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University of Santo Tomas • Diagnosis can be made without radiographs

Medsurg: Orthopedics (2nd Shift 2010) • Tx: Splints, NSAIDs, Injection, Surgery
Dr. Jose Fernando Syquia, MD Intersection Syndrome
• Bursitis at ABPOLLO & EXPOBRE over
WRIST INJURIES
EXCARPI
Wrist Joint
• Tenderness on dorsal distal forearm
• Function: linkage
• No imaging
• 15 Bones
• Tx: Rest, NSAIDs, Injection

• Components:
Ganglion
o Radiocarpal
• Cystic swelling; mucin-filled
o Midcarpal
• Mass/pain
o Radioulnar
• Tx: Observation, Aspiration, Surgery
Ligament Complexes
TFCC Tear
 Extrinsic – forearm to carpal
Triangular Fibrocartilage Complex (TFCC)
 Intrinsic – OI in carpal rows - wrist meniscus
- stabilizes the radial-ulnar joint
Distal Radius Fracture - Components:
• May be comminuted/intraarticular *TFC
• Fall on outstretched hand *Ulnar Meniscus
• Pain over distal forearm near wrist *UCL
• Tx: Surgery/Immobilization *Carpal Ligament
• Colles Fracture – Dorsal/Extended wrist *Extensor Carpi Ulnaris tendon sheath
o Dinnerfork/Silverfork Deformity
• Smith’s Fracture – Volar/Flexed wrist • Ulnar-sided wrist pain
• Barton’s Fracture – Extended & pronates • Clicking sensation with wrist movement
wrist • Decreased grip strength
o Carpal displacement • Pain with resisted writ dorsiflexion
o Dorsal - Outside the joint
o Volar – Exits the joint Carpal Tunnel Syndrome
• Burning volar wrist pain
Scaphoid Fracture • Numbness/paresthesia
• Fall on outstretched hand • Nocturnal paresthesia
• Most common carpal fracture • (+) Tinel’s
• Pain in snuffbox • Tendons in the tunnel:
• Loss of grip strength o Flexor Digitorum Superficialis
• Pain on axial compression of thumb o Flexor Digitorum Profundus
• Tx: Immobilization at least 8 weeks o Flexor Pollicis Longus

Hook of Hamate Fracture Ulnar Nerve Compression


• Racquet sports • Compression at Guyon’s canal
• Compression of superficial/deep structures • Usually in cyclists and karate players
of ulnar nerve in Guyon’s Canal • Pain & paresthesia
• Reduced grip strength
• Unar wrist pain Kienbock’s Disease
• Tenderness over hook of hamate • Avascular necrosis of the lunate
• Chronic dorsal/volar pain
Carpal Dislocation • Localized tenderness over lunate
• Forced dorsiflexion of wrist • Loss of grip strength
• 2 Types: • Radiographs show small lunate w/ increased
• Anterior Lunate Dislocation – Median nerve opacity
compression
• Posterior Lunate Dislocation – Scaphoid fx Madelung’s Deformity
• Severe pain & deformity • Long ulna
• Tx: Surgical reduction & fixation • Radial & palmar angulation of distal radius
• Tx: None if painless
Scapholunate Dislocation
• Fall on dorsiflexed hand Tenosynovitis
• Torn scapholunate ligament • Tx: Biopsy, Synovectomy
• Pain w/without swelling • Clockwork mass
• (+) Watson’s • Imaging: bony erosions & osteopenia
• Tenderness 2 cm distal to Lister’s tubercle
on radial side of lunate
• Terry-Thomas Sign (3mm gap in
scapholunate space)
• Tx: Surgery

De Quervain’s Tenosynovitis
• Inflamed ABPOLLO & EXPOBRE
• Occurs t radial styloid
• Pain & tenderness over radial styloid
• (+) Finkelstein’s