Hand Disorders Flashcards
A 25 year old man is diagnosed as having an undisplaced fracture of the proximal pole of the scaphoid. What is the best course of action?
Immobilisation in future splint for 5 weeks
Arrange an MRI scan
Immobilisation in plaster cast for 4 weeks
Surgical fixation
Initial immbolisation in plaster cast for 2 weeks with check radiographs at that stage
Surgical fixation
It is generally accepted that proximal pole fractures of the scaphoid should be surgically fixed as non union rates of up to 34% can be seen when cast immobilization alone is attempted.
A 63 year old lady presents with a three month history of pins and needles in the fingers of the right hand, particularly at night. On examination, there is some loss of the sensation over the palmar aspect of the lateral three fingers and wasting of the thenar eminence. What is the underlying diagnosis?
Radial nerve injury Ulnar nerve injury Psychosomatic illness Wrist arthritis Carpal tunnel syndrome
Carpal tunnel syndrome
Carpal tunnel syndrome commonly produces pain at night as the wrists are flexed during sleep. Compromise of the median nerve may produce wasting of the thenar eminence muscles.
A 13 year old boy falls onto an outstretched hand and is brought to the emergency department. He is examined by a doctor and a bony injury is cleared clinically. He re-presents a week later with pain in his hand. What is the most likely underlying injury?
Fracture of the distal radius Fracture of the scaphoid Dislocation of the lunate Rupture of flexor pollicis longus tendon Bennett's fracture
Fracture of the scaphoid
Scaphoid fractures in children are rare, will usually involve the distal pole and are easily missed. The initial clinical examination (and sometimes x-rays) may be normal and repeated clinical examination and imaging is advised for this reason. Whilst the other injuries may be sustained from a fall onto an outstretched hand they are less likely to be overlooked on clinical examination. In the case of a Bennetts fracture, the injury mechanism is less compatible with this type of injury.
A 62 year old lady presents with a non tender lump overlying the distal interphalangeal joint of the index finger. On examination, she has a hard, non tender lump overlying the joint and deviation of the tip of the finger. What is the nature of the lesion?
Oslers nodes Bouchards nodes Heberdens nodes Osteosarcoma Infective collection
Heberdens nodes
Heberdens nodes may produce swelling of the distal interphalangeal joint with deviation of the finger tip.
A 17 year old boy is brought to the clinic by his mother who is concerned about a lesion that has developed on the dorsal surface of his left hand. On examination, he has a soft fluctuant swelling on the dorsal aspect of the hand, it is most obvious on making a fist. What is the nature of the lesion?
Ganglion Osteosarcoma Malignant fibrous histiocytoma Bouchards nodes Oslers nodes
Ganglion
Ganglions commonly occur in the hand and are usually associated with tendons. They are typically soft and fluctuant. They do not require removal unless they are atypical or causing symptoms.
A 43 year old man falls over landing on his left hand. Although there was anatomical snuffbox tenderness; no x-rays either at the time, or subsequently, have shown evidence of scaphoid fracture. He has been immobilised in a futura splint for two weeks and is now asymptomatic. What is the most appropriate course of action?
Application of tubigrip bandage and fracture clinic review
Admission and surgical debridement
Application of futura splint and fracture clinic review
Application of below elbow cast for 6 weeks
Discharge with reassurance
Discharge with reassurance
This patient is at extremely low risk of having sustained a scaphoid injury and may be discharged.
A 52 year old male presents with discomfort in the fingers of his left hand. On examination, the ring and little fingers of his left hand are flexed and unable to extend completely. He is able to make a fist with the hand. Palpation reveals thickened nodules on the medial half of the palm. What is the most likely diagnosis?
de Quervain's tenosynovitis Tendon sheath infection Dupuytren's contracture Ganglion Heberden's nodes
Dupuytren’s contracture
Discomfort of the hand is not uncommon in Dupuytren’s contracture, true pain is unusual. The disease most commonly affects the ring and little fingers.
A 42 year old skier falls and impacts his hand on his ski pole. On examination, he is tender in the anatomical snuffbox and on bimanual palpation. X-rays with scaphoid views show no evidence of fracture. What is the most appropriate course of action?
Admission and surgical debridement
Application of tubigrip bandage and fracture clinic review
Application of futura splint and fracture clinic review
Admission for open reduction and fixation
Discharge with reassurance
Application of tubigrip bandage and fracture clinic review
A fracture may still be present and should be immobilised until repeat imaging can be performed. If clinical suspicion persists then subsequent imaging should be with MRI scanning or CT if MRI is contra-indicated.
A 62 year old man presents after his wife commented on the unusual shape of his fingers. On examination, he has a hard swelling adjacent to the distal interphalangeal joint of his index finger of the right hand with lateral deviation of the finger tip. There is no sensory disturbance and the swelling is not tender. Which pathological process underpins the underlying diagnosis?
Rheumatoid arthritis Osteoarthritis Infection with atypical organisms Deposition of immune complexes Malignancy
Osteoarthritis
The description fits with Heberdens nodes. These are bony outgrowths that occur in the distal interphalangeal joint in association with osteoarthritis. They may skew the finger tip sideways. Bouchards nodes are similar, but affect the proximal interphalangeal joint.
A 42 year old lady who has systemic lupus erythematosus presents to the clinic with a 5 day history of a painful purple lesion on her index finger. On examination, she has a tender red lesion on the index finger. What is the diagnosis?
Heberdens nodes Oslers nodes Bouchards nodes Malignant fibrous histiocytoma Osteoclastoma
Oslers nodes
Osler nodes are normally described as tender, purple/red raised lesions with a pale centre. These lesions occur as a result of immune complex deposition. These occur most often in association with endocarditis. However, other causes include SLE, gonorrhoea, typhoid and haemolytic anaemia.
