Disorders of the hand and wrist Flashcards
1
Q
scaphoid fracture
A
- occurs after a fall on an outstretched hand which impacts the scaphoid
- pain in anatomical snuffbox
- swellimg, reduced motion
- fracture may not show up straight away so need to do a follow up scan a few days later, if not have an MRI or CT
- blood supply is retrograde so results in avascular necrosis
2
Q
colles fracture
A
- extra- articualar fracture (doesnt extend to thr wrist joint) of the distal radial metaphysis, with dorsal angylation and impaction
- common in patients with osteoporosis and seen in post - menopausal women
- due to high impact / trauma
- fallen on to an outstretched hand - protonated arm and wrist in dorsiflexion
- painful and swollen wrist
-
treatment = immobolisiation and reduction in a cast
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3
Q
A
4
Q
complication of colles fracture
A
- malunion (looks like a fork)
- median nerve palsy (paralysis)
- secondaty osetoarthritis
- tear of extensor pollicis longus tendon over sharp fragment of bone
5
Q
smith fracture
A
- fracture of distal radius
- opposite to colles
- hand is in plantar flexion
- residual volar displacement of distal radius
6
Q
rheumatoid arthritis of metacarpophalangeal (MCPJ) joints and interphalangeal joints (IPJs)
A
- inflammed synovial cells proliferate to form pannus (dense layer of fatty tissue , penerating through cartilage and adjacent bone = deformity and erosion
- it effects multiple joints in a symmetrical distribution = hard to diagnose
- nodules in fingers and over the elbow is common
7
Q
presentation of patients with rheumatoid arthritis
A
- pain and swelling of PIPJs and MCPJs of fingers
- eryhtema (redness) overlying joints
- stuffness in the morning
- carpal tunnel syndrome (compression of the median nerve in carapl tunnel)
- fatigue and flu like symptoms
8
Q
swan neck defomity (type of deformity with RA)
A
- PIPJ hyperextends and MCPJ and DIPJ are flexed
- tissues on palmar (volar) aspect of PIPJ become lax do to adjactent synovitis
9
Q
boutonniere defomity (type of RA defomity)
A
- MCPJ and DIPJ are hyperextended and PIPJ is flexed
- inflammation of PIP = lengthening of central slip of of extensor digitorum
10
Q
psoriatic arthropathy
A
- psoriasis causes red flaky patches on the skin covered with silvery scales
- only a minority develop arthritis and develops in a symmetrical manner
- affected joints stiffen
- commonly affects DIPJs
- joint in hand commonly effected is 1st carpometacarpal joint
- pain at base of thumb
- pain exacerbated by movement and relieved by stress
- swelling around thumb
11
Q
osteoarthritis of fingers
A
- occur in 5th/6th decade of life
- gradual onset of pain in distal interphalangeal joints
- patients experience stiffness, reduced movement and swelling of affected joints
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12
Q
haberdens nodes
A
- affect DIPJ of the fingers
- develop in middle age
- more common in women than men
- begin with chronic swelling of affected joints or sudden onset of pain, swelling and loss of manual dexterity
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13
Q
carpal tunnel syndrome
A
- compression of the median nerve
- risk factors : pregnancy, obesity, rheumatoid arthritis
- can cause ; ischemia, focal de mylenation, axonal loss
- parasthesia in thumb - half of ring finger
- sensation still intact in the palm as palmar cutaneous branch passes superficial to the palm
- long standing muscle weakness
- thumb still can srill flex and adduct as its innervted by the ulnar nerve
- reduced manual dexterity
- can get thenar wasting
14
Q
ulnar nerve compression in guyons canal
A
- can be compressed as it passes lateral to the pisiform bone
- can occur in cyclists
- parasthesia in ring and little fingerswhich can progress to intrinsic muscles of hand supplied by ulanr nerve
15
Q
dupuytrens contracture
A
- localised thickening in the contracture of the palmar aponeruosis = flexuon defomity
- thickening in nodule of palm
- cords form in palmar fascia
- fingers stuck in a flexed position and cant be flattened
- occurs between 40-60yrs
4 risk factors:
- type 1 diabetes
- smoking
- HIV
- hypo/hyperthroidism
- trauma to hand / fingers
