Common conditions of the wrist and hand Flashcards
What is a scaphoid fracture?
A break of the scaphoid bone in the wrist
What is the usual cause of a scaphoid fracture and how does it present?
FOOSH; usually men
- Pain at base of thumb
- Tender with out without swelling of anatomical snuff box
What are the complications of a scaphoid fracture?
- Non-union
- Avascular necrosis
- Delayed healing from poor blood supply
- Carpal instability
- Secondary osteoarthritis
What is a Colle’s fracture?
An extra-articular fracture of the distal radius (metaphysis) with dorsal angulation of distal radius
What is the usual cause for a Colle’s fracture and how does it present?
FOOSH; usually elderly women or young adults (car, bike, horse-riding)
- Pain
- Bruising
- Swelling
- Dinner fork deformity
What is a Smith’s fracture?
An extra-articular fracture of the distal radius with palmar (volar) angulation of distal fragment
What is the usual cause for a Smith’s fracture and how does it present?
Direct blow to back of wrist (fall onto flexed wrist); rare, most common in young males
- Pain
- Bruising
- Swelling
- Garden spade deformity
Which joints can rheumatoid arthritis affect?
- Metacarpophalangeal joint
- Proximal interphalangeal joints
- Wrist joint
How may rheumatoid arthritis present?
- Pain
- Swelling
- Stiffness
- Volar subluxation (MCPJ)
- Accompanying tenosynovitis (PIPJ)
- Carpal tunnel syndrome
- Erythema
What is a swan neck deformity and what are the causes?
Deformity of the finger where the DIPJ is in flexion and the PIPJ is in hyperextension
- Rheumatoid arthritis
- Ehlers-Danlos
- Injury
What is a boutonniere deformity and what are the causes?
Deformity of the finger with flexed PIPJ and hyperextended MCPJ and DIPJ
- Rheumatoid arthritis
- Post-traumatic injury
What are radiological features of rheumatoid arthritis?
- Soft-tissue swelling
- Joint space narrowing
- Periarticular osteopenia (disease process and treatment e.g. steroids)
- Juxta-articular erosions
- Subluxation and gross deformity
What are the potential complications of a Colle’s fracture?
- Malunion
- Median nerve palsy
- Secondary osteoarthritis
- Post-traumatic carpal tunnel syndrome
- Tear of extensor pollicis longus tendon
How is a Colle’s fracture treated?
Reduction and immobilisation in a cast
What is a psoriatic arthropathy?
A chronic autoimmune disease characterised by psoriasis and inflammatory arthritis
How many psoriatic arthropathy present?
- 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)
Which joint in the hand does osteoarthritis usually occur in?
How does this usually present?
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)
What is a Herbeden’s node?
A common sign of osteoarthritis affecting the distal interphalangeal joint
How does a Herbeden’s node develop?
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
What is a Bouchard’s node?
A common sign of osteoarthritis affecting the proximal interphalangeal joint (Herbeden’s but PIPJ not DIPJ)
What is a Dupuytren’s contracture?
Thickening and contracture of palmar fascia (palmar facial fibromatosis)
-Cords can form from myofibroblasts contracting
How does a Dupuytren’s contracture present?
- Cord = palpable thickening or nodule in the palm
- Typically painless
- Fixed flexion of fingers (usually the ring and little finger)
What is the treatment for Dupuytren’s contracture?
- Surgery
- Excise fibrotic tissue
What are risk factors that can lead to development of Dupuytren’s contracture?
- Diabetes (type 1)
- Thyroid problems
- HIV
- Smoking and alcohol consumption
- Frozen shoulder
- Medication for epilepsy
What is carpal tunnel syndrome?
Compression of the median nerve within the carpal tunnel at the wrist
What are the risk factors to developing carpal tunnel syndrome?
- Pregnancy
- Rheumatoid arthritis
- repetitive movements (e.g. typing)
- Obesity
- Hyperthyroidism
How does carpal tunnel syndrome present?
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
What is ulnar tunnel syndrome?
Compression injury to the ulnar nerve as it passes into hand via Guyon’s canal at the wrist
What are the causes of ulnar tunnel syndrome?
- Idiopathic
- Hook of hamate fracture
- Tumour
- Repetitive trauma (e.g. cycling)
How does ulnar tunnel syndrome present?
- Paraesthesia of ulnar 1.5 digits on palmar surface
- Weakness and wastage of interossei muscles and adductor pollicis
What is a cubital tunnel syndrome?
Compressive neuropathy of the ulnar nerve in the cubital tunnel (elbow = passes behind medial epicodyle of humerus between two heads of FCU, under aponeurosis)
How does a cubital tunnel syndrome present?
- 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)
Describe what happens in radial nerve damage in spiral groove (of humerus)
- 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)
What is the hand of benediction?
Sign of median nerve damage when trying to make a fist
What is an ulnar claw?
A sign of ulnar nerve damage/injury
What is the ulnar paradox phenomenon?
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
