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MSK UPPER LIMBS (S9) > Common conditions of the wrist and hand > Flashcards

Common conditions of the wrist and hand Flashcards

1
Q

What is a scaphoid fracture?

A

A break of the scaphoid bone in the wrist

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2
Q

What is the usual cause of a scaphoid fracture and how does it present?

A

FOOSH; usually men

  • Pain at base of thumb
  • Tender with out without swelling of anatomical snuff box
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3
Q

What are the complications of a scaphoid fracture?

A
  • Non-union
  • Avascular necrosis
  • Delayed healing from poor blood supply
  • Carpal instability
  • Secondary osteoarthritis
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4
Q

What is a Colle’s fracture?

A

An extra-articular fracture of the distal radius (metaphysis) with dorsal angulation of distal radius

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5
Q

What is the usual cause for a Colle’s fracture and how does it present?

A

FOOSH; usually elderly women or young adults (car, bike, horse-riding)

  • Pain
  • Bruising
  • Swelling
  • Dinner fork deformity
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6
Q

What is a Smith’s fracture?

A

An extra-articular fracture of the distal radius with palmar (volar) angulation of distal fragment

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7
Q

What is the usual cause for a Smith’s fracture and how does it present?

A

Direct blow to back of wrist (fall onto flexed wrist); rare, most common in young males

  • Pain
  • Bruising
  • Swelling
  • Garden spade deformity
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8
Q

Which joints can rheumatoid arthritis affect?

A
  • Metacarpophalangeal joint
  • Proximal interphalangeal joints
  • Wrist joint
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9
Q

How may rheumatoid arthritis present?

A
  • Pain
  • Swelling
  • Stiffness
  • Volar subluxation (MCPJ)
  • Accompanying tenosynovitis (PIPJ)
  • Carpal tunnel syndrome
  • Erythema
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10
Q

What is a swan neck deformity and what are the causes?

A

Deformity of the finger where the DIPJ is in flexion and the PIPJ is in hyperextension

  • Rheumatoid arthritis
  • Ehlers-Danlos
  • Injury
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11
Q

What is a boutonniere deformity and what are the causes?

A

Deformity of the finger with flexed PIPJ and hyperextended MCPJ and DIPJ

  • Rheumatoid arthritis
  • Post-traumatic injury
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12
Q

What are radiological features of rheumatoid arthritis?

A
  • Soft-tissue swelling
  • Joint space narrowing
  • Periarticular osteopenia (disease process and treatment e.g. steroids)
  • Juxta-articular erosions
  • Subluxation and gross deformity
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13
Q

What are the potential complications of a Colle’s fracture?

A
  • Malunion
  • Median nerve palsy
  • Secondary osteoarthritis
  • Post-traumatic carpal tunnel syndrome
  • Tear of extensor pollicis longus tendon
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14
Q

How is a Colle’s fracture treated?

A

Reduction and immobilisation in a cast

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15
Q

What is a psoriatic arthropathy?

A

A chronic autoimmune disease characterised by psoriasis and inflammatory arthritis

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16
Q

How many psoriatic arthropathy present?

A
  • Asymmetrical oligoarthritis (one joint at a time)
  • Dactylitis (fusiform (sausage-shaped) swelling of digits)
  • Nail lessions e.g. pitting and onycholysis (separation of nail from nail bed)
17
Q

Which joint in the hand does osteoarthritis usually occur in?
How does this usually present?

A

1st carpometacarpal joint (between Trapezium and 1st metacarpal)
Presentation:
-Pain at base of thumb
-Could have swelling
-Stiffness after periods of rest
-Subluxation in ulnar direction (later stage)

18
Q

What is a Herbeden’s node?

A

A common sign of osteoarthritis affecting the distal interphalangeal joint

19
Q

How does a Herbeden’s node develop?

A

1) Chronic swelling or pain with swelling and loss of manual dexterity
2) Cystic swelling with gelatinous hyaluronic acid
3) Inflammation and pain subsides to an osteophyte

20
Q

What is a Bouchard’s node?

A

A common sign of osteoarthritis affecting the proximal interphalangeal joint (Herbeden’s but PIPJ not DIPJ)

21
Q

What is a Dupuytren’s contracture?

A

Thickening and contracture of palmar fascia (palmar facial fibromatosis)
-Cords can form from myofibroblasts contracting

22
Q

How does a Dupuytren’s contracture present?

A
  • Cord = palpable thickening or nodule in the palm
  • Typically painless
  • Fixed flexion of fingers (usually the ring and little finger)
23
Q

What is the treatment for Dupuytren’s contracture?

A
  • Surgery

- Excise fibrotic tissue

24
Q

What are risk factors that can lead to development of Dupuytren’s contracture?

A
  • Diabetes (type 1)
  • Thyroid problems
  • HIV
  • Smoking and alcohol consumption
  • Frozen shoulder
  • Medication for epilepsy
25
Q

What is carpal tunnel syndrome?

A

Compression of the median nerve within the carpal tunnel at the wrist

26
Q

What are the risk factors to developing carpal tunnel syndrome?

A
  • Pregnancy
  • Rheumatoid arthritis
  • repetitive movements (e.g. typing)
  • Obesity
  • Hyperthyroidism
27
Q

How does carpal tunnel syndrome present?

A

Pain, numbness and tingling at palmar surface of thumb, index, middle and half of the ring finger.
-There could also be muscle wasting of thenar muscles

28
Q

What is ulnar tunnel syndrome?

A

Compression injury to the ulnar nerve as it passes into hand via Guyon’s canal at the wrist

29
Q

What are the causes of ulnar tunnel syndrome?

A
  • Idiopathic
  • Hook of hamate fracture
  • Tumour
  • Repetitive trauma (e.g. cycling)
30
Q

How does ulnar tunnel syndrome present?

A
  • Paraesthesia of ulnar 1.5 digits on palmar surface

- Weakness and wastage of interossei muscles and adductor pollicis

31
Q

What is a cubital tunnel syndrome?

A

Compressive neuropathy of the ulnar nerve in the cubital tunnel (elbow = passes behind medial epicodyle of humerus between two heads of FCU, under aponeurosis)

32
Q

How does a cubital tunnel syndrome present?

A
  • Pain (from site of compression to ulnar nerve territory)
  • Paraesthesis (ulnar nerve territory)
  • Weakness and wasting of interossei, adductor pollicis, FDP to ring and little finger, FCU)
33
Q

Describe what happens in radial nerve damage in spiral groove (of humerus)

A
  • Paralysis of brachrioradialis and all extensor muscles of wrist, thumb and finger
  • Triceps unaffected (innervation branches before spiral groove)
  • Wrist drop
  • Posterior cutaneous nerve of arm and forearm unaffected of paraesthesia (branch before spiral groove)
34
Q

What is the hand of benediction?

A

Sign of median nerve damage when trying to make a fist

35
Q

What is an ulnar claw?

A

A sign of ulnar nerve damage/injury

36
Q

What is the ulnar paradox phenomenon?

A

A more proximal injury would be EXPECTED to have a more pronouced claw but in REALITY its less pronounced - flexor digitorum profundus is paralysed thus no flexion at DIPJ of ring and little finger

MSK UPPER LIMBS (S9) (5 decks)

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