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MSK > Conditions of the Wrist and Hand > Flashcards

Conditions of the Wrist and Hand Flashcards

1
Q

What is dupuytren’s contracture?

A

Characterized by painless thickening and shortening of the longitudinal fibres of the palmar and digital fascia. As the fascia shortens it can draw the fingers down toward the palm.

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2
Q

What is the development of dupuytren’s contracture associated with?

A
  • Genetic - Viking gene
  • Alcohol excess
  • Diabetes Mellitus
  • Smoking
  • Peyronie’s Disease
  • Phenytoin Treatment
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3
Q

How does Dupuytren’s contracture present?

A
  • Puckering of the skin
  • Gradual flexion - usually of the ring and little fingers
  • Functional Problems - Inability to grasp things properly, Loss of finger extension, Can’t put hand in pocket
  • Skin pits - fibres attach to skin and pull down pockets
  • Boutonnieres deformity
  • PIP contracture
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4
Q

How would you treat someone with Dupuytren’s contracture?

A

Observation

Non-operative

  • Radiotherapy
  • Collagenase - Ruptures tendon

Operative

  • Partial fasciectomy - Good correction
  • Dermofasciectomy - Lowest chance of recurrence
  • Arthrodesis
  • Amputation

Other

  • Percutaneous needle fasciotomy
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5
Q

What is trigger finger?

A
  • Stenosing Tenosynovitis
  • Swelling/tightening of the tendon sheath, along with nodule formation on the tendon proximal to A1 pulley, prevents tendon from gliding smoothly, causing it to catch ⇒ fixed in flexion
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6
Q

How does trigger finger present?

A
  • Finger gets fixed in flexion
  • Released by straightening the finger
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7
Q

How do you treat someone with tigger finger?

A

Non-operative

  • Steroid injection
  • Percutaenous release
  • Splintage

Operative

  • Open surgery
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8
Q

What is De Quervans tenosynovitis?

A
  • Stenosing Tenosynovitis of the 1st extensor compartment - APL and EPB as they cross the radial styloid
  • Due to myxoid degeneration of the wall of the tunnel in the extensor retinaculum enclosing APL and EPB ⇒ Becomes grossly thickened
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9
Q

Who does De Quervan’s more commonly present in?

A

Women - Post partum

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10
Q

How does De Quervan’s commonly present?

A
  • Local tenderness - more proximal than OA of 1st CMC joint
  • Finkelsteins test – gripping the thumb in the palm of the hand, then ulnar deviate ⇒positive if painful
  • Resisted thumb extension ⇒ Painful
  • Pain at styloid worsened by thumb flexion
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11
Q

How do you treat someone with De Quervan’s disease?

A

Non-operative

  • Splints
  • Steroids

Operative

  • Decompression - protect sensory branch of the radial nerve
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12
Q

What is carpal tunnel syndrome?

A
  • Compression of the median nerve as it passes under the flexor retinaculum of the wrist.
  • Can be caused by a variety of things, including thickened ligaments or tendon sheaths, and bone enlargement
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13
Q

Who does carpal tunnel more commonly occur in?

A
  • > 80% older than 40 years
  • Female>male - 2:1; women have narrower wrists
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14
Q

What is the aetiology of Carpal Tunnel syndrome?

A

MEDIAN TRAP

  • Myxoedema (hyopthyroidism)
  • ETOH (alcohol)
  • Diabetes mellitus - neuropathy
  • Idiopathic
  • Amyloidosis
  • Neoplasia - Multiple myeloma, benign tumours
  • Trauma - Colle’s fracture, enforced flexion
  • Rheumatoid arthritis
  • Acromegaly
  • Pregnancy (3rd trimester), PMR
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15
Q

How does someone with carpal tunnel syndrome present?

A
  • Numbness and Paraesthesia - thumb, index and middle finger - relieved by dangling hand off the edge of the bed
  • Pain -same distribution as numbness; achingin nature, worse at night and after repetitive actions
  • Positive Phalen’s test - maximal wrist flexion reproduces symptoms within 60 secs
  • Positive Tinel’s sign - tapping flexor aspect of wrist - positive = tingling and pain
  • Sensory loss - lateral 31/2 digits
  • Thenar Atrophy
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16
Q

How is carpal tunnel syndrome diangosed?

A

Clinical Diagnosis

  • Phalens and Tinels both unreliable, but can help
  • Night pain - almost diagnositc

Neurophysiology - helps locate site and severity of lesion

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17
Q

How would you treat someone with carpal tunnell syndrome?

A

3 S’s - Splint, steroids (local), surgery

Surgery

  • Carpal tunnel release
  • Open decompression
  • Endoscopic
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18
Q

What is cubital tunnel syndrome?

A
  • Compression of the ulnar nerve at the median edge of the elbow, in the ulnar groove
  • Stretch and compression of ulnar nerve is moderated by its ability to glide in the groove
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19
Q

What is the general pathophysiology of cubital tunnel syndrome?

