Elbow wrist and hand Flashcards
What is the presentation of tennis elbow?
This is lateral epicondylitis
It is pain over the lateral epicondyle and is evoked by wrist flexion when hand pronated
What is the treatment of lateral epicondylitis?
It is treated with rest and physio, most cases resolve in a year
Steroid injections are not recommended
Only severe cases should be treated with surgical release
What is the presentation and treatment of medial epicondylitis?
Pain evoked by pronation and forearm flexion
What is the presentaion and treatment of olecranon bursitis?
This is following pressure on the elbows, typically when studying.
Consider antibiotics if there is overlying skin cellulitis
Send aspirate for gram staining and microscopy
Could be gouty tophi
What is the presentation of cubital tunnel syndrome?
The ulnar is compressed in the ulnar groove as it passes behind the medial epicondyle
This causes loss of sensation over little finger and medial part of ring finger
May experience clumsiness as lose small muscles of the hand
What is the presentation of a pulled elbow?
This is when the radial head slips out of the annular ligament
It will be held flexed at the elbow and internally rotated
How is a pulled elbow treated?
Treated by cradling the elbow, with thumb and forefinger on radial head, supinate while flexing the elbow
Imaging not required
What is the presentation of carpal tunnel syndrome?
Commonly at night
Median nerve distribution:
-tingling or pain felt in thumb and first 2 fingers
- pain commonly aleviated with shaking of wrist
-wasted thenar eminence, loss of sensation over lateral 3 and a half digits
What tests can be done for carpal tunnel syndrome?
Phalens test - hyperflexion for 1 min reproduces symptoms
Tinels - tap over carpal tunnel - remember is between carpal bones
What is the management of carpal tunnel syndrome?
Conservative treatment is wrist splinting in neutral position - alleviates surgery in a large number
Corticosteroid injections are used short term for relief
Carpal tunnel release surgically can be done is symptoms do not resolve
What are the muscles in the hand supplied by the median nerve?
LOAF lateral 2 Lumbricals Opponens pollicis Adductor pollicis brevis flexor pollicis brevis
What is de quervains disease and how is it treated?
this is a stenosing tenosynovitis of the 1st extensor compartment
Treatment:
-rest, ice and nsaids
-if unsuccessful then corticosteroid injection
-surgical decompression
