Hand and Wrist problems

Question 1

What is carpal tunnel syndrome?

Answer 1

Compression (and subsequent ischaemia) of the medial nerve as it passes underneath the flexor retinaculum

Question 2

Which part of the hand can become wasted in prolonged/severe carpal tunnel syndrome?

Answer 2

Thenar muscles (thenar eminence)

Question 3

What is Dupuytren’s contracture?

Answer 3

Painless (usually bilateral) contracture of the MCP and PIP joints of the ring and little fingers, with nodular thickening of the palm

Question 4

What are the risk factors for Dupuytren’s contracture?

Answer 4

Alcoholism and liver disease
Smoking
Epilepsy/anti-epileptic drugs
Diabetes mellitus
HIV and AIDS
Family history (autosomal dominant pattern)

Question 5

What are the risk factors for carpal tunnel syndrome?

Answer 5

Fluid retention e.g. pregnancy, COCP
Congestive cardiac failure
Rheumatoid/Osteoarthritis
Endocrine disturbances e.g. diabetes mellitus, obesity, hypothyroidism, myxoedema, acromegaly
Trauma e.g. fracture of the distal radius or carpal bone(s)

Question 6

What is De Quervain’s Tenosynovitis?

Answer 6

Painful inflammation an stenosis of the tendon sheaths of the abductor pollicis longus and extensor pollicis brevis.

Question 7

Which clinical test reproduces pain in de Quervain’s tenosynovitis?

Answer 7

Finkelstein’s test

Question 8

Which fingers are most commonly affected in trigger finger?

Answer 8

ring or middle fingers

Question 9

Describe the clinical presentation of trigger finger

Answer 9

Painful clicking sensation on moving the finger
Clicking may progress to locking; patient closes the fist and then cannot straighten the affected finger (may have to use the other hand to “unlock” the finger)

Question 10

What is a ganglion?

Answer 10

A cyst arising from the joint/tendon sheath, commonly on the back of the wrist.
Non-painful
Filled with thick, clear jelly (not synovial fluid) therefore transilluminates).