Hand Flashcards
What forms the carpal tunnel in the wrist?
Carpal bones
Flexor retinaculum (a strong fibrous band that covers the carpal bones on the palmar side of the hand, near the wrist).
How many flexor tendons are around the carpal tunnel and what are they called?
9 flexor tendons
4x FDP (flexor digitorium profundus)
4x FDS (flexor digitorium superficialis)
1x FPL (flexor pollicis longus)
What nerve passes through the carpal tunnel?
Median Nerve
What are the causes of carpal tunnel syndrome?
Most cases of carpal tunnel are idiopathic; however, it can occur secondary to many conditions such as rheumatoid arthritis (decreases the joint space) as well as others such as pregnancy, hypothyroidism and diabetes (these result in a production in fluid retention).
Carpal tunnel syndrome is most likely seen in men. True/false.
False, it is mostly seen in women.
How does Carpal tunnel syndrome present?
Patients complain of paraesthesia (numbness and tingling) affecting the thumb and radial 2.5 fingers. It is described as being worse at night.
What area is wasting in the hand in carpal tunnel syndrome?
Wasting of the thenar eminence. It is a group of three small muscles present at the base of the thumb.
What tests can provoke symptoms of Carpal tunnel syndrome? Adequate for finding a positive result.
Tinel’s sign - percussion over the median nerve to sense tingling and determine nerve damage.
Phalen’s test - holding the wrist in hyper flexion, decreasing the CT (carpal tunnel) space.
Diagnosis is confirmed with nerve conduction studies.
Treatment of carpal tunnel syndrome?
Conservative: involves the use of a wrist splint at night (prevents flexion). This may be supplement by corticosteroid injections.
Surgery: carpal tunnel decompression via surgery can be carried out however there is an associated risk of median nerve damage.
What is Dupuytren’s contracture?
A proliferative connective tissue disorder in which palmar fascia undergoes hyperplasia, with normal fascial bands forming nodules and cords. Eventually progresses to contractures at the MCP and PIP joints.
What is the pathogenesis of Dupuytren’s contracture?
A result of myofibroblast cell proliferation and the production of abnormal collagen (type 3 formed rather than type 1).
Leading to thickening of palmar fascia
Who is most at risk of developing Dupuytrens’s contracture?
Males are most likely to be affected. It has a particularly high prevalence of Scandinavian descent. May develop in in those with alcohol cirrhosis, diabetics are more likely to develop this as well.
What is trigger finger?
It is a non-fixed flexion deformity. It is tendonitis of a flexor tendon to a digit; it is usually distal to a fascial pulley (A1 pulley) over the metacarpal neck. Movement of the affected finger produces a clicking sensation, caused by the nodule catching on and then passing under the pulley.
What is management of trigger finger?
Steroid injection to the tendon sheath to relieve symptoms. Surgery may be required in recurrent and persistent cases.
What effect does Rheumatoid arthritis have on the hand?
Can cause swelling of the joints in the hand, PIPJ and the metacarpophalangeal joints.
What effect does OA have on the hands?
Results in both Heberden’s and Bouchard’s nodes.
Heberden’s nodes = swelling at the DIPJ
Bouchard’s nodes = swelling at the PIPJ
What is Bennett’s fracture?
A fracture of the 1st metacarpal (thumb) base, caused by forceful hyperabduction of the thumb.
Pathophysiology of Bennett’s fracture?
The fracture can extend into first carpometacarpal joint leading to instability and subluxation of the joint. Often requires surgical repair.
If this is missed, articular cartilage of CMC joint will degenerate leading to deformity, dysfunction and arthritis.
Pencil in cup deformity and “sausage fingers” (dactylitis) indicates what type of arthritis?
Psoriatic arthritis
What other conditions is dactylitis associated with?
Reactive arthritis
Gout
Ankylosing spondylitis
What is De Quervain’s tenosynovitis?
A condition where there is swelling and inflammation of the tendon sheaths in the wrist.
What tendons are primarily affected with tenosynovitis?
Abductor pollicis longus tendon
Extensor pollicis brevis tendon
De Quervain’s tenosynovitis is a condition occurring due to repetitive strain injury causing pain on the radial side of the wrist. True/false?
True
A notable cause of bilateral De Quervain’s tenosynovitis?
“Mummy thumb” - new parents repetitively lifting babies in a way that stresses the tendons in the thumb.
Clinical presentation of De Quervain’s tenosynovitis?
Pain - often radiating to the forearm.
Aching
Burning
Weakness
Numbness
Tenderness
What is Finkelstein’s test?
When the thumb is placed in a fist and the wrist is turned in the ulnar direction.
Management of De Quervain’s Tenosynovitis?
Management can involve:
* Rest and adapting activities.
* Use splints to restrict movements.
* Analgesia (i.e. NSAID’s)
* Physiotherapy
* Steroid injections
What is swan neck deformity?
Hyperextension PIPJ
Flexion DIPJ
What is Boutonniere’s deformity?
Flexion PIPJ
Hyperextension DIPJ
