Hand and wrist pathology Flashcards
What are the symptoms of an overuse or strain injury?
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
What is De Quervain’s tenosynovitis?
Disease of unknown cause
Painful inflammation of abductor pollicis longus and extensor pollicis brevis tendons
What are the symptoms of DQT?
Acute pain, tenderness and swelling on thumb side of wrist
Difficulty gripping
What are the signs of DQT?
Swelling over radial border
Tender over radial border
Pain on resisted thumb extension
Positive finklesteins test
What is the management of DQT?
Conservative
- rest
- analgesia
- thumb immobilisation via splint for 3wks
Steroid injections
Surgery- if recurrence
What is carpal tunnel syndrome?
Median nerve compression as it passes through carpal tunnel
Compression until thenar eminence wasting is CPS
Most cases idiopathic
What are the symptoms of CPS?
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
What are the signs of CPS?
Thenar wasting in advanced cases
Reduced thenar bulk
Active thumb abduction and thumb opposition affected
Positive tinnels and phalens
Altered sensation
What is the management of CPS?
Nerve conduction studies show slowing at wrist but can be normal
Conservative
- rest
- NSAIDs
- night time splinting
- steroid injections
Surgery- division of flexor retinaculum
What is cubital tunnel syndrome?
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
What are the symptoms of cubital tunnel syndrome?
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
What are the signs of cubital tunnel syndrome?
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
What is the management of cubital tunnel syndrome?
Conservative
- night time splints
- NSAIDs
- activity modification
Surgery
What are ganglion cysts?
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
What are signs of ganglion cyst?
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
What is the management of ganglion cyst
Conservative
-NSAIDs and reassurance
Aspiration and steroid injections 40% success rate
Surgical removal
-40% recur
What is trigger finger?
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
What are risk factors for trigger finger?
RA
DM
What are signs of trigger finger?
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
What is the management of trigger finger?
Conservative
- resolves spontaneously normally with activity modification
- NSAIDs
- Steroid injections
Surgery in RA patients
What is Dupytrens Contracture?
Progressive painless thickening of the palmar fascia causing flexion deformities of the fingers and functional difficulties
More common in males, nordics and FH
What are signs of dupuytrens contracture?
Nodules, cords in palm or fingers with flexion at MCP and PIP joints
Thickened palmar fascia
Loss of active and passive extension
What is the management of dupuytrens contracture?
No specific treatment if no functional impairment
Surgery if indicated
