve Entrapment: Radial Nerve
4 radial neve sites:
- 1) Fibrous bands anterior to radial head
- 2) Vascular arcade
- 3) Tendinous margin of ECRB
- 4) Arcade of Frohse (proximal edge of supinator)
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Radial Nerve Palsy ("Wrist Drop")
- Extensor muscles supplied by radial n
- May be damaged w/ humeral fxs
- "Saturday Night Palsy" - high radial nerve compression (in the axilla) → sensory loss over radial nerve distribution and motor loss of wrist/thumb/finger extensors ("wrist drop")
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Volkmann's Ischemic Contracture
- Due to brahcial a. injry/compression and resulting ischemia
- Commonly associated w/ supracondylar fx
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