Hand and Wrist Flashcards
What direction are finger dislocations always normally?
Posteriorly
After reduction post dislocation what is needed to happen?
Stable = 2 week in buddy straping
Unstable = brace in Edinburgh position (MCP joints flexed)
What forms a ganglion cyst?
Why can this make aspiration (which can be used for diagnosis in cases where the patient wants further reassurance) difficult?
Outpouching of synovial fluid
Synovial fluid can be v thick which can make it v difficult to aspirate
Patient presents with a fluctuating growth of wrist.
On examination the growth is:
- trans-illuminable
- tethered at base but not attached to skin above
What should the patient be advised with regards to management?
They have a ganglion cyst
- bengin cyst
- will go away by itself with time
- not advised to smash it with a bible
Difference in presentation between Dupuytren’s disease and trigger finger?
Dupuytren’s cannot be actively extended
Trigger finger - can be extended
What causes trigger finger?
How is it managed?
Swelling of the flexor tendons -> tendon gets stuck on pulley -> cannot extend fully
Steroid injection
~surgery
What condition causes an audible click when the affected finger is fully extended?
Trigger finger
What hand/wrist condition is very common in pregnancy, with symptoms generally resolving post birth?
Carpal tunnel syndrome
Where is the pathology in Dupuytren’s contracture?
A condition which causes a fixed flexion deformity
Contractred PALMAR FASCIA not flexor tendons
Is Dupuytren’s contracture a painful condition?
No - if painful consider other pathologies
What examination should be done for Dupuytren’s?
Then how should the condition be managed?
Table-top test (have hand flat on table)
Must be monitored as progresses
Surgery to dissect cords/palmar fascia
What arthritic nodule is more commonly found in OA?
Heberden’s
What hand joint does RA tend to spare?
DIP
Describe the differences between swan neck and Boutonniere deformities in RA?
Swan neck - hyperextension at PIPJ and hyperflexion at DIPJ
Boutonniere - opposite
What kind of distal radius fracture is associated with FOOSH?
What kind of distal radius fracture is associated with falling onto the dorsal surface of a flexed wrist?
FOOSH - Colle’s
Back of flexed wrist - Smith’s
What fracture is more unstable Smith’s or Colle’s?
Smith’s - ALWAYS requires ORIF unlike Colle’s which only sometimes
What distal radius fracture is:
- dorsally displaced
- volarly displaced
- assoc. with Dinner Fork Deformity
Dorsally displaced - Colle’s fracture
Vorally displaced - Smith’s fracture
Dinner Fork Deformity - Colle’s fracture
If a colle’s/smith’s fracture is intra-articular, what is it termed as?
Volar/dorsal Barton’s fracture
Under what circumstances would external fixation be used for a distal wrist fracture?
If it is extremely comminated due to exceptionally high force injury
What is the most commonly dislocated bone in the hand which can cause carpal tunnel syndrome?
Lunate
What is the most commonly fractured bone in the hand?
Why is it dangerous?
Scaphoid
Can cut off blood supply to proximal head -> AVN of proximal scaphoid
What social factor is associated with Dupuytren’s contracture?
Alcohol excess
What bone sits at the base of the thumb?
Trapezium
What is De Quervian’s syndrome/tenosynovitis?
What occupational risk increases chance of occurrence?
What rheumatological condition is strongly associated with it?
How is it diagnosed?
Stenosising tenosynovitis of the EPB and APL
Typing and general repetitive work e.g. factory
RA
Finklestein test - look at one note
