elbow, hand, wrist pathologies Flashcards
what is epicondylitis of the elbow
inflammatory process at the forearm extensor origin on the humeral supracondylar ridge either medial or lateral
other name for lateral and medial epicondylitis
lateral= tennis elbow
medial=golf elbow
epidemiology of epicondylitis
40-50 years
more common in men
difference between lateral and medial epicondulitis pain
lateral: pain in lateral epicondylitis worsened with resisted wrist extension
medial: pain in medial epicondylitis with resisted wrist flexion
treatment for epicondylitis
activity modify brace physio injections surgical release- usually self-limiting
symptoms of ulnar nerve entrapment
-ulnar nerve pain and weakness
-waste hypothenar eminence and intrinsic muscles
-elbow pain and nerve intrapment
clumsier
-loss sensation to medial one and half fingers
-night pain
-worse with elbow flexion
management of ulnar nerve entrapment
splint elbow in extension
ulnar nerve decompression
2 causes or locations for ulnar nerve entrapment
cubital tunnel syndrome- between 2 heads of FCU, paraesthesia to ulna hand, night pain, worse elbow flexion
Guyon’s canal: in wrist,
what is the ulnar claw paradox
closer to the paw the worser the claw
ie the lesser the claw the higher up the lesion is as FDP will be affected meaning there is less flexion in the claw
-due to loss of lumbricals
carpal tunnel syndrome symptoms
pain paraesthesia night pain clumsiness nocturnal dyaesthesia
exam of carpal tunnel syndrome
thenar wasting
weak APB on exam
median nerve altered sensation
what part of the hand sensory is spared in carpal tunnel syndrome and why
thenar eminence sensation often spared (palmar cutaneous branch) goes over the carpal tunnel
reversible causes of carpal tunnel syndrome9
pregnancy RA diabetes hypothyroid obesity colles fracture cushing amyloidosis SLE
treatment for carpal tunnel and 1 yr success rate for conservative
reversible self-limiting 80% improve in a yr
nocturnal splint
NSAID
surgical decompression
what joints does dupuytren’s contractures affect
MCPJ
PIPJ
painless contractures
what causes dup contractures
abnormal thickeing of palmar aponeuosis and shortening
risk factors for dup contractures 5
male >50 smoking dm alcoholism epilepsy ring> little finger
treatment of dup contractures
injectable collagenase
surgical resection
fasciectomy