Forearm /wrist/hand pathologies

Question 1

Median nerve entrapment - Pronator teres syndrome

Answer 1

Compression of pronator teres, flexor digitorum profundis/superficialis
S & S - pain in the volar forearm exacerbated by activity, relieved by rest, decreased sensation in thumb,index finger,middle finger & radial side of ring finger, weak thenar muscles, positive Tinnel or Phalen

Question 2

Median nerve entrapment - Anterior interosseous syndrome

Answer 2

the anterior interosseous nerve, a motor branch of the median nerve, causes pain in the forearm,weakness of the pincer movement of the thumb and index finger.
Caused by inflammation or trauma

Question 3

Ulna nerve entrapment - cubital tunnel syndrome

Answer 3

ulnar nerve impingement along cubital tunnel at the medial edge of the elbow. The cubital tunnel is a channel which allows the ulnar nerve to travel over the elbow. It is bordered by the medial epicondyle of the humerus, the olecranon process of the ulna and the tendinous arch joining the humeral and ulnar heads of the flexor carpi ulnaris muscle.
S & S - Compression of the nerve may leads to a tingling or ‘pins and needles’ sensation along the 1.5 fingers of the ulnar aspect

Question 4

Radial nerve entrapment - radial tunnel syndrome

Answer 4

where the radial n. exits between the brachioradialis & brachialis to the supinator below
Symptoms - pain in upper extensor forearm, dyasthesia in radial nerve distrib, weakening of the extension of the fingers, thumb or wrist

Question 5

Radial nerve entrapment - posterior interosseous syndrome

Answer 5

entrapment of the nerve within supinator muscle or dislocation of the radial head, tumours
Symptoms - proximal forearm pain, motor loss of extensors,

Question 6

Radial nerve entrapment - Wartenberg syndrome

Answer 6

Tendons of brachioradialis & extensor carpi radialis longus compress the nerve
Symptoms - decreased sensation, paraesthesia/tingling in distribution of superficial radial nerve
Positive Tinnel

Question 7

Biceps tendontitis of the elbow

Answer 7

Tissue damage to biceps bracheii tendon causing pain at ant. elbow exacerbated by elbow flexion or flexion-supination
Caused by trauma or overuse by repetitive elbow flexion
S & S - ache or stiffness in ant. elbow that increases with rest
biceps weakness
DD - capsule/lig. sprain, pronator syndrome

Question 8

Triceps tendontitis

Answer 8

damage to the triceps tendon with subsequent degen. & inflam caused by trauma or gradual wear & tear due to repet. elbow extension
aching/swelling, stiffness or pain in post. elbow
DD - olecranon stress fracture

Question 9

Osteoarthritis hand/wrist

Answer 9

Progressive damage of joint cartilage, can include bony overgrowth, fluid accumu.
Women more, 40 plus, DIP affected most (Heberdens nodes) then Bouchards (PIP).
More common in the cotton picking hand
S & S - pain, aching, stiffness, bony enlargement

Question 10

Ulnar nerve entrapment - Guyons canal or ulnar tunnell syndrome (2nd most frequent entrapment in upper extrem.)

Answer 10

nerve compression as it passes through Guyons canal
caused by gripping, hook of hamate fractures, ganglion,
S & S - sensory loss, hypothenar eminence, small finger, numbness, tingling, cold intolerance
Positive Tinel or Phalen

Question 11

Carpel Tunnel Syndrome

contains - 4 FDS, 4 FDP, FPL & median nerve

Answer 11

Median nerve gets compressed by swelling of irritated tendons in carpal tunnel
women x 3 times more likely, diabetes higher risk too
S & S - pain, weakness, numbness in wrist & hand
Positive Tinel or Phalen

Question 12

Dequervains Tenosynovitis

Answer 12

Inflam. & thickening of 1st dorsal compart. of wrist (AbDPL & EPB)
W:M 9:1
Overuse, trauma, systemic inflam. disorders
S & S - pain with thumb movements & wrist deviation
Positive Finklesteins (grip thumb, ulnar deviate)

Question 13

Dupuytrens Contracture

Answer 13

Fibrosis & contracture of palmar fascia
M:F 3:1
Graded 1-3 (thickened nodule & band, limitation of finger extension & finally presence of flexion contracture)

Question 14

Ganglions

Answer 14

soft tissue tumour (benign) that presents adjacent to joints or tendons - near scapho/lunate joint most common
M:F 1:3, 10-40yrs
S & S - dull aching pain, sensory nerve dysfunction

Question 15

Kienbocks disease

Answer 15

collapse of the lunate due to vascular insufficiency & avascular necrosis
common in labourers
S & S - wrist pain in area of lunate, swelling on top of wrist, mechanics of worst eventually are affected

Question 16

Scaphoid Fracture

Answer 16

80% occur in men, mainly in 20s & 30s
FOOSH - hyperextension & radial deviation
S & S - tender at anatomical snuffbox
reduced or painful ROM at wrist
swelling