Common Hand Problems

Question 1

1. Carpal Tunnel Syndrome

Answer 1

• Entrapment Neuropathy of the median nerve.

- Median nerve runs under flexor retinuculum

Question 2

Cause of CTS:

Answer 2

• Idiopathic
• Age related thickening of transverse carpel ligament retinuculum

-Increase swelling of tendons will affect the median nerve:
Inflammatory arthritis (RA)
gout 
acromegaly 
pregnancy 
Hyperthyroidism 
Diabetes

Question 3

Common age group of CTS:

Answer 3

• common in females

- 50s to 60s

Question 4

Hx of CTS:

Answer 4

“absolutely fine during the day, sleeps at night
wake up in the early hours of morning with burning pain, numbing
Has to do something (hang the hand over the side, raise the arm and open close fingers ,put hand against the wall), pain resides in half an hour and starts again.

-while driving, holding a book, knitting

Question 5

Examination of CTS:

Answer 5

1. Any wasting or weakness of thenar muscles
   - ask pt to push thumb till the roof (abduct)
   - push against it
   - look at the thenar muscles (abductor policis bravis)
2. Sensation disturbance from thumb till half of ring finger.
3. Tinel’s test
   - Tap along the course of the median nerve
   - pt will feel electric shock sensation in the middle finger
   - elicit tinel’s sign
4. Phalen’s Maneouver
   - ask pt to join dorsum of hands facing downwards
   - continue for a minute
   - if fingers tingle or get numb there might be CTS

Question 6

Investigations for CTS:

Answer 6

1. Give 1ml of cortisone on the ulnar side of palmaris longis tendon.
   - positive response to the cortisone and comes back

Question 7

Management of CTS:

Answer 7

-No place for NSAIDs 
or analgesics
-Cortisone injection for dx and temp relief 
-Night splints may be used 
-Surgery best

Question 8

What is Dequervain’s Tendinitis?

Answer 8

-entrapment tendinopathy of the first dorsal compartment (Abductor Policis Longus and

Extensor Policis Bravis)

Question 9

Age Group:

Answer 9

• More in females
• Younger age
• Mothers with young infants (Mommy’s wrist)

Question 10

Hx of Dequervains Tendinitis:

Answer 10

-Pt shows Pain on the radial side of wrist

(Basal thumb arthritis, trigger thumb)

• Clicking/locking feeling of wrist
• Pain during some movement

Question 11

O/e for dequervains tendinitis:

Answer 11

• Not a lot to see
• mild swelling might be there

-Diagnostic test-
Finkelstein Test
Place thumb in palm, wrap fingers around it, ask them to move hand downwards, if painful then suspect dequervains tendinitis

Question 12

mangement of dequervains tendinitis:

Answer 12

• Cortisone injection into the sheats mixed with local anaesthetics
• No place for NSAIDs, splints
• Release procedure under local anaesthetic

Question 13

What is a trigger finger?

Answer 13

• Palmar side of the hand
• entrapment tendinopathy
• Tendons run under a series of pulleys
• problem in A1 pulley

Question 14

Who gets trigger finger?

Answer 14

• older age group
• male and females similar
• Diabetes
• RA and gout

Question 15

Hx of trigger finger?

Answer 15

• starts with pain
• worse in morning-
• clicking happens
• pt cannot open their fist

Question 16

o/e of trigger finger?

Answer 16

• Tender over the metacarpal heads

- can see or hear the clicking/locking

Question 17

Mx of trigger finger:

Answer 17

• Surgery best option (open up A1 pulley so tendons can glide)
• can give cortisone

Question 18

What is Gangliones?

Answer 18

• Microscopic degeneration of collagen fibres

- cystic lesion grows out from a collagen structure

Question 19

Population:

Answer 19

• Happens in 50% of population
• Not pathological
• Reassure pts

Question 20

Where are gangliones commonly seen?

Answer 20

• Dorsal wrist Hand
• Dorsal scaphoid ligament

-Volar wrist ganglion (associated with radial artery)

-DIP joint gangliones
assoc with osteoarthritis

-Flexor sheat ganglion
(painful , feels like a bone)