HAND AND WRIST DISORDERS Flashcards
Describe scaphoid fractures
-Most common carpal bone frature
-May occur at any age but most common among young adults
What is the MOI of scaphoid fractures?
-FOOSH resulting in hypertension and impaction of the scaphoid against the rim of the radius.
What is the presentation of scpahoid fractures?
-Pain in the anatomical snuffbox
-Pain exacerbated by moving the wrist
-Passive range of motion is reduced
-Swelling around the radial + posterior aspects of the wrist is common.
Which part of the scapohoid do fractures normally affect?
-Waist of the scaphoid
(can also occur in the proximal/distal pole)
What is important to note in Xrays for scaphoid fracture?
-Plain Xrays taken immediately after injury may not reveal the fracture
-delayed diagnosis is common
-If intial Xray does not show fracture= Follow up xray 10-14 days after.
What are some complciations of scaphoid fractures?
-(scaphoid) Blood supply is mainly retrograde from distal pole to proximal pole.
-Fractures through the waist of the scaphoid can result in avascular necrosis.
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-non union, malunion, secondary OA, carpal instability
What is the management of scaphoid fracture?
-Open reduction and internal fixation
-Casts
What is a Colle’s fracture?
-Extraarticular fracture of the distal radial metaphysis with dorsal angulation and impaction
What is a risk factor for Colle’s fracture?
-Patients with Osteoporrosis (most frequently post menopausal women)
What is the MOI of a Colle’s fracture?
-FOOSH with a pronated forearm and wrist in dorsiflexion
How will a patient present with a Colle’s fracture?
-Painful deformed and swollen wrist
-Dorsal angulation and impaction are usually clearly visible on plain Xrays.
What is the treatment of Colles fracture?
-Reduction and immobilisation in a cast
What are some complication of Colle’s fracture?
-Malunion resulting in ‘dinner fork’ deformity
-Median nerve palsy
-Post traumatic carpal tunnel syndrome
-Secondary OA
-Tear of extensor pollicis longus tendon (attrition of the tendon over a sharp bone fragment)
What is a Smith’s fracture?
-Fracture of the distal radius with palmar angulation of the distal fragment.
-Typically occur in young males and elderly females
What is MOI for a Smiths’s fracture?
-Fall onto the dorsum of a flexed wrist
-Direct blow to the back of the wrist
What are some complications of a Smith’s fracture?
-Malunion resulting in garden spade deformity
-This deformity narrows and distorts the carpal tunnel so can result in carpal tunnel syndrome.
what is rheumatoid arthritis?
-Autoimmune disease in which autoantibodies (rheumatoid factor) attack the synovial membrane
-Inflamed cells proliferate to form a pannus which penetrates through the cartilage and adjacent bone.
which joints in the hand are most commonly affected by rheumatoid arthritis?
-MCPJ
-PIPJ
-Cervial spine
-Can also involve the large joints
what do patients with rheumatoid arthritis of the hand often present with?
-Pain and swelling of the PIPJs and MCPJ of the fingers
-Erythema overlying the joints
-Stiffness (worse after rest)
-Carpal tunnel syndrome
-Fatigue and flu like symptoms
-Rheumatoid nodules (late feature)
What are common deformities seen in RA of the hand?
-Swan neck deformity
-Boutonniere deformity
What is swan neck deformity
-Tissues on the palmar aspect of PIPJ become lax leading to hyperextension
-DIPJ becomes flexed due to problem with insertion of extensor digitorum into base of distal phalanx.
What is boutonnieres deformity?
-MCPJ and DIPJ are hyperextended and the PIPJ is flexed due to slipping of extensor digitorum bands now acting as flexors
What is psoriatic arthropathy?
-Psoriasis is a skin condition that causes red flaky patches of skin covered with silvery scales.
-Patient with psoriasis can develop arthritis
What is the presentation of psoriatic arthropathy?
-Fusiform swelling of the digits known as dactylitis.
-Affected joint will stiffen
-Can result in widespread joint destruction (arthritis mutilans)
-Patients can have nail lesions: pitting and onycholysis
What is the treatment of Psoratic arthrits?
-Corticosteroids
-DMARDs
-Biologics
Which joint of the hand is most commonly affected by OA?
-1st carpometacarpal joint (between the trapezium and 1st metacarpal)
-more common in women
How does a patient present with OA of 1st CMCJ?
-Pain at the base of their thumb
-Pain exacerated by movement and releived by rest
-Stiffness following periods of rest
-Swelling around base of the thumb
What are Heberden’s nodes?
-Classical sign which affect the DIPJ of fingers
-Cystic swelling containing gelatinous hyaluronic acid on dorsolateral aspect of the DIPJ.
-Initial inflammation and pain will subside leaving an osteophyte.
-This process in the PIPJs are called Bouchard’s nodes.
What is Carpal tunnel syndrome?
-Compression of the median enrve as it passes through the carpal tunnel into the hand
-most common site of nerve entrapment
What are risk factors of Carpal tunnel syndrome?
-Obesity
-Reptitive wrist work
-Pregnancy
-Rheumatoid arthritis
-Hypothyroidism
What can result from carpal tunnel syndrome?
-Ischaemia
-Focal demyelination
-Decrease in axonal calibre
-Eventually axonal loss
-Loss of motor function to the thenar muscle leading to atrophy
What is the presentation of carpal tunnel syndrome?
-Paraesthesia in the distribution of the median nerve
-Symptoms are often worse at night
-Daily activities can aggravate paraesthesia
How do you remeber the cause of carpal tunnel syndrome?
MEDIAN TRAP Pneumonic
Describe ulnar nerve compression in Guyon’s canal?
-Ulnar nerve can be compression in Guyon’s canal as it passes radial to the pisiform bone over the palmar surface of the flexor retinaculum.
How does a patient present with Guyon’s canal syndrome?
-Paraesthesia in the ring and little fingers progressing to weakness of the intrinsic muscles of the hand supplied by the ulnar nerve.
Which intrinsic muscles of the hand will be weakened GCS?
-Adductor pollicis
-Palmar and dorsal interossei
-Lumbricals to the ring and little fingers
-Deep head of flexor pollicis brevis
What is Dupuytren’s contracture?
-Localised thickening and contracture of the palmar aponeurosis leading to a flexion deformity of the adjacent fingers.
What is the presentation of Dupuytren’s contracture?
-Initially patient notices thickening or nodule in the palm which may be painless.
-Later myofibroblasts within the nodule contract leading to formation of tight bands called ‘cords’ in the palmar fascia.
-Casuses finger to be stuck in a flexed position.
In which patients in Dupuytren’s contracture commonly seen?
-Occurs most commonly ages 40-60
-More common in males and people of northern european origin
-Inheritence is autosomal dominant (70% of cases have family history)
Which conditions can increase risk of Dupuytren’s contracture?
-Type 1 diabetes
-Smoking
-HIV
-Heart disease
-Trauma to hand or fingers
-Thyroid disease
