Clinical Decision Making
An athlete has snuffbox tenderness after a FOOSH, but radiographs are negative. What injury should you assume until proven otherwise?
What is a scaphoid fracture?
This carpal bone receives its primary blood supply distally, making proximal fractures particularly susceptible to avascular necrosis.
What is the scaphoid?
Which complication of a thumb UCL injury almost always requires surgery because the ligament cannot heal anatomically?
What is a Stener lesion?
A football player cannot actively flex the DIP joint after grabbing an opponent's jersey.
What is Jersey Finger (FDP rupture)?
Ulnar wrist pain with clicking and pain pushing out of a chair.
What is a TFCC injury?
A baseball player continues to have ulnar-sided wrist pain and weak grip despite a diagnosis of "wrist sprain" and normal radiographs. Which advanced imaging study is most likely to confirm the suspected diagnosis?
What is a CT scan for a hook of the hamate fracture?
The hook of this bone and the pisiform form the boundaries of which important tunnel?
What is Guyon's canal?
Why are MCP dislocations more likely than PIP dislocations to require operative treatment?
Because they commonly have interposed soft tissue preventing successful closed reduction.
A baseball player cannot actively extend the DIP joint after being struck by a baseball.
What is Mallet Finger?
Pain over the radial styloid in a new mother with a positive Finkelstein test.
What is DeQuervain's tenosynovitis?
A patient presents with median nerve symptoms after a high-energy wrist injury but has minimal deformity because the injury spontaneously reduced. Which injury should remain high on your differential?
What is a lunate dislocation/perilunate dislocation?
This extensor compartment contains the extensor pollicis longus and is separated from compartment II by Lister's tubercle.
What is Compartment III?
A patient has a central TFCC tear and positive ulnar variance. Which factor predicts poorer surgical outcomes?
What is positive ulnar variance?
This deformity consists of PIP flexion with DIP hyperextension.
What is Boutonnière deformity?
Pain 4–6 cm proximal to Lister's tubercle with crepitus after repetitive rowing.
What is Intersection Syndrome?
Which finding changes management more than pain, swelling, or bruising in both finger fractures and metacarpal fractures?
What is rotational deformity?
Which intrinsic muscle group flexes the MCP joints while simultaneously extending the IP joints?
What are the lumbricals?
Following compartment syndrome, irreversible muscle injury typically occurs after approximately how many hours of ischemia?
What is 8 hours?
Which tendon is ruptured in Jersey Finger?
What is the flexor digitorum profundus?
Diffuse wrist pain after a FOOSH with negative radiographs and inability to bear weight.
What is a wrist sprain until occult fracture or ligament injury is ruled out?
Why does persistent wrist pain with normal radiographs warrant continued investigation following a FOOSH injury?
Because scaphoid fractures, hamate fractures, and lunate injuries are frequently occult on initial radiographs and delayed diagnosis can lead to complications such as AVN or nonunion.
Name the three articulations that collectively allow forearm pronation and supination.
A Galeazzi fracture differs from an isolated radial shaft fracture because it includes injury to which structure?
What is the distal radioulnar joint (DRUJ)?
Which tendon structure is disrupted in Boutonnière deformity?
What is the central slip of the extensor mechanism?
Night numbness involving the thumb, index, and middle finger with thenar weakness.
What is Carpal Tunnel Syndrome?