Hand And Wrist Flashcards
Common hand and wrist problem
Nerve compression syndrome - carpal tunnel or cubital tunnel
Arthritis - OA and RA
Trauma - tendon injuries, chronic injuries
Hx or hand and wrist pain
Pain - is it specific to the wrist or is it generalised other joints affected
ONSET - rapid - trauma or slow - degenerative
Any other joint problems
Other systemic conditions - RA
Prev injury
Hand dominance
Jobs
Hobbies
Holistic approach - how it affects their whole life
What are the signs/ symptoms of a median nerve injury
Thenar eminence wasting
Sensory disturbance in the distribution of the lateral side of the hand (in the anatomical position )
Ulnar nerve lesion signs and symptoms
Claw hand - partial the little and ring finger
Sensory disturbance over the little finger
The total affects depend where the damage is if it in the elbow - cubital tunnel the arm will have some sensory pain and disturbance
If it is damaged a guy one canal multiple symptoms can be caused depending on where the damage is
Location Symptoms Associations
Zone 1 Proximal (prior to ulnar nerve bifurcation) Mixed motor & sensory Ganglia & hook of hammate fractures
Zone 2 Surrounding deep motor branch ulnar nerve Motor only Ganglia & hook of hammate fractures
Zone 3 Surrounding superficial sensory branch of ulnar nerve Sensory only Ulnar artery pathology
Radial nerve injury signs and symtoms
Wrist drop due to the inability to extend the wrist
Anatomical snuff box sensory disturbance
Injury can occur in the upper arm - fracture of the humerus usually the reason
Elbow - entrapped
Wrist - elbow deformity and soft tissue masses
Axilla - most common cause is compression
Dislocation at the head of humerus is possible as well - Saturday night palsy - crutch palsy
What to to determine about swelling of the wrist
Time frame - when did it start sudden or more gradual - getting worse
Is the swelling soft - soft tissue or oedema or is it hard - boney deformity
Diffuse
Single/multiple
Any other joint swellings
What muscles does the median nerve supply
L - lateral 2 lumbricals
O - opponents pollicis
A - abductor Pollicis
F - flexor Pollicis brevis
Some of these muscles make up the thenar eminence - OAF muscles
What muscles does the ulnar nerve supply
Hypothenar Medial 2 lumbricals Adductor Pollicis Palmer and dorsal interossei Palmar brevis Flexor carpii ulnaris Flexor digitorum profundus
Damage to what causes a complete claw hand
Median nerve and the ulnar nerve
OA of the thumb signs symp
May not be symptomatic
May have pain
Exam - axial grind
sign- shouldering of the CMC joint
Tx of OA of the thumb
Splint and analgesia Steroid injection Excision Arthrodiesis Replacement
Sign of OA of the DIP and PIP
DIP - heberdens nodes
PIP - Bouchards nodes
OA tx
Exercise weight loss Local muscle strengthening Heat and cooling therapies Electro therapy MEd - paracetamolNSAIDS Topical NSAIDS Topical capsaicin Steroid injections Joint surgery - arthroplasty fusion
RA hand and wrist
The sign are getting less frequent due to the management of RA with drugs - DMARDS and biological
1st line - DMARDS - methotrexate sulphasalazine, leflunomide
Bridging steroid
Biological- sarilumab
Then adalinumab, etanercept,infliximab, rituximab, abatacept
Combo in severe - DMARDS - methotrexate and a TNF inhibitor
Surgery can be for those who have deformities that are affecting function
What can RA lead to in the hand and wrist and how can these be dealt with surgically
Synovitis - cartilage destruction by pannus the inflammatory granulation tissue, tendon compression and rupture and nerve compression. Erosion and dislocation/ subluxation of the joint Tx - con - splint Surg - synovectomy Finger realignment End on transfer Joint fusion Joint replacement
