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Disorders Of Hand And Wrist Flashcards

1
Q

Why is the ulnar nerve not effected by carpal tunnel syndrome?

A

Passes through Guyon’s canal which is superficial to flexor retinaculum (superficial border to carpal tunnel)

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2
Q

Why is sensation to palm unaffected in carpal tunnel syndrome?

A

Palmar cutaneous branch of medial nerve which supplies section to radial 2/3rds of palm is given off proximal to carpal tunnel

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3
Q

Mechanism of injury of distal radius fractures

A

Fall onto outstretched hand

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4
Q

Who are distal radius fractures common in?

A

Young people with high energy trauma
Older people with low energy trauma

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5
Q

Risk factors for distal radius fractures

A

Osteoporosis

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6
Q

What does a distal radius fracture prompt investigation of?

A

Osteoporosis
Especially in older people with low energy trauma

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7
Q

What is a Colles’ fracture?

A

Extra articular distal radius fracture with dorsal angulation

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8
Q

Types of distal radius fractures

A

Colles’ fracture
Smith’s fracture

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9
Q

Mechanism of injury of Colles’ fracture

A

Fall onto outstretched hand
Wrist in flexed position

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10
Q

Management of Colles’ fracture

A

Reduction + immobilisation in case
Check pulses, sensations + movement

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11
Q

Complications of Colles’ fracture

A

Malunion - dinner fork deformity
Median nerve palsy + post traumatic CTS
Secondary osteoarthritis
Tear of extensor pollicis longus tendon

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12
Q

Typical shape of Colles’ fracture

A

Dinner fork deformity

Dinner - Dorsal

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13
Q

What is a Smith’s fracture?

A

Distal radius fracture with palmar angulation of distal fragment

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14
Q

Mechanism of injury of Smiths fracture

A

Fall onto dorsum of hand
Direct blow to back of wrist

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15
Q

Typical shape of Smith’s fracture

A

Garden space deformity

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16
Q

Complications of Smith’s fracture

A

Malunion narrows + distorts carpal tunnel > carpal tunnel syndrome

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17
Q

Mechanism of scaphoid fracture

A

Fall onto outstretched hand

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18
Q

What is the most common carpal bone fracture?

A

Scaphoid fracture

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19
Q

Presentation of scaphoid fracture
What makes it worse?

A

Pain in anatomical snuffbox
Worsens on moving wrist

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20
Q

What is the risk of a vascular necrosis of scaphoid fracture?

A

Dorsal carpal branch of radial artery supplies scaphoid

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21
Q

Management of fractures

A

Check pulses, sensation + movement
Analgesia
‘Reduce, hold + rehabilitate’
Closed reduction with immobilisation or percutaneous pinning
Open reduction internal fixation
External fixation

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22
Q

Types of closed reduction

A

Immobilisation
Percutaneous pinning

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23
Q

What joints does rheumatoid arthritis commonly affect in hands?

A

MCPJ
PIP

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24
Q

How does rheumatoid arthritis occur?

A

Autoimmune condition
1- autoantibodies attack synovial membrane
2- inflamed synovial cells proliferate > pannus
3- pannus penetrate through cartilage + adjacent bone
4- joint erosion + deformity

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25
Q

How does rheumatoid arthritis effect joins?

A

Symmetrical polyarthopathy - >1joint

26
Q

Symptoms of rheumatoid arthritis in hands

A

Morning stiffness > 1 hour
Pain
Joint swelling + erythema of PIP + MCPJ
Extra-articular features
CTS - due to synovial swelling compression

27
Q

What deformities are associated with rheumatoid arthritis?

A

Swan neck deformity
Boutonniere’s deformity

28
Q

X ray changes of rheumatoid arthritis

A

LESS
Loss of joint space
Erosion of bone
Soft tissue swelling
See through bones - osteopenia
(Subluxation)

29
Q

Describe swan neck deformity

A

Hyperextension of PIP
Flexion of DIP + MCPJ

30
Q

Describe boutonniere’s deformity

A

Hyperextension of DIP + MCPJ
Flexion of PIP

31
Q

What joint of hand is osteoarthritis most common in?

