Arm, Hand pain

Question 1

Pulled elbow

Answer 1

1. Children
2. Pulled at wrist … RADIAL HEAD DISLOCATION (injury/tear of annular radioulnar lig)
3. Pain on supination
4. Mx - Reduction (Xray not needed)
   If pain persists - Xray can be done

Question 2

Tennis elbow

Answer 2

1. Excessive use of forearm muscles - ECRB (extensor carpi radialis brevis)
2. Tendon connecting them to elbow strained - LATER EPICONDYLAR TENDINOPATHY
3. Signs: any one + = diagnosis
   ●tenderness
   ●flexion of wrist - pain (passive stretching)
   ●forearm pronated, elbow extended, resisted
   extension of wrist - pain
4. Pain during hand gripping
5. elbow movement - normal
6. Self limiting, RICE, analgesics, physio
7. Chronic condition - ↓over 2yrs
8. Steroid inj/*below elbow band/surgery if pain persists

Question 3

Olecranon bursitis

Answer 3

Inflamed bursa at elbow
2. Swelling at olecranon process
3. Post trauma, RA, gout, septic arthritis, infection
4. Rx - depends on cause, anti inflammatories
Traumatic - resolves on its own
Septic - aspiration, lab diagnosis

Question 4

CTS Carpal tunnel syndrome c/f

Answer 4

1. MEDIAN NERVE entrapment in carpal tunnel
2. Pins and needles on pulps of thumb, index, middle, half of ring( 3 1/2 fingers)
3. *wake up at night … pins and needles… pain gone after shaking hand
4. Idiopathic, hypothyroid, preg, RA, multiple myeloma, DM etc
5. Clinical diagnosis: (tests can be negative)
   TINEL test
   PHANEL test
   2 POINT DISCRIMINATION
6. Confirmatory test

Question 5

Investigations of CTS

Answer 5

1. Clinical diagnosis: (tests can be negative)
   TINEL test
   PHANEL test
   2 POINT DISCRIMINATION
2. Confirmatory test -
   Electromyelography (EMG)
   Nerve conduction study

Question 6

Mx of CTS

Answer 6

1. Splinting at night, rest
2. Anti infl
3. Steroid oral/injection short term - BEST
4. Sx release of median nerve

Question 7

Trigger finger/thumb

Answer 7

Flexor tenosynovitis
1. Flexion stricture of finger, mc-thumb
2. Need to manually extend
3. Pulley crepitus @ METACARPAL HEADS can be felt, tender
4. A/w DM1, RA, gout, amyloidosis, hypothyroid
5. Mx - PCM…NSAID…Steroid inj…SX

Question 8

*Dupuytren contracture c/f

Answer 8

Viking disease
1. Fibrous hyperplasia of palmar fascia..
2. Flexion contracture of fingers
3. Discomfort, dysfunction > pain
4. M, >65yrs
5. A/w smoking, alc, liver cirrhosis, heavy worker(vibration), DM, COPD, epilepsy

Question 9

*Dupuytren contracture Mx

Answer 9

Mx-
●Range of motion exercises
●Needle aponeurotomy
●Nodule: steroid/collagenase (Xiaflex) injection
●At PIP - Sx
●MCP flexion > 30deg - Sx

Question 10

De Quervain tenosynovitis

Answer 10

Washer woman’ s sprain
1. Extensor pollicis brevis,
Abductor pollicis longus inflammed
2. Staple gun operators
3. Pain with pincer grasping, movement of thumb
4.Traid
5. Mx:
Rest, avoid stress
NSAID’s, steroid inj
Splint - immobilise thumb
Sx

Question 11

Triad of De Quervain tenosynovitis

Answer 11

1. Tenderness over radial styloid
2. Tender swelling of radial styloid
3. Finkelstein sign + (pathognomic)

Question 12

Mallet finger

Answer 12

1. Sport injury - finger tip… flexed
2. Hyperflexion injury
3. Evulsion/rupture of extensor tendon
4. Swan neck deformity
5. Mx: Maintain hyperflexion of DIP with
   Crossed, non stretch adhesive tape - 6wks