University of Santo Tomas

Intersection Syndrome
Medsurg: Orthopedics (2nd Shift 2010)
 Bursitis at ABPOLLO & EXPOBRE over EXCARPI
Dr. Jose Fernando Syquia, MD  Tenderness on dorsal distal forearm
 No imaging
WRIST INJURIES  Tx: Rest, NSAIDs, Injection
Wrist Joint
 Function: linkage Ganglion
 15 Bones  Cystic swelling; mucin-filled
  Mass/pain
 Components:  Tx: Observation, Aspiration, Surgery
o Radiocarpal
o Midcarpal TFCC Tear
o Radioulnar Triangular Fibrocartilage Complex (TFCC)
- wrist meniscus
Ligament Complexes - stabilizes the radial-ulnar joint
 Extrinsic – forearm to carpal - Components:
 Intrinsic – OI in carpal rows *TFC
*Ulnar Meniscus
Distal Radius Fracture *UCL
 May be comminuted/intraarticular *Carpal Ligament
*Extensor Carpi Ulnaris tendon sheath
 Fall on outstretched hand
 Pain over distal forearm near wrist
 Ulnar-sided wrist pain
 Tx: Surgery/Immobilization
 Clicking sensation with wrist movement
 Colles Fracture – Dorsal/Extended wrist  Decreased grip strength
o Dinnerfork/Silverfork Deformity  Pain with resisted writ dorsiflexion
 Smith’s Fracture – Volar/Flexed wrist
 Barton’s Fracture – Extended & pronates wrist Carpal Tunnel Syndrome
o Carpal displacement  Burning volar wrist pain
o Dorsal - Outside the joint  Numbness/paresthesia
o Volar – Exits the joint  Nocturnal paresthesia
 (+) Tinel’s
Scaphoid Fracture  Tendons in the tunnel:
 Fall on outstretched hand o Flexor Digitorum Superficialis
 Most common carpal fracture o Flexor Digitorum Profundus
 Pain in snuffbox o Flexor Pollicis Longus
 Loss of grip strength
 Pain on axial compression of thumb Ulnar Nerve Compression
 Tx: Immobilization at least 8 weeks  Compression at Guyon’s canal
 Usually in cyclists and karate players
Hook of Hamate Fracture  Pain & paresthesia
 Racquet sports
 Compression of superficial/deep structures of ulnar nerve in Kienbock’s Disease
Guyon’s Canal  Avascular necrosis of the lunate
 Reduced grip strength  Chronic dorsal/volar pain
 Unar wrist pain  Localized tenderness over lunate
 Tenderness over hook of hamate  Loss of grip strength
 Radiographs show small lunate w/ increased opacity
Carpal Dislocation
 Forced dorsiflexion of wrist Madelung’s Deformity
 2 Types:  Long ulna
 Anterior Lunate Dislocation – Median nerve compression  Radial & palmar angulation of distal radius
 Posterior Lunate Dislocation – Scaphoid fx  Tx: None if painless
 Severe pain & deformity
 Tx: Surgical reduction & fixation Tenosynovitis
 Tx: Biopsy, Synovectomy
Scapholunate Dislocation  Clockwork mass
 Fall on dorsiflexed hand  Imaging: bony erosions & osteopenia
 Torn scapholunate ligament
 Pain w/without swelling
 (+) Watson’s
 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
 Diagnosis can be made without radiographs
 Tx: Splints, NSAIDs, Injection, Surgery