Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Trauma + Orthopaedics > 2: Joint Disorders Of The Wrist > Flashcards

2: Joint Disorders Of The Wrist Flashcards

1
Q

What is the commonest cause of nocturnal wrist pain

A

Carpal tunnel syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is carpal tunnel syndrome

A

Compression of the median nerve as it passes through the carpal tunnel (under flexor retinaculum)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are 8 risk factors of carpal tunnel syndrome

A
  • Obesity
  • Hypothyroidism
  • Rheumatoid arthritis
  • Osteoarthritis
  • Repeated extension and flexion of the wrist
  • Previous distal radial fracture
  • Pregnancy (62%)
  • Diabetes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What type of symptoms will mild-moderate carpal tunnel syndrome present with

A

Only sensory symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the sensory symptoms of carpal tunnel syndrome

A
  • Parasthesia of the thenar eminence, thumb, index, middle and medial-half of the ring finger
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What symptoms will moderate-severe carpal tunnel syndrome present with

A

Motor and sensory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the MOTOR symptoms of carpal tunnel syndrome

A

Reduced strength in pincer grip - often complain of dropping objects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is a very rare late sign of carpal tunnel syndrome

A

Wasting of the thenar eminence and reduced thumb opposition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is hand of benediction and when is it seen

A

Inability to flex the thumb, index and middle finger. It is seen in injury of the median nerve higher up (NOT in carpal tunnel syndrome)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is hand of benediction also referred to as

A

Pope’s blessing sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What type of injury may cause hand of benediction

A

Supracondylar humeral fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When is an ulna claw seen

A

When patient tries to extend all their fingers (un-make a fist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When is pope blessing sign seen

A

When patient tries to flex their fingers and make a fist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are two signs seen in carpal tunnel syndrome

A

Tinel’s sign

Phalen’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the carpal tunnel

A

Flexor retinaculum and associated carpal bones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does the carpal tunnel contain

A

Flexor tendons and medial.N

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Explain the pathophysiology of carpal tunnel syndrome

A

Any condition increasing pressure in the carpal tunnel can cause compression which impairs blood flow to the median nerve leading to an inflammatory reaction, oedema, hypoxia and degeneration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is main investigation of carpal tunnel syndrome

A

Electromyography (EMG)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What 5 other investigations may be performed in carpal tunnel syndrome and why

A
  1. TFTs - increased risk in hypothyroidism
  2. Pregnancy test
  3. Fasting blood glucose - diabetes
  4. X-ray - OA
  5. anti-CCP - RA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How is mild-moderate carpal tunnel syndrome managed

A

Conservatively:

  • Night splint
  • Rest
  • Analgesia
  • Corticosteroid injections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How is moderate-severe carpal tunnel syndrome treated

A

Open or endoscopic release of transverse carpal ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is a wrist ganglion

A
  • Non-cancerous soft tissue swelling along joint capsule or tendon sheath.
  • Benign lumps that arise from degeneration of joint capsule or tendon sheath and subsequently become filled with fluid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

In which gender are wrist ganglions more common

A

Female

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What age is peak incidence of wrist ganglions

