Hand and Wrist conditions

Question 1

Cause of Scaphoid fracture?

Answer 1

Fall onto palm of abducted hand

Question 2

Sign of scaphoid fracture?

Answer 2

tenderness over the anatomical snuffbox

Question 3

Complications of scaphoid fracture

Answer 3

Blood supply to the scaphoid bone is from a distal blood vessel only. Can be damaged. Can lead to avascular necrosis of the proximal fragment. Can lead to degenerative joint disease of the wrist

Question 4

Signs of Rheumatoid arthritis of the wrist and hand?

Answer 4

Symmetrical swelling and tenderness of the metacarpophalangeal joint, PIP and wrist joints

Ulnar deviation of the fingers and wrists. Swelling of the metacarpophalangeal joint joints–>finger displacement. Extensor tendons displaced in ulnar and palmar direction. And the ulnar collateral ligament is stronger than the radial collateral ligament

Z deformity of the thumb. Fixed flexion of thr metacarpophalangeal joint joint, hyperextended IP joint

Swan neck deformity. Hyperextension of the PIP and flexion of the DIP joints

Question 5

What three features are on the X ray of RA?

Answer 5

Erosions

Synovitis

Sofft tissue swelling

Question 6

Pathophysiology behind osteoarthritis of the hand

Answer 6

Normal synovial joint sees distance between the bone ends (Maintained by the thickness of the articular cartilage)
In osteoarthritis, you get a destruction of the articular cartilage–>narrowing of the joint space
You get thickening oif the subarticular bone due to thickening

Question 7

What are the key features of osteoarthritis on an X ray?

Answer 7

Osteophytes
Joint space narrowing
Sclerosis

Question 8

What are Heberdens nodes?

Answer 8

Osteophytes on the IP joints in the hand

Question 9

Compare RA to osteoarthritis
Age of onset
Gender difference?
Most commonly affected joints?
Any other areas they can affect?

Answer 9

Age:
OA above 40yrs
RA between 20-60

Gender difference:
OA equal
RA affects women more

Commonly affected joints:
OA affects PIP and DIP joints more
RA affects metacarpophalangeal joint and PIP joints more

Other areas?:
OA: Only affects joints
RA: Can present with extra articular features eg. fatigue, eye, skin problems

Question 10

What is De Quentin’s Tenosynovitis?

Answer 10

Inflammation of the synovial sheath and tendons of the thumb

Question 11

What tendons are commly involved with De Quentin’s Tenosynovitis?

Answer 11

Extensor pollicis brevis

Abductor pollicis longus

Question 12

Symptoms of De Quentin’s Tenosynovitis?

Answer 12

Pain to turn wrist, grab and make a fist

Question 13

What causes carpal tunnel syndrome? (2)

Answer 13

Increase in pressure inside the carpal tunnel caused by decreased size of the carpal tunnel or increased size of the structures inside the carpal tunnel

Question 14

Symptoms of Carpal Tunnel syndrome?

Answer 14

Parasthesia, Hypoesthesia or anaesthesia in the lateral three and half digits
Because median nerve in carpal tunnel v sensitive to compression
However sensation in the central palm unaffected since the palmar cutaneous branch of the median nerve passes above the carpal tunnel no through it

Inability to oppose thumbs

Loss of coordination and thumb strength (Weakness of Abductor Pollicis Brevis and Opponens pollicis)

Question 15

Treatment of Carpal Tunnel syndrome?

Answer 15

Division of the flexor retinaculum

Question 16

Causes of Carpal Tunnel syndrome?

TRAMPD

Answer 16

Trauma
Rheumatoid arthritis
Acromegaly
Myxoedema
Pregnancy
Diabetes

Question 17

What is in the Guyons Canal?

Answer 17

Ulnar nerve and artery

Question 18

Signs of compression of the ulnar nerve in the Guyons Canal?

Answer 18

Hypoesthesia of the medial 1 and a half fingers

Weakness of intrinsic hand muscles

Question 19

What is Dupuytrens Contracture and what causes it?

Answer 19

Flexion of the fingers towards the palm

Due to palmar fusion leading to progressive shortening and thickening and fibrosis of the palmar fascia and aponeurosis

Question 20

What is reflex sympathetic dystrophy associated with (Symptoms)

Answer 20

Sweating, temp changes, shiny, pain and swelling of an extremity

A regional pain syndrome

Question 21

What is the cause of Traumatic Median nerve division at the wrist?

Answer 21

Laceration of the wrist in an attempted suicide

Question 22

What does Traumatic Median nerve division at the wrist result in?

Answer 22

Paralysis of the thenar muscls and firstt Two lumbricals
Opposition of the thumb not possible
Sensation lost over the thumb, adj 2 and half fingers as well

Question 23

What is the characteristic symptom of radial nerve lesion at the elbow?

Answer 23

Wrist drop

Radial nerve supplies all the extensor muscles