hand and wrist pathology Flashcards
why do you get a claw hand in a distal ulnar nerve palsy
lose medial two lumbricals (4+5th finger) so get unopposed action of extensors. still have flexion of PIPJ and DIPJ due to that half of FDP.
causes of an ulnar nerve palsy
trauma, cubital tunnel syndrome
apart from claw hand, other signs of a ulnar nerve palsy
wastage of intrinsic muscles of hands (interossei and hypothenar eminence)
RF of dupytrens contracture
DM, alcoholic liver disease, family history
disease progression of dupytrens contractures
start as a node which progresses to fibrous cord and then becomes flexed (due to altered collagen matrix)
Dx of dupytrens contracture
clinical diagnosis but can do HbA1c and LFT
MX of dupytrens contracture
hand therapy, fasciectomy
O/E of carpal tunnel syndrome
wasting of thenar eminence, weakness of thumb abduction, sensation loss but not to the palm as the palmar branch has already come off before the tunnel
special tests for carpal tunnel syndrome
Phalens and tunnels
causes of CTS
pregnancy, RA, repetitive wrist movement, acromegaly, hypothyroidism, pill, diabetes
Ix for CTS
NCS
Mx of CTS
-conservative for 6 weeks - splint, physio, analgesics then may need surgery
complications of surgical decompression for carpal tunnel syndrome
trigger finger and non resolution of symptoms
what nerve is damaged in a hand of benediction (when asked to make a fist, only the 4th and 5th fingers can bend)
median (in a supracondylar fracture)
what causes trigger finger
disparity between the size of the tendon and the pulley which is runs through (associated with RA and DM)
RF for trigger finger
prolonged gripping
Mx of trigger finger
steroid injection and splint to keep finger extended (consider surgery if this doesn’t work)
what may be present at the base of a finger in trigger finger
a nodule
what is de quervains tenosynovitis
inflam in the sheath where the tendons (EPB and APL)lining the lateral border anatomical snuffbox are. Get pain over radial styloid process and pain when abducting thumb
special test for de quervains tenosynovitis
finkelsteins
mx of de quervains tenosynovitis
splint, analgesia, surgical release
kanavels signs of flexor tendon sheath infection
1) fixed flexion
2) fusiform swelling
3) pain on passive extension
4) pain on palpation
Mx of flexor tendon sheath infection (commonly caused by bites)
IV abx and surgery
2 options for stabilising scaphoid fracture
future splint or below elbow backstab
what kind of scaphoid fractures always need surgery
displaced and those affecting the proximal pole