A

Can be caused by

  • OA or RA narrowing of ulnar groove ⇒ constriction of ulnar nerve as it passes behind the medial epicondyle
  • Friction on ulnar nerve due to cubitus valgus (complication in children after supracondylar fractures) ⇒ Nerve fibrosis ⇒ neuropathy
  • Direct trauma
20
Q

What is the aetiology of Cubital tunnel syndrome?

A
  • Sleeping with the arm folded behind neck, elbows bent.
  • Pressing the elbows upon the arms of a chair while typing.
  • Resting or bracing the elbow on the arm rest of a vehicle.
  • Bench pressing.
  • Intense exercising and strain involving the elbow.
21
Q

How does cubital tunnel syndrome present?

A
  • Sensory loss - over medial 11/2 fingers
  • Clumsiness
  • Weakness/wasting - Medial wrist flexors (little fingers), Interossei, Medial two lumbricals
  • Hyothenar wasting
  • CLAW HAND - severity depends on where lesion is
    • Ulnar paradox - more distal the lesion, more severe the claw
22
Q

How do you manage someone with cubital tunnel syndrome?

A

General

  • Rest
  • Avoid pressure on the nerve
  • Soft elbow splinting - if continuous (> 6 months)
  • Hand Splint - may prevent clawing

Operative

  • Decompression
  • Nerve re-routing?
23
Q

What is a ganglion?

A
  • Mucin-filled cyst, often painless swelling caused by a partial tear of the joint capsule or tendon sheath.
  • Attached to synovial cavity, but have no synovial lining
24
Q

How do you treat someone with a ganglion?

A
  • Leave - most resolve on their own within 6 months
  • AVOID EXCISION
25
Q

Where in the hand does OA most commonly present?

A

1st carpometacarpal joint - thumb

26
Q

Who is most commonly affected by OA of the base of the thumb?

A

Women

27
Q

How does OA of the base of the thumb commonly present?

A
  • Night pain
  • Pain associated with use - gripping/twisting e.g. opening jars
  • Pain with passive motion
  • Crepitus
28
Q

How does OA of the base of the thumb present on X-ray?

A
  • Loss of Joint Space
  • Osteophyte Formation
  • Subchondral Sclerosis
  • Subchondral Cysts
29
Q

How would you manage someone with OA of the base of the thumb?

A
  • Simple analgesia
  • Surgery - if discomfort disabling
30
Q

What is the name given to the bony prominence that occurs in OA of the PIP?

A

Bouchard’s Nodes

31
Q

What is the name given to the bony prominences that occur in OA of the DIP joint?

A

Heberden’s Nodes

32
Q

What are the features of a Colles type fracture?

A
  • Dorsal angulation and displacement
  • Radial shortening and deviation
  • Supination
33
Q

How would you reduce a colles type fracture?

A
  • Adequate analgesia
  • Exaggerate dorsal angulation while maintaining distal traction
  • Correct dorsal and radial angulation while maintaining distal traction
  • Apply backslab while maintaining traction - maintain in ulnar deviation with some wrist flexion
  • X-ray
34
Q

What must be obtained if closed reduction of a distal radius fracture is performed?

A

Post-reduction X-ray

35
Q

What is a smith’s fracture?

A

Reversed Colles

  • Volar displacement and angulation
36
Q

How would you manage a smiths fracture?

A

ORIF - fragments tend to migrate palmarly otherwise

37
Q

What is a barton’s fracture?

A

Intra-articular fracture involving the dorsal aspect of the distal radius

38
Q

What are signs of a scaphoid fracture?

A
  • Tender in anatomical snuff box and over scaphoid tubercle
  • Pain on axial compression of the thumb
  • Pain on ulnar deviation of pronated wrist
  • Pain on supination against resistance
39
Q

What would you do if you suspected a scaphoid fracture?

A

Request scaphoid X-ray

40
Q

How would you manage a scaphoid fracture?

A
  • Nonoperative - thumb spica cast immobilization - stable nondisplaced fracture (majority of fractures)
  • Operative - ORIF vs percutaneous screw fixation indications
41
Q

What analgesia would you consider using in a Colles fracture reduction?

A
  • Haematoma block
  • Bier’s Block
42
Q

How would you follow up a schaphoid fracture managed with a cast?

A

X-ray - Neutral forearm cast if non-displaced

43
Q

What is the main complication that can occur with scaphoid fractures?

A

Avascular necrosis of proximal pole - relies on interosseous supply from the distal part

44
Q

What can failure to flex the DIP joint against resistance indicate?

A

FDP division

45
Q

What can failure to flex PIP against resistance, but DIP flexion is still intact, indicate?

A

FDS division

46
Q

How are flexor tendon injuries best managed?

A

Primary repair - most are open injuries

MSK (27 decks)

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