Hand and Wrist Conditions Flashcards
1
Q
Describe common conditions of the hand and wrist
A
- Scaphoid fracture
- Colles’ fracture
- Smith’s fracture
- Rheumatoid arthritis of MCPJ and IPJs
- Osteoarthritis of 1st CMC joint and DIPJs
- Carpal tunnel syndrome
- Ulnar nerve compression Guyon’s canal
- Depuytren’s Contracture
- DeQuervain Tenosynovitis
- Tendon avulsion
- Boxers fracture
- Reflex sympathetic dystrophy
2
Q
Describe the presentation of scaphoid fracture
A
- Most common in adolescents and young adults falling on an outstretched hand
- Most frequently fractured carpal bone
- Patients usually present with pain the anatomical snuffbox region especially during wrist movement
- Delayed presentation - hard to view on initial X-rays
3
Q
Describe the damaging consequence of scaphoid fracture
A
- Blood supply to the scaphoid from dorsal carpal branch of the radial nerve
- Blood supply from distal to proximal pole, thus fractures through the waist can result in avascular necrosis especially in the proximal pole
- Osteoporosis can occur due to malunion or avascular necrosis
4
Q
Describe the mechanism and presentation of Colles’ fracture
A
- Dorsal displacement and angulation of the distal radius
- Shortening of the arm
- Particularly common in patients with osteoporosis and thus in post-menopausal women
- Mechanism commonly falling on an outstretched hand with pronated forearm and dorsiflexed wrist
- Patient presents with painful, deformed, swollen wrist
- Fracture line with dorsal angulation similar to a dinner fork
5
Q
Describe the mechanism and presentation of Smiths’s fracture
A
- Palmar displacement and angulation of distal radius with palmar angulation of the distal fracture fragment
- Shortening of the arm
- Mechanism commonly falling onto a flexed wrist or a direct blow to the back of the wrist
- Palmar displacement and angulation similar to a garden spade deformity
6
Q
Describe the presentation of rheumatoid arthritis in the hands
A
- Inflamed synovial cells proliferate to form a pannus which penetrates through the cartilage and adjacent bone, leading to joint erosion and deformity
- Mainly affects the MCPJ and PIPJ of the hands and feet
- Symmetrical inflammation of hand
- Stiffness that is worst in the morning or after periods of inactivity
- Carpal tunnel syndrome
- Fatigue and flu like symptoms
- Rheumatoid nodules a late feature
7
Q
Describe the hand deformities that can occur from rheumatoid arthritis of the hand
A
- Swan neck deformity occurs when the PIPJ hyperextends and the MCPJ and DIPJ are flexed
- Boutonneire deformity when the MCPJ and DIPJ are hyperextended and the PIPJ is flexed
8
Q
Describe the presentation of osteoarthritis in the hand
A
- Most common 1st CMC joint and DIPJs
- Patients complain of pain at the base of their thumb
- Exacerbated by movement and relieved by rest
- Stiffness increases following periods of rest
- Swelling around the base of the thumb
9
Q
Describe Herberden’s nodes
A
- Herberden’s nodes classic sign of osteoarthritis affecting the DIPJs of fingers
- Due to chronic swelling developing a cyst
10
Q
Describe carpal tunnel syndrome and its risk factors
A
- Compression of median nerve as it passes through the carpal tunnel
- Risk factors include obesity, repetitive wrist work, pregnancy, rheumatoid arthritis
11
Q
Describe the presentation of carpal tunnel syndrome
A
- Presents with paraesthesia in the lateral 3.5 fingers
- Symptoms worse at night and often wake patient up
- Sensation to the palm is spared as palmar cutaneous branch of median nerve branches proximal to the carpal tunnel
- Can lead to motor weakness in LOAF muscles within the hand, eventually causing muscle wasting
12
Q
Describe Ulnar nerve compression in Guyon’s canal and its presentation
A
- Ulnar can be compressed in Guyon’s canal as it passes lateral to the pisiform bone over the flexor retinaculum
- Presents with paraesthesia in medial 1.5 fingers, progressing weakness in intrinsic muscles of hand supplied by ulnar nerve
- Can lead to ulnar claw
13
Q
Describe Dupuytren’s contracture and its presentation
A
- Thickening and contracture of the palmar aponeurosis leading to a flexion deformity of adjacent fingers
- Build up of scar tissue within palm - collagenase
- Lumps in palm causes shrinkage
- Can cause fingers to permanently bend
- Causes include diabetes, smoking, excessive alcohol, heart disease, HIV
14
Q
Describe De Quervain tenosynovitis and its presentation
A
- Inflammation of the sheath that surrounds two extensor pollicis brevis and abductor pollicis longus which control thumb movement
- Presents with pain on the radial side of the wrist, spasms, tenderness
- Finkelstein’s test - grab thumb and ulnar deviate hand
- If pain in distal radius side, then tenosynovitis likely
15
Q
Describe tendon avulsion
A
- Snap of flexor digitorum profundus snaps when grabbing something that slips away
- Pull off bone fragment
- Loss of flexion
