Hand Flashcards
What is the classification of trigger finger (stenosing tenovaginitis)
Green classification
Stages
I: pre-triggering: pain along flexor tendon but no demonstrable triggering
II: triggering: catch but can actively extend
III: triggering and locking
a: req active extension
b: req active flexion
IV: contracture: fixed flexion contracture of PIPJ
What is the mgx of trigger finger
Conservative
- lifestyle: avoid trauma
- occupational therapy: splint PIPJ in 15deg/ physioT
H&L injections (triamcinolone and lignocaine)
Op:
- division of A1 pulley in the midline (tendon sheath)
What are the kanavel signs
infectious tenosynovitis of flexor tendon sheath in hand
o Slight flexed position of affected finger
o Fusiform swelling over affected tendon
o Tenderness on percussion along tendon sheath
o Tenderness on extension of affected finger
what are the zones of the hand
o Zone 1: FDP o Zone 2: FDP and FDS (‘No man’s land as healing is poor) o Zone 3: Palm o Zone 4: Carpal tunnel o Zone 5: Forearm
principles of tx of infected hand
- antibiotics: flucloxacillin/ cephalosporin
- rest and elevation: sling, roller towel
- analgesia
- drainage
- send pus for microb investigation
- splintage (where ligaments are in greatest length - reduce likelihood of stiffness)
- physiotherapy
what are the 5 tissues of the hand
- skin and subcutaneous tissue
- muscle and tendon
- blood vessels
- nerves
- bones and joints
Ulnar nerve examination
- look
- test
Look:
- claw hand
- wasting of the first dorsal interosseous, guttering
Test:
- abduction of index finger (1st dorsal interosseous)
- adduction (cross first 2 fingers)
- FDP of little finger
- froment sign (adductor policis)
- sensation to little finger and hypothenar eminence
What does the ulnar nerve supply
Motor: thenar muscles except LOAF
- hypothenal (ODM, AbDM, FDM)
- 3rd/4th lumbricals
- dorsal and palmar interossei
- adductor pollicis
forearm: FCU, radial half of FDP
Sensory: innervate anterior and posterior surfaces of the medial 1 Half fingers and its associated palm area
Localising site of injury in ulnar n lesions
Elbow: FDP and sensation to hypothenar lost
wrist: above is preserved
Differentials of ulnar n palsy
- carrying angle of elbow
- lacerations over medial aspect of elbow
- thickened ulnar nerve
- ulnar n subluxation
Median n examination
Look: wasting of thenar eminence Test: - FPB (abducting thumb) - ok sign (FDP and FPL) - flexion of PIPJ (FDS) Special: - tinel and phalen at carpal tunnel
Localisation in medial n palsy
carpal tunnel:
- spare thenar sensation, FDP, FPL, FDS
- affects FPB
AIN lesion:
- hits FDP, FPL
High lesion:
affects all
What does the median nerve supply
Motor:
- flextors in forearm less FCU and ulnar 2 FDP: pronator teres, FCR, palmaris longus, FDS, lat 2 FDP, FPL, PQ
- LOAF: lumbricals 1,2 and thenar muscles
Sensory
- palmar: thenar eminence + 3half fingers
- volar: tips of 3half fingers
Radial nerve examination
Look: finger drop/ wrist drop Test: - EPL (retropulsion of thumb) - extension of fingers (ED) - extension of wrist (ECR, ECU) - extension of elbow (triceps brachii) - sensation over first webspace
Localisation of radial nerve lesion
PIN:
- finger drop (no wrist drop)
- no sensory loss
Spiral groove:
- wrist drop
- sensory loss
What does the radial nerve supply
Sensory: posterior forearm, dorsal hand
Motor:
- triceps brachii
- extensor muscles in forearm
how many dorsal components does the hand hand and their contents
1st: APL, EPB
2nd: ECRL, ECRB
3rd: EPL
4th EDC + Ex indicis
5th EDM
6th ECU
What is a ganglion and
Common sites for ganglions
Ganglion: fluid filled outpouching of the synovial mb of a joint or tendon sheath
Usually found over dorsal or palmar radial side of wrist, over flexor sheaths and over DIPK
PVNS
- what is it
- how to diagnose
- types and where to find
- features
- tx
benign proliferative disorder of synovial lining of joint, bursa, tendon sheaths > inflammation and nodular thickening of synovial mb
histo diagnosis (giant cell seen)
Types
- diffuse: knee>hip>ankle>shoulder
- localised: hands/ feet (volar aspect of DIPJ)
- firm, not transilluminable, non tender
TX: synovectomy
RA features of the hand
Elbow: swelling, subluxation of radius
Wrist: carput ulnae syndrome, swelling
MPJ: ulnar deviation, swelling, volar subluxation
Fingers: boutonneire/ swan neck
Thumb: CMC swelling/ subluxation, z deformity
OA features of hand
PIP: radial/ulnar dev, Bouchard nodes
DIP: heberden nodes, mucous cyst, mallet deformities, deviation
Thumb:
- swelling/ subluxation of CMC jt, grind test positive
active vs passive ROM limitation
active < passive:
- muscle weakness/ nerve palsy
- tendon rupture
- tendon adhesion
Passive limited
- joint contracture
Allen test
- what does it test
- how to test
- significance
Test patency of palmar arch (communication between radial and ulnar artery)
- test arterial blood flow
- elevate hand, clench fist for 30 sec
- occlude ulnar and radial arteries
- open hand
- release ulnar pressure. maintain radial pressure. time length req for colour to return (n=5-15sec)
if time increased: ulnar artery supply insufficient. may not be safe to cannulate/ needle radial artery
DeQuervain tenosynovitis
- what tendons involved
- RF
- how to test
- mgx
first dorsal comp: EPB, AbPL
RF: clothes wringing, pruning, cutting with scissors
Finkelstein test
Mgx: Conservative - lifestyle: rest - occupational: thumb spica - physioT: ultrasound - meds: NSAIDS H&L Sx: decompression of 1st compartment (tendon sheath release)
