Hand and wrist problems Flashcards
What is carpal tunnel syndrome
compression of the median nerve in the carpal tunnel
What covers the palmer aspect. of the median nerve
transverse carpal ligament
What are the symptoms of carpal tunnel syndrome?
- pain + pins and needles in thumb, index and middle finger
- Pt shakes hand for relief (esp @ night)
- Sx occur mainly at night in early disease
What can be found on examination in carpal tunnel syndrome?
- weak thumb abduction
- wasting of THENAR eminence
- +ve tingles sign - tapping on carpal tunnel produces sx
- Phalen’s sign, flexion of wrists for 60s produces sx
How is carpal tunnel diagnosed?
- clinically
2. electrophysiology: motor and sensory, prolongation of action potential
What are the causes of carpal tunnel?
- idiopathic
- pregnancy
- f>m
- RA
- Oedema
- Lunate fracture
What is the management of carpal tunnel
- surgical decompression
2. Splinting and bracing
What are the risk factors for dupuytrens
- age
- m>F
- FHx
What happens in dupuytrens contracture
fixed flexion contracture of the hand caused by underlying contract rues of the underlying Palmar aponeurosis (becomes hyperplastic)
What digits are spared in dupuytrens?
index finger and thumb
Is dupuytrens painful?
no
Is dupuytrens slow or fast progressing?
slow
what is the treatment of dupuytrens contracture?
fasciectomy
What is the risk of treatment of dupuytrens?
neurovascular damage to digital nerves and arteries
what is a ganglion
fluid filled bump associated w joint or tendon sheath
How are ganglions treated?
usually asymptomatic so can be left alone
if troublesome may be excised or steroid injection if inflamed
What is trigger finger?
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
What are sx of trigger finger
finger locked in flexed position
pain at distal palm near A1 pulley
finger clicking
What are the associations of trigger finger?
mostly idiopathic
f>m
RA, DM
What fingers are trigger finger more common in?
thumb
middle
ring finger
What is the management of trigger finger
steroid injection
splint
What nerve roots make up the radial nerve
C5-T1
Go over the sensory distribution of the radial, ulnar and median nerve
ok hehe
What are the motor functions of the radial nerve?
extend arm at elbow
wrist extension
finger extension
supinate forearm
What are the motor functions of the ulnar nerve
flex + adduct hand at wrist
flex ring and little fingers at DIP
abduction at fingers
what are the motor functions of the median nerve
pronation of forearm
flexion of wrist + digits of hand
What nerve roots make up the ulnar nerve
C8 + T1
What nerve roots make up the median nerve?
C6-T1
How do u test each of the peripheral nerves of the arm in the hand examination?
radial - wrist dorsiflexion, resist pushing down
ulnar - cross middle and index finger
median - break finger and thumb apart
What is a pulled elbow?
Subluxation of radial head
What age group does pulled elbow usually occur? Why?
<6yrs
distal attachment of annular ligament covering radial head is weaker in children
What are the sx of pulled elbow
elbow pain
limited supination and extension
What is the rx of pulled elbow?
analgesia
supinate elbow whilst flexed at to 90 degrees
What is tennis elbow
lateral epicondylitis
What causes tennis elbow?
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
What age group are usually affected by tennis elbow?
45-55
What are the features of tennis elbow
- pain and tenderness localised to lateral condyle (prominent part of bone of humerus)
- pain worse on wrist extension against resistance w elbow extended
or
supination fo forearm w elbow extended
What is the treatment of tennis elbow
- avoid muscle overload
- simple analgesia
- steroid inj
- physio
How long do episodes of tennis elbow last?
6m - 2yrs
What is golfers elbow?
medial epicondylitis
What are the clinical features of golfers elbow?
- pain and tenderness localised to medial epicondyle
- pain is aggravated by wrist flexion and pronation
- numbness/tingling in 4th + 5th finger (ulnar nerve)
What is cubital tunnel syndrome?
compression of the ulnar nerve
What are the initial and late sx of cubital tunnel syndrome? when are sx aggravated?
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
What is radial tunnel syndrome?
compression of posterior interosseous branch of radial nerve
What are the features of radial tunnel syndrome?
sx similar to lateral epicondylitis
pain is 4-5cm distal to lateral epicondyle
sx may worsen w extending elbow and pronating forearm
