NMS Q&A Family Medicine

Musculoskeletal Problems of the Upper Extremities 149action to take a “shortcut” to the DIP, resulting in paradoxicalflexion of the PIP while extending the DIP.14. The answer is B, continuous splinting in extensionfor 6 weeks. This is an example of a partial avulsion ofthe extensor tendon, in this case brought about by thecareening baseball’s striking the patient’s flexed thumband violently stressing the PIP into hyperflexion. In asimilar case involving one of the fingers, the result isreferred to as a mallet finger. Prolonged splinting (6 to8 weeks) in extension is necessary for the extensor mechanismto heal. Delayed treatment can result in the situationin which the patient is unable to extend the finger atDIP joint without surgical intervention. Surgical repairhas not produced satisfactory results; splinting in flexionis counterproductive; arthrodesis is virtually neverresorted to; and NSAIDs as a sole treatment is inadequate.15. The answer is A, open reduction and internal fixationof the fracture. Closed treatment in a fracture involvingmore than 30% of the articular surface is highly likely todevelop degenerative arthritic change. All the other choicesoffer less aggressive treatment than open reduction.ReferencesBoyd AS , Benjamin HI , Asplund C . Splints and castings: Indicationsand methods . Am Fam Physician . 2007 ; 75 : 342 – 348 .Churgay C . Diagnosis and treatment of biceps tendinitis andtendinosis . Am Fam Physician . 2009 ; 80 :( 5 ): 470 – 476 .Daniels JM , Zook EG , Lynch JM . Hand and wrist injuries: Part I.Emergent evaluation . Am Fam Physician . 2004 ; 69 :1941–1948.Daniels JM , Zook EG , Lynch JM . Hand and wrist injuries:Part II. Non-emergent evaluation . Am Fam Physician . 2004 ;69 : 1949 – 1956 .Dixit S , DiFiori JP , Mines B . Management of patellofemoral painsyndrome . Am Fam Physician . 2007 ; 75 : 194 – 202, 204 .Myers A . Common Problems of the Upper Extremities . In: RudyDR , Kurowski K , eds. Family Medicine: House Officer Series .Baltimore, MD : Williams & Wilkins ; 1997 : 383 – 398 .Phillips TG , Reibach AM , Slomiany WP . Diagnosis and managementof scaphoid fractures . Am Fam Physician . 2004 ; 70 : 879 –884 .Viera AJ . Management of carpal tunnel syndrome . Am FamPhysician . 2003 ; 68 : 265 – 272 .