Compressive Neuropathies, Elbow and Hand Flashcards
What forms the carpal tunnel of the wrist?
carpal bones
flexor retinaculum
Any swelling within the confines of the carpal tunnel may cause what?
medial nerve compression
What can carpal tunnel syndrome occur secondary to?
RA (synovitis leads to less space)
Many conditions which involve fluid retention eg pregnancy, diabetes, CKD, hypothyroid
Which fracture may cause carpal tunnel syndrome?
colles fracture
Is carpal tunnel more common in men or women?
women (8 times more)
How will patients present with carpal tunnel syndrome?
numbness in median nerve innervated digits (thumb and radial 2.5 fingers, worse at night
weakness of thumb
clumsiness
What may be seen on examination in carpal tunnel syndrome?
muscle wasting of thenar eminence
Which tests can be done in Carpal Tunnel?
Tinel’s test (decreases space in carpal tunnel)
Phalen’s test (holds wrists hyper flexed)
What confirm diagnosis of carpal tunnel?
nerve conduction studies - see slowing of conduction across wrist
Treatment of carpal tunnel syndrome?
wrist splints to prevent flexion
surgical carpal tunnel decompression (very commonly performed)
Which nerve is compressed in cubital tunnel syndrome and where?
ulnar nerve
at albow behind medial epicondyle (funny bone area)
Which muscles may be weak in cubital tunnel syndrome?
1st dorsal interosseus and adductor pollicis
What test can assess muscle weakness in cubital tunnel syndrome?
Froment’s test
What may be the cause of compression in cubital tunnel syndrome?
tight band of fascia forming the root of the tunnel (Osborne’s fascia)
What confirm diagnosis of cubital tunnel syndrome?
nerve conduction studies
What may give rise to either type of epicondylitis?
common extensor and flexor origins’ attachment (enthesis) can become painful (enthesopathy)
Which is the elbow commonly affected by, OA or RA?
RA
Is tennis elbow lateral or medial?
lateral
Is golf elbow lateral or medial?
medial
Injection for golfer’s elbow poses a risk of injury to which nerve?
ulnar
What is Dupytrens contracture?
connective tissue disorder
specialized palmar fascia undergoes hyperplasia
Nodules/cords formed
Leads to contractures at MCP and PIP joints
What is the pathology of Dupytrens?
proliferation of myofibroblast cells and production of abnormal collagen (type 3 instead of type 1)
Contractures most commonly affect which fingers?
ring and pinky
Who are more likely to have Dupytrens, men or women?
men (10:1)
What can dupytrens be a features of?
alcoholic cirrhosis
side effect of phenytoin therapy
Peyronie’s disease
Ledderhose disease
Is dupytrens less common in diabetics?
no, more common
What is an indication for surgery in Dupytrens?
contracture at PIP joint
What surgery is done in Dupytrens?
fasciectomy or fasciotomy
What is trigger finger?
tendonitis of flexor tendon resulting in nodular enlargement of affected tendon
Movement o finger in trigger finger produces what?
clicking sensation
Which fingers are most commonly affected in trigger finger?
middle and ring
In whom is DIP OA very common?
post menopausal women
What are seen on examination of DIPs with OA?
Heberden’s nodes
What are seen on examination of PIPs with OA?
Bouchard’s nodes
Which joint is extremely commonly affected by OA in women over 40?
trapziometacarpal joint at base of thumb
OA of the radio carpal join is normally due to what?
trauma
Name the 3 stages of disease of the hand by RA.
- synovitis and tenosynovitis
- erosion of joint
- joint instability and tendon rupture
List the 5 hand deformities caused by RA.
Volar MCP joint xubluxation
Ulnar deviation
Swan neck deformity (hyperextension at PIP with flexion of DIP)
Boutonnier deformity (flexion at PIP with hyperextension at DIP)
Z thumb
What are ganglion cysts?
common mucinous filled cysts adjacent to tendon or synovial joint
What is a ganglion cyst in the knee?
Baker’s cyst
What do ganglion cysts feel like?
firm, smooth, rubbery, should transilluminate
