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MDD > Hand and wrist pathology > Flashcards

Hand and wrist pathology Flashcards

1
Q

What are the symptoms of an overuse or strain injury?

A

Can determine exact time and mechanism of injury
Pain is non-progressive and produced by one or few movements

Localised tenderness and pain reproduced on resisted active movement

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2
Q

What is De Quervain’s tenosynovitis?

A

Disease of unknown cause

Painful inflammation of abductor pollicis longus and extensor pollicis brevis tendons

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3
Q

What are the symptoms of DQT?

A

Acute pain, tenderness and swelling on thumb side of wrist

Difficulty gripping

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4
Q

What are the signs of DQT?

A

Swelling over radial border
Tender over radial border
Pain on resisted thumb abduction
Positive finklesteins test

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5
Q

What is the management of DQT?

A

Conservative

  • rest
  • analgesia
  • thumb immobilisation via splint for 3wks

Steroid injections

Surgery- if recurrence

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6
Q

What is carpal tunnel syndrome?

A

Median nerve compression as it passes through carpal tunnel

Compression until thenar eminence wasting is CPS

Most cases idiopathic

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7
Q

What are the symptoms of CPS?

A

Pain/paraesthesia in hand- worse in morning

  • due to wrist flexion when sleeping
  • wakes patient- can shake hand or hang it over side of bed to relieve

Thenar muscle weakness- dropping shopping bags etc

Sensory loss in palm/radial 3.5 fingers

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8
Q

What are the signs of CPS?

A

Thenar wasting in advanced cases
Reduced thenar bulk
Active thumb abduction and thumb opposition affected

Positive tinnels and phalens

Altered sensation

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9
Q

What is the management of CPS?

A

Nerve conduction studies show slowing at wrist but can be normal

Conservative

  • rest
  • NSAIDs
  • night time splinting
  • steroid injections

Surgery- division of flexor retinaculum

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10
Q

What is cubital tunnel syndrome?

A

Compression neuropathy of the ulnar nerve at cubital tunnel of elbow

Becomes compressed due to flexed elbows for long periods of time e.g. typing at desk

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11
Q

What are the symptoms of cubital tunnel syndrome?

A

Pain near elbow joint
-radiates down ulnar border of forearm

Paraesthesia and sensor nerve loss over ulnar distribution e.g. pinky

Reduced pinch and grip strength

If severe
-clawing of the hand due to hypothenar and interosseous muscle wasting

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12
Q

What are the signs of cubital tunnel syndrome?

A

Guttering between metacarpals, hypothenar muscle wasting

Tenderness around cubital tunnel

Reduced movement, unable to extend IPJs or actively adduct/abduct fingers

loss of sensation, reduced first dorsal interosseous power, +ve tinnels and +ve elbow flexion test

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13
Q

What is the management of cubital tunnel syndrome?

A

Conservative

  • night time splints
  • NSAIDs
  • activity modification

Surgery

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14
Q

What are ganglion cysts?

A

Soft tissue swellings with degenerative myxoid fluid that stems from underlying joint capsule, ligament or tendon sheath
Patients complain of lump on hand or wrist

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15
Q

What are signs of ganglion cyst?

A

Lump on dorsum of wrist, volar aspect of wrist, base of finger or DIPJ

Can be hard or soft but not fixed to skin

More obvious with joint movement

Transilluminates

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16
Q

What is the management of ganglion cyst

A

Conservative
-NSAIDs and reassurance
Aspiration and steroid injections 40% success rate

Surgical removal
-40% recur

17
Q

What is trigger finger?

A

Idiopathic fibrosis of the flexor tunnel leading to intratendinous nodule that interrupts normal finger movement

Usually involves middle/ring finger

Finger gets stuck in flexion and on further effort snaps into extension

Severe- permanently locked

18
Q

What are risk factors for trigger finger?

A

RA

DM

19
Q

What are signs of trigger finger?

A

Potential flexion at PIPJ or DIPJ

Can feel triggering of flexor tendons by placing finger in palm and asking to flex finger- feel nodule

Jerky/hesitant active flexion and extension

20
Q

What is the management of trigger finger?

A

Conservative

  • resolves spontaneously normally with activity modification
  • NSAIDs
  • Steroid injections

Surgery in RA patients

21
Q

What is Dupytrens Contracture?

A

Progressive painless thickening of the palmar fascia causing flexion deformities of the fingers and functional difficulties

More common in males, nordics and FH

Causes include

  • trauma
  • DM
  • phenytoin drug
  • alcoholic liver disease
22
Q

What are signs of dupuytrens contracture?

A

Nodules, cords in palm or fingers with flexion at MCP and PIP joints

Thickened palmar fascia

Loss of active and passive extension

23
Q

What is the management of dupuytrens contracture?

A

No specific treatment if no functional impairment

Surgery if cannot lie hand flat on table

MDD (44 decks)

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