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Orthopaedics > Hand and wrist problems > Flashcards

Hand and wrist problems Flashcards

1
Q

What is carpal tunnel syndrome

A

compression of the median nerve in the carpal tunnel

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2
Q

What covers the palmer aspect. of the median nerve

A

transverse carpal ligament

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3
Q

What are the symptoms of carpal tunnel syndrome?

A
  1. pain + pins and needles in thumb, index and middle finger
  2. Pt shakes hand for relief (esp @ night)
  3. Sx occur mainly at night in early disease
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4
Q

What can be found on examination in carpal tunnel syndrome?

A
  1. weak thumb abduction
  2. wasting of THENAR eminence
  3. +ve tingles sign - tapping on carpal tunnel produces sx
  4. Phalen’s sign, flexion of wrists for 60s produces sx
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5
Q

How is carpal tunnel diagnosed?

A
  1. clinically

2. electrophysiology: motor and sensory, prolongation of action potential

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6
Q

What are the causes of carpal tunnel?

A
  • idiopathic
  • pregnancy
  • f>m
  • RA
  • Oedema
  • Lunate fracture
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7
Q

What is the management of carpal tunnel

A
  1. surgical decompression

2. Splinting and bracing

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8
Q

What are the risk factors for dupuytrens

A
  • age
  • m>F
  • FHx
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9
Q

What happens in dupuytrens contracture

A

fixed flexion contracture of the hand caused by underlying contract rues of the underlying Palmar aponeurosis (becomes hyperplastic)

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10
Q

What digits are spared in dupuytrens?

A

index finger and thumb

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11
Q

Is dupuytrens painful?

A

no

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12
Q

Is dupuytrens slow or fast progressing?

A

slow

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13
Q

what is the treatment of dupuytrens contracture?

A

fasciectomy

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14
Q

What is the risk of treatment of dupuytrens?

A

neurovascular damage to digital nerves and arteries

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15
Q

what is a ganglion

A

fluid filled bump associated w joint or tendon sheath

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16
Q

How are ganglions treated?

A

usually asymptomatic so can be left alone

if troublesome may be excised or steroid injection if inflamed

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17
Q

What is trigger finger?

A

disparity between size of tendons and the pulleys through which they pass
tendon becomes stuck and can’t pass smoothly through pulley
finger becomes locked in flexed position

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18
Q

What are sx of trigger finger

A

finger locked in flexed position
pain at distal palm near A1 pulley
finger clicking

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19
Q

What are the associations of trigger finger?

A

mostly idiopathic
f>m
RA, DM

20
Q

What fingers are trigger finger more common in?

A

thumb
middle
ring finger

21
Q

What is the management of trigger finger

A

steroid injection

splint

22
Q

What nerve roots make up the radial nerve

A

C5-T1

23
Q

Go over the sensory distribution of the radial, ulnar and median nerve

A

ok hehe

24
Q

What are the motor functions of the radial nerve?

A

extend arm at elbow
wrist extension
finger extension
supinate forearm

25
Q

What are the motor functions of the ulnar nerve

A

flex + adduct hand at wrist
flex ring and little fingers at DIP
abduction at fingers

26
Q

what are the motor functions of the median nerve

A

pronation of forearm

flexion of wrist + digits of hand

27
Q

What nerve roots make up the ulnar nerve

A

C8 + T1

28
Q

What nerve roots make up the median nerve?

A

C6-T1

29
Q

How do u test each of the peripheral nerves of the arm in the hand examination?

A

radial - wrist dorsiflexion, resist pushing down
ulnar - cross middle and index finger
median - break finger and thumb apart

30
Q

What is a pulled elbow?

A

Subluxation of radial head

31
Q

What age group does pulled elbow usually occur? Why?

A

<6yrs

distal attachment of annular ligament covering radial head is weaker in children

32
Q

What are the sx of pulled elbow

A

elbow pain

limited supination and extension

33
Q

What is the rx of pulled elbow?

A

analgesia

supinate elbow whilst flexed at to 90 degrees

34
Q

What is tennis elbow

A

lateral epicondylitis

35
Q

What causes tennis elbow?

A

repetitive strain injury resulting from tendon overuse and failed healing of the tendon. In addition, the extensor carpi radialis brevis muscle plays a key role

36
Q

What age group are usually affected by tennis elbow?

A

45-55

37
Q

What are the features of tennis elbow

A
  1. pain and tenderness localised to lateral condyle (prominent part of bone of humerus)
  2. pain worse on wrist extension against resistance w elbow extended
    or
    supination fo forearm w elbow extended
38
Q

What is the treatment of tennis elbow

A
  • avoid muscle overload
  • simple analgesia
  • steroid inj
  • physio
39
Q

How long do episodes of tennis elbow last?

A

6m - 2yrs

40
Q

What is golfers elbow?

A

medial epicondylitis

41
Q

What are the clinical features of golfers elbow?

A
  1. pain and tenderness localised to medial epicondyle
  2. pain is aggravated by wrist flexion and pronation
  3. numbness/tingling in 4th + 5th finger (ulnar nerve)
42
Q

What is cubital tunnel syndrome?

A

compression of the ulnar nerve

43
Q

What are the initial and late sx of cubital tunnel syndrome? when are sx aggravated?

A

initially - intermittent tingling in 4th and 5th finger
later - numbness in 4th and 5th fingers w/ associated weakness
aggravated by resting elbow on firm surface for long periods

44
Q

What is radial tunnel syndrome?

A

compression of posterior interosseous branch of radial nerve

45
Q

What are the features of radial tunnel syndrome?

A

sx similar to lateral epicondylitis
pain is 4-5cm distal to lateral epicondyle
sx may worsen w extending elbow and pronating forearm

Orthopaedics (11 decks)

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