Elbow + Hand Problems

Question 1

What is carpal tunnel syndrome?

Answer 1

Compression of the median nerve in the carpal tunnel in the wrist

Question 2

What are the risk factors for carpal tunnel syndrome?

Answer 2

RA
Injury, esp Colles fracture
Pregnancy
DM
CKD
Hypothyroidism

Question 3

What are the clinical features of carpal tunnel syndrome?

Answer 3

Pain, numbness +/- paraesthesia
Thumb + radial 2 and 1/2 fingers
Worse at night
Wasting of thenar eminence if chronic

Question 4

How can the symptoms of carpal tunnel be reproduced on examination?

Answer 4

Percuss over median nerve –> Tinel’s test

Hold wrist in full flexion for 1 minute –> Phalen’s test

Question 5

How is carpal tunnel syndrome diagnosed?

Answer 5

Clinical diagnosis

Nerve conduction studies if any doubt

Question 6

What is the non-surgical management of carpal tunnel syndrome?

Answer 6

Wear a wrist splint at night
Physio
Steroid injections

Question 7

What is the surgical management of carpal tunnel syndrome?

Answer 7

If conservative management fails –> carpal tunnel release surgery

• cut through flexor retinaculum to decompress nerve
• local anaesthetic, day case
• usually successful but risk of nerve damage

Question 8

What causes cubital tunnel syndrome?

Answer 8

Compression of ulnar nerve at the elbow behind the medial epicondyle (funny bone)

Question 9

What are the clinical features of cubital tunnel syndrome?

Answer 9

Paraesthesia in ulnar 1 and 1/2 fingers

Weakness of index finger adduction + adductor pollicis

Question 10

Which joint is responsible for flexion/extension at the elbow?

Answer 10

Humero-ulnar joint

Question 11

Which joint is responsible for supination/pronation of the forearm?

Answer 11

Radio-capitellar joint

Question 12

Where is the common extensor origin of the elbow?

Answer 12

Lateral epicondyle

Question 13

Where is the common flexor origin of the elbow?

Answer 13

Medial epicondyle

Question 14

What is epicondylitis?

Answer 14

Inflammation of the enthesis (attachment of tendons) at the epicondyles

Question 15

What is another name for lateral epicondylitis?

Answer 15

Tennis elbow

Question 16

What causes lateral epicondylitis?

Answer 16

Repetitive strain injury due to regular resisted extension of the forearm

Question 17

What are the clinical features of lateral epicondylitis?

Answer 17

Pain at elbow, radiating down forearm
Worsening over weeks/months
Local tenderness over or distal to the lateral epicondyle
Pain on resisted middle finger + wrist extension

Question 18

What is the management for lateral epicondylitis?

Answer 18

Self-limiting, conservation management:
- rest
- physio
- NSAIDs
- steroid injection
- wrist/elbow brace
Surgery very rare

Question 19

What is golfer’s elbow?

Answer 19

Medial epicondylitis

Question 20

What are the clinical features of medial epicondylitis?

Answer 20

Tenderness over pronator teres + flexor carpi radialis tendons and their insertion

Question 21

What is the treatment for golfer’s elbow?

Answer 21

Same as tennis elbow

Question 22

What causes trigger finger?

Answer 22

Tendonitis of a flexor tendon –> nodular enlargement of that tendon, usually distal to A1 fascial pulley over metacarpal neck

Question 23

What are the clinical features of trigger finger?

Answer 23

Clicking sensation as nodule catches on pulley
Pain be painful
Finger may lock in flexed position

Question 24

Which fingers are most commonly affected by trigger finger?

Answer 24

Middle + ring fingers

Question 25

How is trigger finger managed?

Answer 25

- wear small finger splint at night - steroid injections - percutaneous trigger finger release (excision of A1 pulley)

Question 26

What is Dupuytren's contracture?

Answer 26

Contraction of the longitudinal palmar fascia --> severe limitation of digital movement

Question 27

Which fingers are most commonly affected by Dupuytren's contracture?

Answer 27

Ring + little fingers (ulnar digits)

Question 28

What are some risk factors for Dupuytren's contracture?

Answer 28

``` Male Familial AD Alcoholic cirrhosis Phenytoin side effect Diabetes ```

Question 29

What are the management options for Dupuytren's contracture?

Answer 29

Depends on severity: - hand therapy exercises - injectable collagenase clostridium histolyticum - surgery --> fasciectomy (recurrence very common)

Question 30

What are some features of OA in DIPs?

Answer 30

Heberden's nodes (bony thickness) | Dorsal ganglion cyst (mucous cyst)

Question 31

What are the surgical management options for DIP OA?

Answer 31

Removal of osteophytes/cysts | If severe --> arthrodesis (fusion of bones)

Question 32

What are some features of PIP OA?

Answer 32

Bouchard's nodes

Question 33

What are the management options for ganglion cysts?

Answer 33

Monitor - usually disappear spontaneously (Aspiration carries risk of infection and high risk of recurrence Cyst excision only if symptomatic, not for cosmetic reasons)

Question 34

What are the features of RA in the hands?

Answer 34

Tends to spare DIPs (in contrast to OA and psoriatic arthritis) Synovitis + tenosynovitis --> erosion of joints, joint instability + tendon rupture Deformities

Question 35

What deformities might be seen in the hand of someone with RA?

Answer 35

``` Volar MCP subluxation Ulnar deviation Swan neck deformity Boutonniere deformity Z shaped thumb ```

Question 36

What is a swan neck deformity?

Answer 36

Hyperextension at PIP, flexion at DIP

Question 37

What is a Boutonniere deformity?

Answer 37

Flexion at PIP, hyperextension at DIP