Hand and wrist Flashcards by Nader Raafat

Colles’ fracture

Extra-articular

Distal radius

Dorsal displacement

Low-energy

Dinner fork deformity

How well did you know this?

Not at all

Perfectly

Barton’s

Intra articular

Partial fracture

?Volar displacement

How well did you know this?

Not at all

Perfectly

Smith’s

Extra-articular

Radial

Volar displacement

How well did you know this?

Not at all

Perfectly

Management of wrist fracture

Closed reduction

Plaster cast for 5-6 weeks

F/U radiology at 1 and 2 weeks –> malunion/failure of reduction –> consider internal/external fixation

How well did you know this?

Not at all

Perfectly

Complications of wrist fracture

Malunion –> reduced grip strength + wrist stiffness + pain

Median nerve compression/carpal tunnel syndrome

How well did you know this?

Not at all

Perfectly

Features of scaphoid fractures

FOOSH

Localised radial-sided carpal pain (anatomical snuffbox)

Difficulty with pronation

Request scaphoid X-ray series +/- MRI

How well did you know this?

Not at all

Perfectly

Management of scaphoid fractures

Undisplaced –> scaphoid cast + immobilisation for 8-12 weeks

Displaced –> internal fixation with screws

How well did you know this?

Not at all

Perfectly

Management of metacarpal and phalangeal fractures

Splintage for 2-3 wee with MCP at 90degrees and IPs at full extension, thumb in abduction and opposition

How well did you know this?

Not at all

Perfectly

Management of extensor tendon injuries

Open –> surgical (suturing, splinting, physio)

Closed–> splinting in extended position

How well did you know this?

Not at all

Perfectly

Examination of flexortendons

How well did you know this?

Not at all

Perfectly

Clinical features of capal tunnel syndrome

Paraesthesia + weakness in radial 3.5 fingers

Pain worse at night, may be relieved by shaking hand or running under cold water

How well did you know this?

Not at all

Perfectly

Associations of carpal tunnel syndrome

Pregnancy

Hypothyroid

Female

Basal thumb arthritis

How well did you know this?

Not at all

Perfectly

Management of carpal tunnel

Splinting

Steroid/anaesthetic injections

Surgical decompression

How well did you know this?

Not at all

Perfectly

Hand nerve examination

How well did you know this?

Not at all

Perfectly

Pathophysiology of Dupuytren’s

Abnormal myofibroblast activity –> thickening + shortening of palmar fascia –> finger flextion

How well did you know this?

Not at all

Perfectly

Cliinical features of Dupuytren’s

Thickened cords/nodules + fixed flexion of fingers (commonly ring/little MCP)

More aggressive disease: several joints, feet may be affected

Associations of Dupuytren’s

HIV, alcoholism, diabetes, FHx, men (5th-7th decde), Northern European descent

Leddenhose (in foot) and Peyronie’s (in penis)

Features of wrist ganglions

Most common hand mass: 70% dorsal

Smooth, fluctatues in size, non-painful, transilluminates

If does not transilluminate suspect bone tumour

Pathophysiology of wrist ganglions

Herniation of synovial cavity + filling up with mucin

Management of wrist ganglions

Most resolve spontaneously, high recurrence rate withs surgery/aspiration

De Quervain’s tenosynovitis pathophysiology

Thickening of extensor retinaculum –> compression of thumb extensor tendons

Associations of De Quervain’s tenosynovitis

Females post-partum/perimenopause

Overuse –> affects dominant hand

Clinical features of De Quervain’s

Radial sided wrist pain exacerbated by thumb flexion and ulnar deviation

Management of De Quervain’s

Rest + splinting

Activity modification, steroid injections

Rarely surgical release

Presentation of trigger finger

Painful locking of digit (often ring) in full flexion, must be passively extended Palpable nodule at base of MCP No thickening of fascia!! (c.f. Dupuytren's) Assoc w/ diabetes + RA + amyloid

Pathophysiology of trigger finger

Fibrocartilage metaplasia --\> thickening of A1 pulley system --\> prevent free running of flexor tendon

Osteo vs rheumatoid arthritis of hand

**Bony** **DIP involvement** **Worse with activity** **Heberden's nodules**

What is a perilunate dislocation?

High-energy trauma --\> displacement of carpus relative to lunate High risk of median nerve palsy, compartment syndrome, osteoarthritis

Presentation of nodal OA

Strong genetic component Peri-menopausal women Sequential, additive destruction of hand joints (DIPJs\>PIPJs) Eventually painless hand deformities, increase progression of other joint OA

Chauffer's fracture

Radial styloid fracture

What is Froment's sign?

Test of ulnar nerve palsy, failure of adductor pollucis When asked to pinch thumb goes into flexion

Roof and base of carpal tunnel

Flexor retinaculum Carpal bones

Contents of carpal tunnel

9 tendons: flexor digitorum profundis (4) Flexor digitorum superficialis (4) Flexor pollicis longus (1) Median nerve (-palmar cutaneous branch)