Hand and Wrist

Question 1

What direction are finger dislocations always normally?

Answer 1

Posteriorly

Question 2

After reduction post dislocation what is needed to happen?

Answer 2

Stable = 2 week in buddy straping

Unstable = brace in Edinburgh position (MCP joints flexed)

Question 3

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?

Answer 3

Outpouching of synovial fluid

Synovial fluid can be v thick which can make it v difficult to aspirate

Question 4

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?

Answer 4

They have a ganglion cyst

• bengin cyst
• will go away by itself with time
• not advised to smash it with a bible

Question 5

Difference in presentation between Dupuytren’s disease and trigger finger?

Answer 5

Dupuytren’s cannot be actively extended

Trigger finger - can be extended

Question 6

What causes trigger finger?

How is it managed?

Answer 6

Swelling of the flexor tendons -> tendon gets stuck on pulley -> cannot extend fully

Steroid injection
~surgery

Question 7

What condition causes an audible click when the affected finger is fully extended?

Answer 7

Trigger finger

Question 8

What hand/wrist condition is very common in pregnancy, with symptoms generally resolving post birth?

Answer 8

Carpal tunnel syndrome

Question 9

Where is the pathology in Dupuytren’s contracture?

A condition which causes a fixed flexion deformity

Answer 9

Contractred PALMAR FASCIA not flexor tendons

Question 10

Is Dupuytren’s contracture a painful condition?

Answer 10

No - if painful consider other pathologies

Question 11

What examination should be done for Dupuytren’s?

Then how should the condition be managed?

Answer 11

Table-top test (have hand flat on table)

Must be monitored as progresses
Surgery to dissect cords/palmar fascia

Question 12

What arthritic nodule is more commonly found in OA?

Answer 12

Heberden’s

Question 13

What hand joint does RA tend to spare?

Answer 13

DIP

Question 14

Describe the differences between swan neck and Boutonniere deformities in RA?

Answer 14

Swan neck - hyperextension at PIPJ and hyperflexion at DIPJ

Boutonniere - opposite

Question 15

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?

Answer 15

FOOSH - Colle’s

Back of flexed wrist - Smith’s

Question 16

What fracture is more unstable Smith’s or Colle’s?

Answer 16

Smith’s - ALWAYS requires ORIF unlike Colle’s which only sometimes

Question 17

What distal radius fracture is:

• dorsally displaced
• volarly displaced
• assoc. with Dinner Fork Deformity

Answer 17

Dorsally displaced - Colle’s fracture
Vorally displaced - Smith’s fracture
Dinner Fork Deformity - Colle’s fracture

Question 18

If a colle’s/smith’s fracture is intra-articular, what is it termed as?

Answer 18

Volar/dorsal Barton’s fracture

Question 19

Under what circumstances would external fixation be used for a distal wrist fracture?

Answer 19

If it is extremely comminated due to exceptionally high force injury

Question 20

What is the most commonly dislocated bone in the hand which can cause carpal tunnel syndrome?

Answer 20

Lunate

Question 21

What is the most commonly fractured bone in the hand?

Why is it dangerous?

Answer 21

Scaphoid

Can cut off blood supply to proximal head -> AVN of proximal scaphoid

Question 22

What social factor is associated with Dupuytren’s contracture?

Answer 22

Alcohol excess

Question 23

What bone sits at the base of the thumb?

Answer 23

Trapezium

Question 24

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?

Answer 24

Stenosising tenosynovitis of the EPB and APL

Typing and general repetitive work e.g. factory
RA

Finklestein test - look at one note