A

1st carpometacarpal joint

32
Q

Symptoms of osteoarthritis in hand

A

Pain at base of thumb
Swelling around base at thumb
Morning stiffness < 1 hour

33
Q

X ray changes in osteoarthritis

A

LOSS
Lss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis

34
Q

What is squaring of wrist due to?
What does it suggest?

A

Subluxation of 1st CMJ
Osteoarthritis of 1st CMJ

35
Q

What joints do Herberden’s nodes effect?

36
Q

What joints do Bouchard’s nodes effect?

37
Q

What are heberden’s + bouchard’s nodes due to?

A

Osteophytes

38
Q

What is psoriasis?

A

Skin condition that causes red, flaky patches of skin covered in silvery scales

39
Q

Where does psoriasis generally occur?

A

Elbows
Knees
Scalp
Lower bacl

40
Q

What joint does psoriatic arthritis most commonly affect?

A

DIPJ
Signs involve the nail so joint closest to nail

41
Q

signs of psoriatic arthritis

A

Dactylitis
Nail pitting
Onchylosis

42
Q

What is dactylitis?

A

Swelling of digit

43
Q

What is onchylosis?

A

Nail pulling away form nail bed

44
Q

What is Dupuytre’s contracture?

A
  • Thickening of palmar aponeurosis
  • Begins as a nodule/thickening in palm
  • Skin becomes tethered due to myofibroblasts
  • Fixed flexor deformity
45
Q

Most common fingers effected by Dupuytren’s contracture

A

Ring + little

46
Q

Risk factors of Dupuytren’s contracture

A

Type 1 diabetes
Smoking
Trauma to hand or fingers
Heart disease

47
Q

What nerve in compressed in Guyon’s canal syndrome?

A

Ulnar nerve compression

48
Q

Presentation of Guyon’s canal syndrome

A

Paraesthesia in ring and little finger due to ulnar nerve compression

49
Q

Guyon’s canal syndrome causes weakness in what muscles?

A

Intrinsic muscles of hand supplied by ulnar nerve

ADductor pollicis
Palmar + dorsal interosseous
Lumbricals to little + ring finger
Deep head of flexor pollicis brevis

50
Q

Causes of carpal tunnel syndrome

A

MEDIAN TRAP
Myxoedema
Edema prementrualy
Diabetes
Idiopathic
Acromegaly
Neoplasm
Trauma
Rheumatoid arthritis
Amyloidosis
Pregnancy

51
Q

What are symptoms of carpal tunnel caused by?

A

Compression of median nerve

52
Q

Symptoms of carpal tunnel syndrome

A

Loss of sensation in radial 3 1/2 digits
Sensation of palm intact
Weakness + atrophy to thenar muscles

53
Q

Why is there weakness + atrophy of thenar muscles in carpal tunnel syndrome?

A

Motor branch of median nerve branches distal to carpal tunnel

54
Q

What muscles experience weakness in carpal tunnel syndrome?

A

thenar muscles
ADductor pollicis brevis
Flexor pollicis brevis
Oppenens pollicis

55
Q

First line treatment of carpal tunnel syndrome

A

NSAIDs
Analgesia

56
Q

Second line treatment of carpal tunnel syndrome

A

Corticosteroid injections

57
Q

Final treatment of carpal tunnel syndrome

A

Carpal tunnel release

58
Q

Treatment of carpal tunnel syndrome

A

1st - NSAIDs + analgesia
2nd - corticosteroid injections
Last - carpal tunnel release

59
Q

Test for carpal tunnel syndrome

A

Tunnel’s test + Phalen’s test
If + will produce CTS symptoms

60
Q

What is Tinnel’s test?

A

Tapping over flexor reticulum

61
Q

What is Phalen’s test?

A

Hyperflexion of wrist

62
Q

Areas of growing bones in children

A
  • epiphysis: rounded edge
  • physis: growth plate - area of cartilage where growth occurs
  • metaphysis: area between the physis and shaft
  • diaphysis: shaft

MSK (25 decks)

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