Disorders Of Wrist And Hand Flashcards
What is cause of scaphoid fracture
FOOSH resulting in hyperextension and scaphoid impacts against rim of radius
Symptoms of scaphoid fracture
Pain in snuffbox
Exacerbated by wrist movements
Swelling around radial aspects of wrist
Problem with scaphoid X-ray
Doesn’t immediately show on X-ray. Need follow up after 10-14 days. Patient should be treated as if they have a fracture (I BROKE THIS BONE)
After 14 days if still not gone and patient symptomatic use CT or MRI
Why is it dangerous to break your scaphoid
Blood supply is retrograde and can result in avascular necrosis - will have high risk of non-union/malunion and secondary arthritis (more common in non-union/malunion)
What is colles’ fracture
Extra-articular (not in joint) fracture of distal radius. (Often have associated ulnar styloid fracture)
In which people is colles fracture common
In patients with osteoporosis and in post-menopausal women. Only happens in children in high impact trauma e.g skiing
How does a colles fracture occur
FOOSH with pronated forearm and wrist in dorsiflexion. Fracture is dorsally ambulated and impacted (looks like fork deformity)
Treatment of colles fracture
Reduction (put it back into place) and immobilisation in the cast
Complications of colles fracture
Malunion , resulting in dinner forks deformity
Medan nerve palsy and post-traumatic carpal tunnel syndrome
Secondary osteoarthritis
Tear of extensor pollicis longs tendon (Sharp bone cuts it)
What is a smith fracture
Fracture of the distal radius with palmar angulation (reverse colles fracture)
Much less common. Happens in young males and old ladies
Difference between colles and smith fracture
CandD are next to each each other in the alphabet = colles and distal
S and P are near each other in the alphabet = smith and Palmar.
In colles distal fragment (always talking about distal in fractures) dislodges dorsally (towards dorsal)
In smiths distal fragment dislodges palmarly (towards plamar)
What does malunion of smith fracture result in
Looks like garden spade. This narrows the carpel tunnel and can result in carpel tunnel syndrome
Which joints does rheumatoid arthritis particularly affect
MCPJ - metacarpophalangeal joints and PIPJ - proximal interphalangeal joints of hands and feet, and the cervical spine
What is symmetric polyarthritis
Rheumatoid arthritis is usually described as this. It means it affects multiple joints and in symmetrical distribution e.g right and left wrists. This makes mild swelling hard to diagnose
Presentation of patient with rheumatoid arthritis
Pain and swelling of PIPJ and MCPJ
Erythema over joints
Stiffness (mostly in mornings or after long periods of inactivity)
Carpal tunnel syndrome (due to compression from synovial swelling)
Fatigue and flu-like symptoms
