Hand Conditions Flashcards
What is carpal tunnel syndrome?
Compression of the median nerve causing pain and numbness in the median nerve distribution of the hand
What is the pathology of CTS?
Compression of contents is due to:
- Swelling of contents
- Narrowing of the tunnel
What is the sensory branch of the median nerve?
Palmar digital cutaneous branch
What area does the palmar digital cutaneous branch supply?
Palmar aspects of:
- Thumb
- Index and middle finger
- Lateral half of ring finger
What is the motor function of the median nerve in the hand?
Thenar muscles:
- Abductor pollicis brevis
- Flexor pollicis brevis
- Opponens pollicis brevis
What are some risk factors for CTS?
Repetitive strain
Obesity
Perimenopause
RA
Diabetes
Acromegaly
Hypothyroidism
What are some sensory symptoms?
Numbness
Paraesthesia
Burning sensation
Pain
Worse at night
What are some motor symptoms?
Weakness of thumb movements
Weakness of grip strength
Difficulty with thumb fine movements
Wasting of thenar muscles
What is the management of CTS?
Rest and altered activities
Wrist splints to maintain a neutral position
Steroid injections
Surgery
What procedure is done for CTS?
Open or endoscopic
Flexor retinaculum is cut to release pressure on median nerve
What is Dupuytren’s contracture?
Condition where the fascia of the hand becomes thickened and tight leading to finger contractures
What is a contracture?
Shortening of the soft tissues leading to restricted movement in a joint
What causes the thickening of fascia on Dupuytren’s?
Inflammatory process in response to microtrauma
What is the presentation of Dupuytren’s?
Hard nodules on the palm
Skin thickening and pitting
Finger pulled into flexion
No pain
What finger is most affected in Dupuytren’s?
Ring finger
What finger is least affected in Dupuytren’s?
Index finger
What are the 3 surgical options for Dupuytren’s?
Needle fasciectomy- divide and loosen the cord causing the contracture
Limited fasciectomy- remove abnormal fascia and cord
Dermo fasciectomy- removal abnormal fascia and cord and associated skin. Replaced with skin graft
What are the non surgical options for Dupuytren’s?
Conservative
Radiotherapy- slow down cellular activity that produces collagen
What is trigger finger?
Stenosing tenosynovitis
Causes pain and difficulty moving a finger
What is the pathophysiology of trigger finger?
Thickening of the flexor tendons or tightening of the sheaths that they pass through
Causes pain, stiffness or catching symptoms
May be a nodule on the tendon causing the finger to get stuck in the bent position
What part of the sheath is most commonly affected in trigger ifnger?
First annular (A1) pulley at the MCP joint
What is the presentation of trigger finger?
Painful and tender
Does not move smoothly
Popping or clicking sound
Gets stuck in a flexed position
Symptoms are worse in the morning
What is the management of trigger finger?
Rest and analgesia
Splinting
Steroid injections
Surgery to release A1 pulley
What is De Quervain’s tenosynovitis?
Swelling and inflammation of the tendon sheaths in the wrist
Which 2 tendons are most affected in De Quervain’s?
Abductor pollicis longus (APL) tendon
Extensor pollicis brevis (EPB) tendon
What is the mechanism of injury in De Quervain’s?
Repetitive strain injury
What is the presentation of De Quervain’s?
Symptoms at the radial aspect of the wrist:
- Pain, often radiating to the forearm
- Aching
- Burning
- Weakness
- Numbness
- Tenderness
What is Finkelstein’s test?
Resisted thumb extension will cause pain in De Quervain’s
What is the management of De Quervain’s?
Rest and adapting activities
Using splints to restrict movements
Analgesia (e.g., NSAIDs)
Physiotherapy
Steroid injections
