Hand and Wrist Conditions Flashcards
Features of peripheral nerve entrapment
Pain/paraesthesia in distribution of the nerve.
Altered sensation in the distribution of the nerve.
Reduced muscle function supplied by the nerve.
Associated conditions with carpal tunnel syndrome
Diabetes mellitus,
Hypothyroidism,
Rheumatoid arthritis,
Acromegaly,
Wrist fractures,
Pregnancy,
Heavy vibrating machinery
What nerve is affected by carpal tunnel syndrome?
Median nerve
Presentation of carpal tunnel ssyndrome
Nocturnal waking with tingling (relieved by shaking hands etc),
Altered/reduced sensation in median nerve.
Difficulty manipulating small objects.
Clumsiness.
Ring finger splitting.
Reduced power of muscles innervated by median nerve (thumb abduction)
Thenar muscle wasting
Positive tinel’s test and phalen’s test.
Management of carpal tunnel syndrome
6 week trial of conservative treatments eg, Wrist splints (especially for nocturnal symptoms), or steroid injections (especially during pregnancy),
Severe symptoms or symptoms which persist then perform carpal tunnel decompression surgey
What are the features and management of cubital tunnel syndrome
Nocturnal waking with tingling in the ulnar nerve distribution (4th/5th finger).
Altered/reduced sensation in ulnar nerve distribution.
Ring finger splitting.
Reduced power of ulnar nerve innervated muscles in hand (finger abduction),
Claw posture,
Hypothenar and interosseus muscle wasting.
Positive Tinel’s sign at elbow.
Management - Soft elbow splints for nocturnal symptoms and cubital tunnel decompression surgery. NOT steroid injections (risk of injuring nerve)
Features of trigger finger
Caused by discrepancy between size of tendons and pulleys which they pass. Either thickening of tendon or narrowing of tendon sheeth
Associated with women, rheumatoid arthritis and diabetes mellitus.
Presentation - initially stiffness and snapping when extending flexed digit.
Management - steroid injections (very successful), can use finger splints after and surgery can be used if patients don’t respond to steroid injections.
Describe features of extensor tendon subluxation
Tendon of finger subluxes on flexion into ulna gutter and then either flicks back into extension or finger has to be straightened manually
Features of Dupuytren’s contracture
What - Thickening of palmer fascia
Causes - Manual labour, phenytoin treatment, alcoholic liver disease, diabetes mellitus and trauma to the hand.
Features - Ring finger and little finger most commonly affected.
Management - surgical treatment indicated when MCP joints cannot be straightened and the hand cannot be placed flat on the table
Differential diagnosis for radial sided wrist pain?
De Quervain’s stenosing tenosynovitis,
Scaphoid fracture,
Radial styloid fracture,
Thumb CMC joint osteoarthritis,
Features of De Quervain’s stenosing teno-vaginitis?
Presentation - pain on wringing or removing stiff lids. Pain on resisted abduction and positive Eichoff’s test.
Treatment - splintage/steroid injections or surgical release of 1st dorsal compartment.
Differential diagnosis for lumps and bumps in the hand?
Ganglion,
Giant cell tumour,
Heberden’s and Bouchard’s nodes,
Skin lesions,
Gouty tophi,
Rheumatoid nodules,
Inclusion cysts,
Osteochondroms,
Enchondroma
explain features of ganglions
Common sites include - dorsal wrist, volar wrist, finger flexor sheath, DIP joint.
Presentation - Firm and well circumscribed mass that transilluminates
Management - often nothing but can aspirate or excise
