Elbow, wrist and hand

Question 1

Lateral / Medial Epicondylitis

Answer 1

Inflammation of the tendons that join the forearm muscles on the outside/inside of the elbow
Lateral - tennis elbow
Medial - golfers elbow

Question 2

Causes

Answer 2

Damage to muscles & tendons that control your wrist and fingers.
Damage is typically related to excess or repeated stress.

Question 3

Age/risk factors

Answer 3

Age 40 or older
Performing repetitive activity at least two hours a day
Obese
A smoker
Racket/throwing sports
Weight training
Forceful, repetitive occupational movements e.g. construction, plumbing and carpentry

Question 4

Clinical presentation

Answer 4

Pain and tenderness. Usually felt on the inner side of your elbow, the pain sometimes extends along the inner side of your forearm. Pain typically worsens with certain movements.
Stiffness. Your elbow may feel stiff, and making a fist might hurt.
Weakness.
Numbness or tingling. These sensations might radiate into one or more fingers — usually the ring and little fingers.

Question 5

Prognosis

Answer 5

83% Pts avoid surgery
Recovery linked to degree of pain and level of manual labour

Question 6

Olecranon Bursitis

Answer 6

bursa fills with extra fluid and becomes swollen if it becomes irritated or inflamed

Question 7

Causes

Answer 7

Accumulation of fluid cells within the bursal cavity, frequently caused by repetitive trauma that thickens the bursal wall.
Atraumatic causes can be septic, Crystal induced or idiopathic.

Question 8

Age/risk factors

Answer 8

40-70
Repetitive elbow motion occupations, e.g. mining, gardening or mechanical work.

Question 9

Clinical presentation

Answer 9

Swelling/redness & warmth
Pain
Limited ROM
Highest pain in full flexion, lowest full extension
Tenderness - highest in septic cases

Question 10

Prognosis

Answer 10

Pts show improvement after 1-3 weeks

Question 11

Carpal Tunnel Syndrome

Answer 11

Compression of the median nerve at the wrist

Question 12

Causes

Answer 12

Canal is too small
Contents too large for canal
Injuries when wrist is in flexion or extension as carpal tunnel is smaller

Question 13

Age/risk factors

Answer 13

More common in women
Distal radius fractures
RA - swelling and inflammation compresses tunnel
Diabeties mellitus
Common use of vibrating hand tools
Obesity

Question 14

Clinical presentation

Answer 14

Numbness/tingling in thumb, index, middle and radial half of ring finger
Waking in the night and shaking hand to relive symptoms
Pain on radial side of wrist that radiates proximally
Aggravated by tasks like driving or talking on the phone
Weakness in the hand, may be common the drop objects

Question 15

Prognosis

Answer 15

Resolves in 3-6 months

Question 16

DeQuervains Tenosynovitis

Answer 16

Painful condition affecting the tendons on the thumb side of the wrist
Develops within the first extensor compartment - Extensor pollicis brevis and abductor pollicis brevis are the two tendons affected.

Question 17

Causes

Answer 17

Chronic overuse of the wrist
Radial and ulnar deviation of the wrist
Direct trauma to tendon sheath

Question 18

Age/risk factors

Answer 18

More common in women - especially new mothers due to increased fluid retention
Middle aged
Wrist fracture
RA
Diabeties mellitus

Question 19

Clinical presentation

Answer 19

Pain near the base of the thumb
Swelling near the base of the thumb
Difficulty moving the thumb and wrist when doing something that involves grasping or pinching
Aggravated by use of wrist and thumb.
Tenderness/thicker tendon sheath
Limited ROM

Question 20

Prognosis

Answer 20

Surgical treatment may be required if Pt doesn’t respond to period of treatment

Question 21

Ganglion Cyst

Answer 21

Fluid-filled swelling that usually develops near a joint, tendon or nerve
Most common soft tissue mass of the hand/wrist

Question 22

Causes

Answer 22

Trauma
A herniation of synovial tissue through the wrist capsule
Leakage of synovial fluid from a rent in the joint capsule may cause an irritation of the surrounding tissue. The local tissue reacts by forming a pseudocapsule. The ganglion fluid develops related to the irritation of the synovial fluid and this tissue.

Dorsal wrist joint cysts, which arise from the region of the scapholunate ligament - most common and account for approximately 60% to 70% of all ganglion cysts of the hand and wrist. Can also arise from:
Radiocarpal joint or scaphotrapezial joints.
Distal radial ulnar joint.
Flexor carpi radialis tendon

Question 23

Age/risk factors

Answer 23

20-50
3x more common in women
OA
Wrist joint or tendon injury

Question 24

Clinical presentation

Answer 24

Discomfort/ache
Most painful when wrist is in full extension
Round or oval and usually measure less than an inch (2.5 centimeters) in diameter
Pain. Ganglion cysts usually are painless. But if a cyst presses on a nerve — even if the cyst is too small to form a noticeable lump — it can cause pain, tingling, numbness or muscle weakness

Question 25

Prognosis

Answer 25

Some resolve spontaneously
Some may lead to a nerve compression syndrome