elbow, wrist and hand conditions

Question 1

is lateral epicondylitis also known as tennis or golfer’s elbow

Answer 1

tennis

Question 2

is medial epicondylitis also known as tennis or golfer’s elbow

Answer 2

golfer’s

Question 3

what is lateral epicondylitis

Answer 3

inflammation of the common extensor tendon as a result of repetitive strain

Question 4

lateral epicondylitis presentation

Answer 4

• pain on elbow movement
• history of repetitive use in occupation/hobbies
• tenderness over local epicondyle and pain on resisted extension of wrist and fingers

Question 5

lateral epicondylitis diagnosis

Answer 5

clinical

Question 6

lateral epicondylitis management

Answer 6

self limiting (rest, ice, NSAIDs, brace and physiotherapy)

Question 7

what is medical epicondylitis

Answer 7

inflammation of the common flexor tendon as a result of repetitive strain

Question 8

medial epicondylitis presentation

Answer 8

• pain on elbow movement
• history of repetitive use in occupation/hobbies
• tenderness over medial epicondyle and pain on pronation/wrist flexion

Question 9

medial epicondylitis diagnosis

Answer 9

clinical

Question 10

medial epicondylitis management

Answer 10

self limiting (rest, ice, NSAIDs, brace and physiotherapy)

Question 11

Dupuytren’s contracture is more common in

Answer 11

men

Question 12

Dupuytren’s contracture causes

Answer 12

• idiopathic
• familial
• alcohol
• diabetes
• anti-epileptics

Question 13

Dupuytren’s contracture pathophysiology

Answer 13

• progressive, painless, fibrotic thickening and contracture of the palmar aponeurosis of the hand
• results in the development of fascial nodules and cord, and contracture of the fingers
• contracture initially starts with flexion of MCP joints and then flexion of IP joints

Question 14

Dupuytren’s contracture presentation

Answer 14

• visible contraction of fingers
• puckering and tethering of the skin
• usually symmetrical and bilateral, and most commonly affects ring and pinkie fingers
• palpable nodules and positive tabletop test

Question 15

Dupuytren’s contracture management

Answer 15

• depends on degree of finger contraction and level of disability it creates
• do nothing
• fasciotomy or fascia removal (risk of reccurence)
• finger amputation

Question 16

trigger finger pathophysiology

Answer 16

• thickened portions of the flexor tendon sheaths
• caused by nodular enlargement of a flexor tendon distal to the A1 pulley due to tendonitis
• when the finger is flexed, the nodule will move proximal to the pulley but when extended there will be a trigger sensation as the nodules moves back under the A1 pulley

Question 17

trigger finger presentation

Answer 17

• clicking sensation when extending the finger
• pain on extension of the finger
• finger being stuck in a flexed position
• most commonly affects middle and ring fingers

Question 18

trigger finger management

Answer 18

• immobilisation or steroid injection
• incision and separation of the A1 pulley

Question 19

what is a ganglia

Answer 19

mucous filled cysts that are found adjacent to a tendon or synovial joint

Question 20

ganglia presentation

Answer 20

• lump at wrist or at flexor tendons
• localised pain

Question 21

ganglia management

Answer 21

• leave alone as they can spontaneously resolve
• needle drainage
• surgical excision

Question 22

what is Dequiveren’s tenosynovitis

Answer 22

inflammation of the tendons of extensor pollicis brevis and abductor pollicis longus as they pass over the styloid process of the radius and through the anatomical snuffbox

Question 23

Dequiveren’s tenosynovitis cause

Answer 23

thought to arise due to repetitive strain and can result in stenosis of the tendons

Question 24

Dequiveren’s tenosynovitis presentation

Answer 24

• swelling on radial aspect of wrist
• pain on lifting objects with hands, wrist flexion and abduction
• Finkelstein’s positive

Question 25

Dequiveren’s tenosynovitis management

Answer 25

• 1st line: spica thumb splint, rest and NSAIDs
• 2nd line: steroid injections