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
