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Orthopaedics > Elbow + Hand Problems > Flashcards

Elbow + Hand Problems Flashcards

1
Q

What is carpal tunnel syndrome?

A

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

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2
Q

What are the risk factors for carpal tunnel syndrome?

A 
RA
Injury, esp Colles fracture
Pregnancy
DM
CKD
Hypothyroidism
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3
Q

What are the clinical features of carpal tunnel syndrome?

A

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

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4
Q

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

A

Percuss over median nerve –> Tinel’s test

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

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5
Q

How is carpal tunnel syndrome diagnosed?

A

Clinical diagnosis

Nerve conduction studies if any doubt

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6
Q

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

A

Wear a wrist splint at night
Physio
Steroid injections

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7
Q

What is the surgical management of carpal tunnel syndrome?

A

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
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8
Q

What causes cubital tunnel syndrome?

A

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

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9
Q

What are the clinical features of cubital tunnel syndrome?

A

Paraesthesia in ulnar 1 and 1/2 fingers

Weakness of index finger adduction + adductor pollicis

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10
Q

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

A

Humero-ulnar joint

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11
Q

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

A

Radio-capitellar joint

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12
Q

Where is the common extensor origin of the elbow?

A

Lateral epicondyle

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13
Q

Where is the common flexor origin of the elbow?

A

Medial epicondyle

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14
Q

What is epicondylitis?

A

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

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15
Q

What is another name for lateral epicondylitis?

A

Tennis elbow

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16
Q

What causes lateral epicondylitis?

A

Repetitive strain injury due to regular resisted extension of the forearm

17
Q

What are the clinical features of lateral epicondylitis?

A

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

18
Q

What is the management for lateral epicondylitis?

A 
Self-limiting, conservation management:
- rest
- physio
- NSAIDs
- steroid injection
- wrist/elbow brace
Surgery very rare
19
Q

What is golfer’s elbow?

A

Medial epicondylitis

20
Q

What are the clinical features of medial epicondylitis?

A

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

21
Q

What is the treatment for golfer’s elbow?

A

Same as tennis elbow

22
Q

What causes trigger finger?

A

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

23
Q

What are the clinical features of trigger finger?

A

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

24
Q

Which fingers are most commonly affected by trigger finger?

A

Middle + ring fingers

25
Q

How is trigger finger managed?

A
  • wear small finger splint at night
  • steroid injections
  • percutaneous trigger finger release (excision of A1 pulley)
26
Q

What is Dupuytren’s contracture?

A

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

27
Q

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

A

Ring + little fingers (ulnar digits)

28
Q

What are some risk factors for Dupuytren’s contracture?

A 
Male
Familial AD
Alcoholic cirrhosis
Phenytoin side effect
Diabetes
29
Q

What are the management options for Dupuytren’s contracture?

A

Depends on severity:

  • hand therapy exercises
  • injectable collagenase clostridium histolyticum
  • surgery –> fasciectomy (recurrence very common)
30
Q

What are some features of OA in DIPs?

A

Heberden’s nodes (bony thickness)

Dorsal ganglion cyst (mucous cyst)

31
Q

What are the surgical management options for DIP OA?

A

Removal of osteophytes/cysts

If severe –> arthrodesis (fusion of bones)

32
Q

What are some features of PIP OA?

A

Bouchard’s nodes

33
Q

What are the management options for ganglion cysts?

A

Monitor - usually disappear spontaneously

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

34
Q

What are the features of RA in the hands?

A

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

35
Q

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

A 
Volar MCP subluxation
Ulnar deviation
Swan neck deformity
Boutonniere deformity
Z shaped thumb
36
Q

What is a swan neck deformity?

A

Hyperextension at PIP, flexion at DIP

37
Q

What is a Boutonniere deformity?

A

Flexion at PIP, hyperextension at DIP

Orthopaedics (18 decks)

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