Disorders Of Hand And Wrist Flashcards by Emily Stephens

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

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

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Why is sensation to palm unaffected in carpal tunnel syndrome?

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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Mechanism of injury of distal radius fractures

Fall onto outstretched hand

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Who are distal radius fractures common in?

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

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Risk factors for distal radius fractures

Osteoporosis

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What does a distal radius fracture prompt investigation of?

Osteoporosis
Especially in older people with low energy trauma

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What is a Colles’ fracture?

Extra articular distal radius fracture with dorsal angulation

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Types of distal radius fractures

Colles’ fracture
Smith’s fracture

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Mechanism of injury of Colles’ fracture

Fall onto outstretched hand
Wrist in flexed position

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Management of Colles’ fracture

Reduction + immobilisation in case
Check pulses, sensations + movement

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Complications of Colles’ fracture

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

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Typical shape of Colles’ fracture

Dinner fork deformity

Dinner - Dorsal

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What is a Smith’s fracture?

Distal radius fracture with palmar angulation of distal fragment

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Mechanism of injury of Smiths fracture

Fall onto dorsum of hand
Direct blow to back of wrist

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Typical shape of Smith’s fracture

Garden space deformity

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Complications of Smith’s fracture

Malunion narrows + distorts carpal tunnel > carpal tunnel syndrome

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Mechanism of scaphoid fracture

Fall onto outstretched hand

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What is the most common carpal bone fracture?

Scaphoid fracture

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Presentation of scaphoid fracture
What makes it worse?

Pain in anatomical snuffbox
Worsens on moving wrist

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

Dorsal carpal branch of radial artery supplies scaphoid

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Management of fractures

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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Types of closed reduction

Immobilisation
Percutaneous pinning

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What joints does rheumatoid arthritis commonly affect in hands?

MCPJ
PIP

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How does rheumatoid arthritis occur?

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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How does rheumatoid arthritis effect joins?

Symmetrical polyarthopathy - >1joint

Symptoms of rheumatoid arthritis in hands

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

What deformities are associated with rheumatoid arthritis?

Swan neck deformity Boutonniere’s deformity

X ray changes of rheumatoid arthritis

**LESS** **L**oss of joint space **E**rosion of bone **S**oft tissue swelling **S**ee through bones - osteopenia (Subluxation)

Describe swan neck deformity

Hyperextension of PIP Flexion of DIP + MCPJ

Describe boutonniere’s deformity

Hyperextension of DIP + MCPJ Flexion of PIP

What joint of hand is osteoarthritis most common in?

1st carpometacarpal joint

Symptoms of osteoarthritis in hand

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

X ray changes in osteoarthritis

**LOSS** **L**ss of joint space **O**steophytes **S**ubchondral cysts **S**ubchondral sclerosis

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

Subluxation of 1st CMJ Osteoarthritis of 1st CMJ

What joints do Herberden’s nodes effect?

DIPJ

What joints do Bouchard’s nodes effect?

PIPJ

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

Osteophytes

What is psoriasis?

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

Where does psoriasis generally occur?

Elbows Knees Scalp Lower bacl

What joint does psoriatic arthritis most commonly affect?

**DIPJ** Signs involve the nail so joint closest to nail

signs of psoriatic arthritis

Dactylitis Nail pitting Onchylosis

What is dactylitis?

Swelling of digit

What is onchylosis?

Nail pulling away form nail bed

What is Dupuytre’s contracture?

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

Most common fingers effected by Dupuytren’s contracture

Ring + little

Risk factors of Dupuytren’s contracture

Type 1 diabetes Smoking Trauma to hand or fingers Heart disease

What nerve in compressed in Guyon’s canal syndrome?

Ulnar nerve compression

Presentation of Guyon’s canal syndrome

Paraesthesia in ring and little finger due to ulnar nerve compression

Guyon’s canal syndrome causes weakness in what muscles?

**Intrinsic muscles of hand supplied by ulnar nerve** ADductor pollicis Palmar + dorsal interosseous Lumbricals to little + ring finger Deep head of flexor pollicis brevis

Causes of carpal tunnel syndrome

**MEDIAN TRAP** **M**yxoedema **E**dema prementrualy **D**iabetes **I**diopathic **A**cromegaly **N**eoplasm **T**rauma **R**heumatoid arthritis **A**myloidosis **P**regnancy

What are symptoms of carpal tunnel caused by?

Compression of median nerve

Symptoms of carpal tunnel syndrome

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

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

Motor branch of median nerve branches distal to carpal tunnel

What muscles experience weakness in carpal tunnel syndrome?

**thenar muscles** ADductor pollicis brevis Flexor pollicis brevis Oppenens pollicis

First line treatment of carpal tunnel syndrome

NSAIDs Analgesia

Second line treatment of carpal tunnel syndrome

Corticosteroid injections

Final treatment of carpal tunnel syndrome

Carpal tunnel release

Treatment of carpal tunnel syndrome

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

Test for carpal tunnel syndrome

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

What is Tinnel’s test?

Tapping over flexor reticulum

What is Phalen’s test?

Hyperflexion of wrist

Areas of growing bones in children

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