Common Clinical Conditions of the Hand Flashcards
What are the three functional needs of the hand
- Sensation
- Mobility
- Strength
What are the two digits which are the powerful gripping digits
The little finger and the ring finger
Which nerve is important in innervation of the powerful gripping fingers (the little finger and the ring finger)
The ulnar nerve
What is Carpal Tunnel Syndrome
Pressure on the median nerve at the wrist.
Where does the median nerve enter the hand
Under the carpal tunnel.
What is the main symptom of carpal tunnel syndrome
Numbness and tingling
What are the risk factors for carpal tunnel syndrome
- Gender - more common in females
- Age
- White race
- Diameter of carpal tunnel
- Obesity
- Hormonal - hypothyroidism, menopause, diabetes, contraceptive pill
When do symptoms for carpal tunnel tend to be worst
At night
What is the result of an advances case of carpal tunnel syndrome
Muscle wasting of the muscles supplied by the median nerve.
When is carpal tunnel syndrome most likely to occur for women
During pregnancy or menopause.
What are the options for treatment of carpal tunnel syndrome
- Night splint
- Steroid injection
- Operation to release the pressure on the median nerve.
What happens in the operative treatment for carpal tunnel syndrome
The flexor retinaculum is divided.
What causes ulnar nerve dysfunction
Irritation/compression of the ulnar nerve at the elbow.
Why is the ulnar nerve susceptible to damage at the elbow
The ulnar nerve is exposed to trauma at the elbow and is also susceptible to stretching and compression when the elbow flexes and direct pressure over the epicondyle.
What is the presentation of ulnar nerve dysfunction
- Paraesthesia (tingling)
- Hypoaesthesia (numbness)
- Weakness of grip
- Paralysis of affected muscles
- Clawing of the hand
What is Froments sign
This is a clinical examination that can be done in which the patient grips a piece of paper. An affected hand does not have the important muscle that will stabilise the grip so the thumb will flex upwards due to compensation by another flexor muscle.
What is the treatment for ulnar nerve dysfunction
Release of pressure at the elbow.
What is Dupuytren’s disease
Thickening and contracture of the palmar and digital fascia. Only longitudinal fibres (not transverse) are affected.
What is the cause of Dupuytrens disease
The cause is unknown but there are some associated factors which includes genetics, systemic disease such as diabetes and liver cirrhosis, and trauma.
What is the management approach is a patient has a nodule of Dupuytrens but no contracture
In this case, the patient should just be given advice - what it is and that contracture may occur however no treatment is required at this stage.
What are the indications for surgery for Dupuytrens
A contracture which is affecting function of the hand.
What are the surgical options in the treatment of Dupuytrens
Fasciotomy and fasciectomy
What happens in fasciotomy
Division of the cords.
What happens in fasciectomy
Excision of the fascia.
What is a clinical condition of the hand that often happens in those who ski
Rupture of the ulnar collateral ligament of the thumb.
What is done to treat rupture of the ulnar collateral ligament
Surgery to repair the thumb.
What kind of joint is the trapeziometacarpal joint
A double saddle joint - allows rotation of the thumb.
What is the most common joint in the hand affected by osteoarthritis
The trapeziometacarpal joint at the base of the thumb.
What are the symptoms of osteoarthritis of the trapeziometacarpal joint
Often this is asymptomatic but is very marked on an x-ray.
In which group of people is osteoarthritis of the trapeziometacarpal joint most common
Middle aged women.
What are the non surgical treatments for osteoarthritis of the trapeziometacarpal joint
It can often be controlled using analgesics and rest.
What are the surgical options for treatment for OA of the trapeziometacarpal joint
- Excision of the trapezium
- Joint replacement.
What happens in rheumatoid arthritis
There is synovial proliferation that destroys the articular cartilage and narrows the joint space. This results of loss of movement of the joint.
What can be the results of rheumatoid arthritis
- joint destruction
- Stretching/rupture of ligaments
- Rupture of tendons
- Muscle weakness
What are the surgical treatments for RA
- Remove the inflamed synovium
- Repair damaged soft tissues such as tendons or ligaments
- Stabilise or replace damaged joints.
