Hand and Wrist pathology

Question 1

Pathology of carpal tunnel syndrome

Answer 1

Compression of the median nerve in the carpal tunnel

Question 2

Risk factors for carpal tunnel syndrome

Answer 2

Female, Obesity, Pregnancy, Hypothyroidism, RA, Repetitive activity

Question 3

Symptoms of carpal tunnel syndrome

Answer 3

Parathesia (in lateral 3.5 digits), Clumsiness, Pain (lateral 3.5 digits, worse at night)

Question 4

Signs of carpal tunnel syndrome

Answer 4

Positive Phalens test, Thenar wasting, Durhan’s sign

Question 5

Describe Durhan’s sign

Answer 5

Pain on compression of carpal tunnel for 30 seconds

Question 6

Describe Phalen’s sign

Answer 6

Pain on flexion of the wrist for 60 seconds

Question 7

Investigations for carpal tunnel syndrome

Answer 7

EMG

Question 8

Management of carpal tunnel syndrome

Answer 8

Conservative: Night splint
Medical: NSAIDs, Steroid injections
Surgical: Carpal tunnel release

Question 9

Define Dupuytren’s contracture

Answer 9

Contracture of flexor tendon of the digit

Question 10

Risk factors for Dupuytren’s contracture

Answer 10

HIV, Alcoholism, Diabetes, Genetic (autosomal dominant)

Question 11

Symptoms of Dupuytren’s contracture

Answer 11

Pain (palm), Decreased range of motion

Question 12

Signs of Dupuytren’s contracture

Answer 12

Nodules in palmar fascia, Palpable flexor tendon

Question 13

Management of Dupuytren’s contracture

Answer 13

Conservative: Physiotherapy
Medical: Steroid injections
Surgical: Resection and fasciotomy

Question 14

Pathology of trigger finger

Answer 14

Nodules on flexor tendons prevent them passing through the pulley

Question 15

Symptoms of trigger finger

Answer 15

Pain in the palm, Clicking, Locking

Question 16

Signs of trigger finger

Answer 16

Tenderness in the palm, Palpable lump

Question 17

Management of trigger finger

Answer 17

Conservative: Splints
Medical: NSAIDs, Steroid injections
Surgical: Release of the pulley

Question 18

Pathology of ganglion

Answer 18

Synovial cyst due herniation of synovium

Question 19

Signs of ganglion

Answer 19

Lump (transilluminant, well subscribed)

Question 20

Investigations for ganglion

Answer 20

Biopsy (mucin)

Question 21

Management of ganglion

Answer 21

Conservative: Observation, Aspiration
Surgical: Resection

Question 22

Pathology of mallet finger

Answer 22

Dysfunction of terminal extensor tendon of the digit

Question 23

Symptoms of mallet finger

Answer 23

Pain (in the DIP)

Question 24

Signs of mallet finger

Answer 24

Swelling in DIP, Resting flexion of the DIP, Decreased extension

Question 25

Investigations for mallet finger

Answer 25

X-ray

Question 26

Management of mallet finger

Answer 26

Conservative: Extension splinting
Surgical: ORIF, Closed reduction, Tendon reconstruction, Arthrodesis

Question 27

Symptoms of thumb osteoarthritis

Answer 27

Pain (usually base of thumb), Difficulty gripping

Question 28

Signs of thumb osteoarthritis

Answer 28

Positive grind test, Swelling, Crepitus

Question 29

Describe the grind test

Answer 29

Rotating thumb elicits pain

Question 30

Investigations for thumb OA

Answer 30

X-ray

Question 31

Management for thumb OA

Answer 31

Conservative: Brace
Medical: NSAIDs, Hyalgan injections
Surgical: Trapizial resection, Osteotomy 1st metacarpal, Arthrodesis, Arthroplasty