Hand and wrist

Question 1

Carpal tunnel syndrome

Answer 1

Compression of median nerve in carpal tunnel

Question 2

Median nerve lesion at wrist

Answer 2

Paralysis of thenar muscles - can’t do okay sign

Question 3

Median nerve lesion at elbow

Answer 3

Weak wrist flexion
Loss of finger flexion
Paralysis of thenar muscles

Question 4

Carpal tunnel borders

Answer 4

Superior: Flexor retinaculum
Lateral: Scaphoid and trapezium
Medial: Hook of hamate and pisiform

Question 5

Contents of carpal tunnel

Answer 5

FPL tendon
FDP tendons x 4
FDS tendons x 4

Medial nerve - palmar cutaneous branch of the median nerve is given off prior to the carpal tunnel - spares sensation to the thenar eminence

Question 6

Causes of carpel tunnel syndrome

Answer 6

• Primary / idiopathic
• Secondary:
• Water: pregnancy, hypothyroidism
• Radial #
• Inflammation: RA, gout
• Soft tissue swelling: lipomas, acromegaly, amyloidosis
• Toxic: DM, EtOH

Question 7

Risk factors for carpal tunnel syndrome

Answer 7

• F>M
• Pregnancy
• Hypothyroidism
• DM
• Alcohol

Question 8

Symptoms of carpal tunnel syndrome

Answer 8

• Tingling/ pain in thumb, index and middle fingers
• Pain worse at night or after repetitive actions
• Relieved by shaking / flicking
• Clumsiness

Question 9

Signs of carpal tunnel syndrome

Answer 9

• ↓ sensation over lateral 3½ fingers
• ↓ 2-point touch discrimination - early sign of irreversible damage
• Wasting of thenar eminence - late sign of irreversible damage
• Phalen’s and Tinel’s test +ve

Question 10

Phalen’s test

Answer 10

Holding the wrist in flexion for 60 seconds to elicit numbness/pain in median nerve distribution

Question 11

Tinel’s test

Answer 11

Tapping the nerve in the carpal tunnel to elicit pain in median nerve distribution

Question 12

Mx of carpal tunnel syndrome

Answer 12

Conservative:
• Mx of underlying cause
• Wrist splints
- Neutral position
- Esp. at night
• Local steroid injections

Surgical:
• Carpal tunnel decompression by division of the flexor retinaculum

Question 13

Dupuytren’s Contracture

Answer 13

Progressive, painless fibrotic thickening of palmar fascia

Associated with:
• AIDS
• DM 
• FHx
• Alcoholic liver disease 
• Pheytoin - epilepsy 
• Smoking

Question 14

Trigger Finger

Answer 14

• Tendon nodule which catches on proximal side of
tendon sheath → triggering on forced extension.
• → Fixed flexion deformity
• Usually ring and middle fingers
• Assoc. with RA
• Rx: steroid injection (high recurrence) or surgery

Question 15

De Quervain’s tenosynovitis

Answer 15

Gamer’s thumb
Inflammation of the synovium that surrounds a tendon sheath
Affects extensor pollicus brevis and abductor pollicus longus