Final Frontier Wrist Conditions

Question 1

How does Ape Hand deformity present? (3)

Answer 1

-Wasting of the thenar eminence as a result of median nerve palsy
-thumb falls back in line with the fingers
-patient is unable to oppose or flex the thumb

Question 2

What are two other names for Benediction’s Hand Deformity?

Answer 2

1. Bishop’s hand
2. Duchene’s sign

Question 3

How does Benediction’s Hand deformity present? (2)

Answer 3

1. Wasting of hypothenar muscles, interossei muscles, and the two medial lumbrical muscles due to ulnar n palsy
2. There is also hyperextension of the MCP & flexion of the IP joints

Question 4

What most commonly causes Boutonniere Deformity? (2)

What occurs anatomically in a Boutonniere Deformity?

Answer 4

1. Trauma
2. Rheumatoid arthritis

-a rupture of the central tendinous slip of the extensor hood

Question 5

How does someone with Boutonniere Deformity present?

Answer 5

-Extension of MCP & DIP with flexion of PIP

Question 6

What is the deformity known as Carpal (Carpometacarpal) Bossing?

Answer 6

overgrowth of hard bone on the posterior aspect of the hand where the index and/or middle finger meets the trapezoid and capitate

Question 7

What is Carpal Bossing indicative of and how is it usually fixed?

Answer 7

it is an indication of arthritis and can be seen on x-ray; unless it causes pain it is usually left alone

Question 8

How is claw fingers deformity caused?

Answer 8

loss of intrinsic muscle action and the overaction of the extrinsic (long) extensor muscles on the proximal phalanx of fingers

Question 9

How would someone with claw fingers present?

Answer 9

-MCPs are hyperextended
-PIP & DIP are in flexion

Question 10

If someone has claw fingers, and intrinsic function is lost, what is that called?

Answer 10

intrinsic minus hand

Question 11

What occurs anatomically with the “intrinsic minus hand” deformity? (3)

Answer 11

-normal cupping of the hand is lost
-both longitudinal & transverse arches of the hand disappear
-intrinsic muscle wasting

Question 12

What typically causes intrinsic minus hand deformity?

Answer 12

-combined median & ulnar nerve palsy

Question 13

Describe how Masse’s sign would appear on a patient (2)

Answer 13

-flattening of the dorsal transverse metacarpal arch and the hand appears flattened
-hypothenar muscle paralysis also occurs

Question 14

What is a dinner fork deformity?

Answer 14

seen with a malunion distal radial fracture (Colles fracture) with the distal radius positioned posteriorly

Question 15

What is drop wrist deformity?

Answer 15

the extensor muscles of the wrist are paralyzed as a result of a radial nerve palsy

Question 16

What is Dupuytren’s contracture?

Answer 16

progressive disease of genetic origin results in contracture of the palmar fascia

Question 17

How would a patient with Dupuytren’s contracture present?

Answer 17

flexion of MCP & PIP joints and is usually seen in the ring or little finger with the skin often adherent to the fascia

Question 18

Who does Dupuytren’s contracture affect more?

Answer 18

affects men more often than women and is usually seen in the 50-70 yr old age group

Question 19

What causes Mallet Finger deformity?

Answer 19

a rupture or avulsion of the extensor tendon where it inserts into the distal phalanx of the finger (the distal phalanx rests in a flexed position)

Question 20

What causes myelopathy hand?

Answer 20

dysfunction of the hand caused by cervical spinal cord pathology in conjunction with cervical spondylosis

Question 21

How would a patient present with “myelopathy hand”?

Answer 21

patient will show an inability to extend and adduct the ring and little finger; sometimes middle finger despite good function of the wrist, thumb, and index finger

Question 22

How else would a patient present systemically if they had “myelopathy hand”?

Answer 22

exaggerated triceps reflex & positive pathological reflexes (Hoffman reflex)

Question 23

How would you know if a patient has a Pitres-Testus Sign?

Answer 23

ask the pt to shape the hand in a form of a cone and cannot do so because of loss of hypothenar muscles due to ulnar nerve neuropathy

Question 24

What is the hand deformity “polydactyly”?

Answer 24

congenital anomaly characterized by the presence of more than the normal number of fingers, or in the case of the foot, toes

Question 25

What is the hand deformity "Triphalangism"?

Answer 25

three phalanges instead of the normal two as would be seen in the thumb

Question 26

What might a prominent ulnar head indicate? (3)

Answer 26

DRUJ pathology 1. Posterior dislocation 2. Ulnar side carpal pathology (subluxation and pronation of ulnar carpals) 3. TFCC pathology

Question 27

If there is a prominent ulnar head in an individual who has rheumatoid arthritis, what is that called?

Answer 27

ulnar caput syndrome

Question 28

Describe the "shoulder sign" of the thumb

Answer 28

if the 1st CMC joint is subluxated which may occur in arthritis and if the subluxation is >2-3mm there will be a slight step in the joint

Question 29

How would someone with a "Swan Neck deformity" present?

Answer 29

-flexion of MCP & DIP -PIP in hyperextension

Question 30

What causes Swan Neck deformity and who do we commonly see it in?

Answer 30

-contracture of the intrinsic muscles or tearing of the volar plate -often seen in patients with RA or following trauma

Question 31

What is syndactyly and which fingers does it affect most?

Answer 31

congential condition in which some fingers or toes are wholly or partially united, joined, or webbed -webbing is most common between the ring & middle finger

Question 32

What is trigger finger?

Answer 32

thickening of the flexor tendon sheath (Notta's nodule) which causes sticking of the tendon when the patient attempts to flex the finger

Question 33

What specifically happens anatomically to cause trigger finger?

Answer 33

a low-grade inflammation of the proximal fold of the flexor tendon leads to swelling and constriction in the digital flexor tendon

Question 34

What is the typical progression of trigger finger?

Answer 34

as the condition worsens, the finger will flex but not let go, and it will have to be passively extended until finally a fixed flexion deformity occurs

Question 35

Describe the population that is most commonly affected by trigger finger compared to trigger thumb

Answer 35

trigger finger: middle-aged women; usually occurs in 3rd or 4th finger and is most often associated with RA (worse in the morning) trigger thumb: young children

Question 36

How does ulnar drift anatomically occur and who is it most commonly seen in?

Answer 36

weakening of the capsuloligamentous structures of the MCP joints and the accompanying "bowstring" effect of the extensor communis tendons -most commonly seen in RA

Question 37

What is ulnar variance?

Answer 37

the distal articular surface of the ulna to the distal articular surface of the radius

Question 38

What could be potential findings for ulnar variance? (2) How is it best measured?

Answer 38

positive=ulna is more distal than radius negative=ulnar is shorter than radius -shoulder ABD to 90 degrees, elbow flexed to 90 degrees, forearm, wrist, and hand in neutral

Question 39

When does ulnar variance become more positive? (2) When does it decrease? What does it mean clinically if it is negative?

Answer 39

-pronation & power grips -decreases in supination -if negative, it means greater loads pass through the radius

Question 40

How would someone with zigzag deformity of the thumb present and what is it often associated with?

Answer 40

thumb is flexed at CMC and hyperextended at the MCP joint -deformity is associated with RA