A

20-40y

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are 3 RF's for wrist ganglions
- OA - Previous injury to the joint or tendon - Female
26
Why does OA increase risk of ganglions
Increases synovial fluid production which can then leak from the joint capsule or tendon sheath
27
What is the most common site for wrist ganglions to occur
dorsum of the wrist
28
What % of ganglions occur at the dorsum of the wrist
60-70%
29
How do ganglions present clinically
- Painless, smooth spherical mass - Can appear suddenly or gradually - May appear and then subside
30
On examination, how may wrist ganglions appear
- Transillumable | - Mobile
31
What may ganglions cause if placing pressure on nerves
Parasthesia or motor weakness
32
Give 3 differentials for wrist ganglions
- Lipoma - Sarcoma - Tenosynovitis
33
How is tenosynovitis differentiated from a wrist ganglion
Swelling along the entirety of the tendon sheath
34
How is giant cell tumour differentiated from wrist ganglion
- Not transillumable - Solid mass - Less mobile
35
How is a lipoma differentiated from a wrist ganglion
- Not spherical or smooth | - Not transillumable
36
How is a wrist ganglion diagnosed
Clinically
37
Why may an x-ray be ordered for a wrist ganglion
To exclude osteoarthritis of the scaphotrapezotrapezoid joint or sarcoma
38
Why may an US or MRI be ordered
To assess depth, size and shape of the ganglion
39
What is the management of a non-painful non-limiting wrist ganglion
Active monitoring
40
If a wrist ganglion is painful or limits movement what may be done
Aspiration
41
What is the problem with aspirating a ganglion
- Infection risk | - Often recurrs
42
What other intervention may be offered for a painful, limiting wrist ganglion
Cyst excision
43
What are the indications for cyst excision
Recurrence following aspiration and still symptomatic
44
What is DeQuervain's Tenosynovitis
thickening of the abductor polices Longus (APL) and extensor polices brevis (EPB) tendon due to myxoid degeneration
45
What tendons are thickened in DeQuervain's Tenosynovitis
- Extensor polices brevis (EPB) | - Abductor polices longus (APL)
46
Which gender is DeQuervain's Tenosynovitis more common
Females
47
Which age group is DeQuervain's Tenosynovitis more common
30-50y
48
What causes DeQuervain's Tenosynovitis
- Repetitive abduction and extension of the thumb | - Rheumatoid arthritis
49
How will DeQuervain's tenosynovitis present
- Pain over radial aspect of the wrist. Exacerbated by gripping objects - Swelling at the dorsum of the thumb
50
What is a stereotypical presentation of DeQuervain's tenosynovitis
Pregnant women develops pain and welling over the thumb
51
What sign is positive in DeQuervain's tenosynovitis
Finklesteins sign
52
What is finklestein sign
Pain on gripping the thumb to the palm of the same hand with passive ulna deviation
53
Describe the pathophysiology of De Quervain's tenosynovitis
There is thickening of the first extensor compartment which contains the APL and EPB tendons
54
How is DeQuervain's tenosynovitis diagnosed
Clinically
55
How is DeQuervain's tenosynovitis managed
1. Conservatively. With analgesia (NSAIDs), thumb splinting (SICA) and corticosteroid injections 2. Surgical release - if pregnant
56
What is dupuytrens contracture
painless thickening of the palmar fascia
57
In which gender is dupuytren's contracture more prevalent
males
58
What % of dupuytrens contracture occurs in male's
80%
59
In which ethnic origin is dupuytrens contracture more common
scandinavian
60
What is the pathophysiology of risk factors for dupuytren's contracture
all risk factors cause ischemia of the palmar fascia increasing the risk of injury and thickening
61
What are 5 risk factors for dupuytren's contracture
- Liver cirrhosis - Alcohol abuse - Diabetes - Smoking - Recurrent trauma (occupation)
62
Why is dupuytren's contracture looked for in an abdominal examination
As it can indicate liver cirrhosis
63
Which fingers are most commonly affected in dupuytren's contracture
4th and 5th fingers
64
What is the earliest sign of dupuytrens contracture
Skin puckering by the flexure crease
65
What are 3 other signs of dupuytren's contracture
1. Palmar nodules 2. Palmar cords 3. Flexion contracture
66
What are palmar nodules
Formation of nodules adjacent to the distal palmar crease
67
What are planar cords
Formation of cords adjacent to the nodules
68
What is a flexure contracture
Contracture at MCPs and PIPS
69
What is the problem with dupuytren's contracture
Can interfere with function
70
Explain the pathophysiology of dupuytren's contracture
- Injury to the palmar fascia triggers myofibroblast proliferation causing thickening and formation of nodules - Nodules adhere to overlying dermis causing puckering - Nodules progress to cords which form flexion contractures
71
How can dupuytren's contracture be diagnosed
Clinically
72
What is first-line management of dupuytrens contracture
Conservative - Physiotherapy - Splinting - Corticosteroid injections
73
When is surgery indicated for dupuytrens contracture
Functional disability secondary to contracture
74
What does surgery for dupuytren's contracture entail
Manipulation under anaesthesia
75
What is another term from trigger finger
Stenosing tenosynovitis
76
What is trigger finger
Swelling and thickening of the flexor finger tendons with associated stenosis of the A1 pulley
77
In which gender is trigger finger more prevalent
Females (6:1)
78
What is the peak incidence of trigger finger
>40y
79
What are two risk factors for stenosing tenosynovitis
Diabetes | Rheumatoid arthritis
80
What is the clinical presentation of trigger finger
- Painful locking of the finger in a flexed position. On extension it will suddenly release to give a 'popping' sensation - Finger is commonly found flexed over the palm and needs physically straightening
81
Which fingers are most commonly affected in stenosing tenosynovitis
Thumb Middle Ring
82
How may trigger finger be identified on examination
Palpable nodules over MCP
83
Explain the pathophysiology of trigger finger
- Swelling of tendon sheath proximal to A1 pulley prevents tendon gliding and 'catches' it to cause locking in flexion - As extension occurs, the nodule moves with the flexor tendon but becomes jammed on the pulley and has to be flicked straight causing 'triggering'
84
What is the 1st line management of trigger finger
Conservative: - Splinting - NSAID
85
What is second-line management of trigger finger
Surgical release of A1 pulley
86
what structure is most likely damaged in scaphoid fracture
dorsal carpal arch of the radial artery

Trauma + Orthopaedics (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions