Hand and Wrist

Question 1

What is the cause of carpal tunnel syndrome?

Answer 1

Compression of the median nerve as it passes under flexor retinaculum.

Question 2

What is this a presentation of?

Paraesthesia of thumb, 4th and 3rd digits and lateral palm. Wasting in thenar region.

Answer 2

Carpal tunnel syndrome

Question 3

Which two tests specifically identify carpal tunnel syndrome?

Answer 3

Tinel’s - tap on carpal tunnel

Phalen’s - backs of hand together, wrists flexed

Question 4

How is suspected carpal tunnel syndrome investigated?

Answer 4

EMG

Question 5

What is the treatment for carpal tunnel syndrome?

Answer 5

Rest, weight reduction, wrist splint, short term steroid injection, carpal tunnel decompression surgery if severe.

Question 6

What is this a presentation of?

Smooth, fluid swellings on dorsal aspect of hand which transilluminates.

Answer 6

Wrist ganglions

Question 7

What is the treatment for wrist ganglions?

Answer 7

Not needed unless causing pain/pressure, aspiration may work but surgical excision gives less recurrence.

Question 8

What is De Quervain’s tenosynovitis?

Answer 8

Thickening and tightening of abductor pollicis longus and extensor pollicis brevis tendons at anterior border of anatomical snuffbox.

Question 9

What is this a presentation of?

Pregnant lady with swelling and pain over dorsal thumb, pain on resisted thumb extension.

Answer 9

De Quervain’s tenosynovitis

Question 10

What is Finkelstein’s test and what is it positive in?

Answer 10

1. Pain on gripping thumb into palm of same hand with passive ulnar deviation.
2. De Quervain’s tenosynovitis

Question 11

What is the treatment for De Quervain’s tenosynovitis?

Answer 11

Rest, ice, NSAIDs, thumb spica splint, steroid injections, surgical decompression of tendons.

Question 12

What is this describing?
Progressive, painless, fibrotic thickening of the palmar fascia, ring and little fingers affected mainly, often bilateral.

Answer 12

Dupuytren’s contracture

Question 13

What are the risk factors for Dupuytren’s contracture?

Answer 13

Scandinavian, male, older, smoking, alcohol, diabetes mellitus, family history.

Question 14

What is the treatment for Dupuytren’s contracture?

Answer 14

Injectable collagenase Clostridium histolyticum, surgical fasciotomy.

Question 15

What is the cause of trigger finger?

Answer 15

Nodular thickening of the flexor tendon and stenosis of the A1 pulley.

Question 16

What is this a presentation of?

Clicking/locking of ring/middle finger in flexion, found when waking and needs to be forcibly straightened.

Answer 16

Trigger finger

Question 17

What is the treatment for trigger finger?

Answer 17

Night splinting in extension, steroid injections, surgical release of A1 pulley.