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
what is trigger finger
stenosing tenosynovitis
narrow tendon sheath means flexor tendon catches
symptoms of trigger finger
- finger becomes caught in flexion
- pain and popping flexing finger
- thickening of ganglion
difference trigger to duputyren contracture
with trigger finger can extend passively
but cant with dup
who is more affected by trigger finger 3
middle aged women- menopause
DM
RA
which 3 fingers are most affected
ring, middle finger and thumb
management of trigger finger
injections
but if >2 injections and no change then do a flexor pully release
de quervian tenosynovitis- what is it?
inflammation of extensor tendons underneath the extensor retinaculum
repetitive strain injury
where/ when is the pain in de quervian tenosynovitis
- pain over radial styloid
- first dorsal compartment of wrist when gripping
- resisted thumb extension
symptoms of de quervian tenosynvoitis
swelling and tenderness
pain
test for de quervian tenosynovitis
worse with finkelstein’s test- deviate hand ulnar with thumb across palm
treatment de quervian
rest splint physio injection surgical release
most common places to find OA in the hand
more common in DIP of fingers and CMCJ of thumb
where is herbeden and bouchard nodules and z thumb
Herbeden=dipj
bouchard=pipj
treatment base of thumb OA surgical
trapezium excision
2 main types of hand infections
flexor sheath infection
paronychia-nail bed
flexor sheath infection- Kanavel’s cardinal signs 5
- fusiform sausage swelling
- flexed posture
- tender along tendon sheath
- pain on passive extension
- swollen, flexed, pain extending, pain palpation
treatment for flexor sheath infeciton
iv antibiotics
surgical washout
common organism in paronychia
s.aureus
treatment for paronychia
release of pus under pressure by probing the nail fold or formal incision and drainage under digital nerve block
what is mallet finger
injury to extensor tendon ie torn from DIPJ insertion so terminal phalanx assumes a flexed posture- splint
what is radicular pain
pain that follows a dermatome ie spinal path root
signs for carapl tunnel syndrome
ok sign loss
tinel sign and phalen
signs of a higher median nerve palsy and what specific nerve affected
loss of OK sign
loss sensation radial 3.5 digits
anterior interosseous
ulnar deviation
high radial nerve palsy sign
wrist drop
lost wrist extension
lost mcp, thumb ad finger extension
sensory loss over 1st dorsum space
low radial nerve palsy signs
elbow extension spared
lost thumb and finger extension
what nerve specifically is affected in radial nerve palsy
dorsal interosseous nerve
what causes a high radial nerve palsy versus a lower radial nerve palsy
#humerus=high elbow dislocate=low
2 tests for carpal tunnel syndrome
tinel’s test: tapping
Phalen’s test
