Hand and wrist disorders Flashcards
What are DDx of tingling fingers
- Peripheral nerve entrapment (Carpal Tunnel Syndrome and Cubital Tunnel Syndrome)
- Central nerve entrapment
- Peripheral Neuropathy
what are the contents of the carpal tunnel
Carpal tunnel is a space surrounded by carpal bones and the top is roofed by the Transverse carpal ligament.
Contents:
- Median Nerve
- 4 x FDS (Flexor Digitorum Superficialis)
- 4 x FDP (Flexor Digitorum Profundus)
- FPL (Flexor Pollicis Longus)
what are the conditions associated with Carpal tunnel syndrome
Usually idiopathic, but these conditions can be associated
- Diabetes Mellitus
- Hypothyroidism
- Rheumatoid Arthritis
- Acromegaly (bilateral carpal tunnel)
- Wrist fractures
- Pregnancy
- Use of heavy vibrating machinery
What is the presentation and positive clinical signs of Carpal tunnel syndrome.
Presentation:
- Nocturnal waking with tingling (relieved by shaking hands/ running under water/ keeping dependant)
- Altered/Reduced sensation in median nerve distribution
- Difficulty manipulating small objects
- Clumsiness (dropping cups/mugs/ loose change)
Clinical Signs:
- +ve Tinel’s sign
- +ve Phalen’s test
- Thenar muscle wasting
- Reduced power of muscle innervated by median nerve (reduced thumb abduction)
- Reduced sensation in median nerve distribution
Describe the sensory innervation of the hand
What are the management options of carpal tunnel syndrome?
- Wrist splints (especially for nocturnal symptoms)
- Steroid injections (especially during pregnancy)
- Carpal tunnel decompression surgery- Local anaesthetic with tourniquet - Divide flexor retinaculum longitudinally
What are the DDx of stuck fingers?
trigger finger
extensor tendon subluxation
What is the pathophysiology of trigger finger and conditions associated with it?
Constriction and thickening of A1 Pulley due to Nodule on tendon
Associated conditions:
- Diabetes (difficult to treat)
- RA
- Women
- Older people
What is the clinical presentation and management of trigger finger?
Presentation: Finger sticks in flexion then clicks painfully as finger is extended, does not move smoothly
symptoms worse in morning and improve throughout the day
Management:
Non-operative
- Splintage
- 50-60% improve with a single steroid injection, ~80% with 2 injections
Operative
- Surgical release/widening of A1 pulley
Describe the epidemiology of Duputryens disease and associated conditions
Older, White man of caucasian descent, AD inheritance
Associated conditions: Diabetes, epilepsy and anticonvulsants, alcohol
How does Duputryen disease present
“Stuck fingers”
Fixed Flexion deformity of the MCP and ICP joints
Commonly affects the ring and little finger
What is the operative management of Duputryen disease
Needle aponeurectomy (under LA)
Collagenase injections
Fasciectomy (surgical excision of cords)
Dermofasciectomy (surgical excision of cords and overlying skin
Recurrence rate is very high
What are common sites for ganglion cysts and management
Dorsal wrist
Volar wrist
Finger flexor sheath
DIP joint
Management- do nothing (resolves on its own), Aspirate, excise
Investigatiion for carpal tunnel syndrome and what do you see
Nerve conduction studies- Action potential prolongation in motor and sensory axons
What is De Quarvains Tenosynovitis and clinical features
Repetitive strain injury causing inflammation of the tendons in hand:
- Extensor Pollicis brevis
- Abductor pollicus longus
CF:
- Usually female aged 30-50
- pain on the radial side of the wrist
- tenderness over the radial styloid process
- abduction of the thumb against resistance is painful
