Common Clinical Conditions of the Hand

Question 1

What are the three functional needs of the hand

Answer 1

• Sensation
• Mobility
• Strength

Question 2

What are the two digits which are the powerful gripping digits

Answer 2

The little finger and the ring finger

Question 3

Which nerve is important in innervation of the powerful gripping fingers (the little finger and the ring finger)

Answer 3

The ulnar nerve

Question 4

What is Carpal Tunnel Syndrome

Answer 4

Pressure on the median nerve at the wrist.

Question 5

Where does the median nerve enter the hand

Answer 5

Under the carpal tunnel.

Question 6

What is the main symptom of carpal tunnel syndrome

Answer 6

Numbness and tingling

Question 7

What are the risk factors for carpal tunnel syndrome

Answer 7

• Gender - more common in females
• Age
• White race
• Diameter of carpal tunnel
• Obesity
• Hormonal - hypothyroidism, menopause, diabetes, contraceptive pill

Question 8

When do symptoms for carpal tunnel tend to be worst

Answer 8

At night

Question 9

What is the result of an advances case of carpal tunnel syndrome

Answer 9

Muscle wasting of the muscles supplied by the median nerve.

Question 10

When is carpal tunnel syndrome most likely to occur for women

Answer 10

During pregnancy or menopause.

Question 11

What are the options for treatment of carpal tunnel syndrome

Answer 11

• Night splint
• Steroid injection
• Operation to release the pressure on the median nerve.

Question 12

What happens in the operative treatment for carpal tunnel syndrome

Answer 12

The flexor retinaculum is divided.

Question 13

What causes ulnar nerve dysfunction

Answer 13

Irritation/compression of the ulnar nerve at the elbow.

Question 14

Why is the ulnar nerve susceptible to damage at the elbow

Answer 14

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.

Question 15

What is the presentation of ulnar nerve dysfunction

Answer 15

• Paraesthesia (tingling)
• Hypoaesthesia (numbness)
• Weakness of grip
• Paralysis of affected muscles
• Clawing of the hand

Question 16

What is Froments sign

Answer 16

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.

Question 17

What is the treatment for ulnar nerve dysfunction

Answer 17

Release of pressure at the elbow.

Question 18

What is Dupuytren’s disease

Answer 18

Thickening and contracture of the palmar and digital fascia. Only longitudinal fibres (not transverse) are affected.

Question 19

What is the cause of Dupuytrens disease

Answer 19

The cause is unknown but there are some associated factors which includes genetics, systemic disease such as diabetes and liver cirrhosis, and trauma.

Question 20

What is the management approach is a patient has a nodule of Dupuytrens but no contracture

Answer 20

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.

Question 21

What are the indications for surgery for Dupuytrens

Answer 21

A contracture which is affecting function of the hand.

Question 22

What are the surgical options in the treatment of Dupuytrens

Answer 22

Fasciotomy and fasciectomy

Question 23

What happens in fasciotomy

Answer 23

Division of the cords.

Question 24

What happens in fasciectomy

Answer 24

Excision of the fascia.

Question 25

What is a clinical condition of the hand that often happens in those who ski

Answer 25

Rupture of the ulnar collateral ligament of the thumb.

Question 26

What is done to treat rupture of the ulnar collateral ligament

Answer 26

Surgery to repair the thumb.

Question 27

What kind of joint is the trapeziometacarpal joint

Answer 27

A double saddle joint - allows rotation of the thumb.

Question 28

What is the most common joint in the hand affected by osteoarthritis

Answer 28

The trapeziometacarpal joint at the base of the thumb.

Question 29

What are the symptoms of osteoarthritis of the trapeziometacarpal joint

Answer 29

Often this is asymptomatic but is very marked on an x-ray.

Question 30

In which group of people is osteoarthritis of the trapeziometacarpal joint most common

Answer 30

Middle aged women.

Question 31

What are the non surgical treatments for osteoarthritis of the trapeziometacarpal joint

Answer 31

It can often be controlled using analgesics and rest.

Question 32

What are the surgical options for treatment for OA of the trapeziometacarpal joint

Answer 32

• Excision of the trapezium

- Joint replacement.

Question 33

What happens in rheumatoid arthritis

Answer 33

There is synovial proliferation that destroys the articular cartilage and narrows the joint space. This results of loss of movement of the joint.

Question 34

What can be the results of rheumatoid arthritis

Answer 34

• joint destruction
• Stretching/rupture of ligaments
• Rupture of tendons
• Muscle weakness

Question 35

What are the surgical treatments for RA

Answer 35

• Remove the inflamed synovium
• Repair damaged soft tissues such as tendons or ligaments
• Stabilise or replace damaged joints.