Elbow, wrist and hand Flashcards
Lateral / Medial Epicondylitis
Inflammation of the tendons that join the forearm muscles on the outside/inside of the elbow
Lateral - tennis elbow
Medial - golfers elbow
Causes
Damage to muscles & tendons that control your wrist and fingers.
Damage is typically related to excess or repeated stress.
Age/risk factors
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
Clinical presentation
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.
Prognosis
83% Pts avoid surgery
Recovery linked to degree of pain and level of manual labour
Olecranon Bursitis
bursa fills with extra fluid and becomes swollen if it becomes irritated or inflamed
Causes
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.
Age/risk factors
40-70
Repetitive elbow motion occupations, e.g. mining, gardening or mechanical work.
Clinical presentation
Swelling/redness & warmth
Pain
Limited ROM
Highest pain in full flexion, lowest full extension
Tenderness - highest in septic cases
Prognosis
Pts show improvement after 1-3 weeks
Carpal Tunnel Syndrome
Compression of the median nerve at the wrist
Causes
Canal is too small
Contents too large for canal
Injuries when wrist is in flexion or extension as carpal tunnel is smaller
Age/risk factors
More common in women
Distal radius fractures
RA - swelling and inflammation compresses tunnel
Diabeties mellitus
Common use of vibrating hand tools
Obesity
Clinical presentation
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
Prognosis
Resolves in 3-6 months
DeQuervains Tenosynovitis
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.
Causes
Chronic overuse of the wrist
Radial and ulnar deviation of the wrist
Direct trauma to tendon sheath
Age/risk factors
More common in women - especially new mothers due to increased fluid retention
Middle aged
Wrist fracture
RA
Diabeties mellitus
Clinical presentation
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
Prognosis
Surgical treatment may be required if Pt doesn’t respond to period of treatment
Ganglion Cyst
Fluid-filled swelling that usually develops near a joint, tendon or nerve
Most common soft tissue mass of the hand/wrist
Causes
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
Age/risk factors
20-50
3x more common in women
OA
Wrist joint or tendon injury
Clinical presentation
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
Prognosis
Some resolve spontaneously
Some may lead to a nerve compression syndrome
