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.
+
-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