Hand And Wrist Flashcards
Carpal tunnel - contents
Median nerve
Tendons
- flexor pollicis longus (one sheath)
- flexor digitorum profundus (4 tendons)
- flexor digitorum superficialis (4 tendons)
Carpal tunnel - causes
Myxoedema oEdema Diabetes mellitus Idiopathic Acromegaly Neoplasm
Trauma
Rheumatoid arthritis
Amyloidosis
Pregnancy
Carpal tunnel - clinical features
Sensory - palmar thumb, index and middle finger - paraesthesia and numbness - worse at night Motor - weakened pinch grip and palmar grip - thenar atrophy - clumsiness Phalens - wrist flex ion for 60 seconds exacerbates symptoms Tinels - tapping median nerve over flexor surface of the wrist
Carpal tunnel - management
NSAIDs, night splints and activity modification
Steroid injections
Carpal tunnel release
Osteoarthritis- signs on hand
Highest joint focus is in the hands - increased wear and tear
DIP
- Heberdens nodes (osteophytes)
- mucous cysts - can be drained
Nails
- splitting, ridging, deformity and decreased gloss
PIP
- Bouchards nodes
- joint contracture with fibrosis of ligaments
Osteoarthritis - management in hand
NSAIDs and steroid injections
Surgery
- trapeziectomy
- arthrodesis (joint fusion)
Rheumatoid arthritis - clinical features of the hand
Rheumatoid nodules (seen in positive RF)
Ulnar deviation
Metacarpophalangeal subluxation
Swann neck deformity - DIP flexion and PIP hyperextension
Z-thumb - MCP flexed and DIP hyperextended
Extensor tendon rupture
Boutonnière deformity - DIP hyperextnsion and PIP flexion
Flexor tenosynovitis - causes
a.k.a trigger finger
Entrapment of the flexor tendon at the level of the A1 pulley
Idiopathic
Repeated, strong grip
Flexor tenosynovitis - associated conditions
Rheumatoid arthritis
Diabetes mellitus
Amyloidosis
Flexor tenosynovitis - management
Non-operative
- NSAIDs, night splints and activity modification
- steroid injections
Surgery
- surgical debridement and A1 pulley release
Dupytren’s disease - description
A benign, proliferative disorder characterised by fascial nodules and contracture of the hand
Dupytren’s disease - aetiology
Genetics - strong family history - autosomal dominant Age Male Caucasian of European descent Smoking Alcohol/liver cirrhosis Diabetes Autoimmune conditions The above injuries to the palmar fascia causes thickening and cord formation
Dupytren’s disease - clinical features
Can affect any finger - 4th/5th most common
Skin puckering
Palmar nodules
Cords
Flexion contracture of the affected finger
Dupytren’s disease - management
Non-operative
- Physiotherapy and brace/splint
- interlesional injections - corticosteroids/collagenase
Surgery
- fasciotomy/fasciectomy
- performed if there is any functional disability
