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)
