Hand Disorders Flashcards
What is dupuytren’s contracture
Abnormal thickening of tissues in the palm of the hand - flexion contracture of the hand
How does dupuytren’s contracture present
Finger gets ‘caught on things’
No pain typically
Men 40-60 yrs
Diabetes and smoking are risk factors
How do you diagnose and treat dupuytrens contracture
Tabletop test - lay hand flat on table - if they can’t flatten it, test is positive
Palpable cord on exam
CLINICAL DIAGNOSIS
Treatment - monitor, corticosteroid injection, surgery
What’s De Quervain’s tenosynovitis
Sheath of the tendons on thumb side of wrist become inflamed/swollen - restricts tendon movement
Presentation and management of De Quervain’s tenosynovitis
Discomfort and pain when pt turns wrist or makes fist or grabs anything
Finklestein test
Treatment - analgesia, splint, steroid injection, surgery
What is a boxer’s fracture and why is it called that? - common exam question
Fracture of 5th metatarsal - usually after punching something
How do you identify a scaphoid fracture?
Pain in anatomical snuffbox or over base of thenar eminence
Management of scaphoid fracture
If tenderness over anatomical snuffbox or if any doubt - send for MRI and splint (immobilise)
Hard to see on x-ray
Why should scaphoid fracture not be missed
Due to low blood supply to bone, scaphoid fracture can cause complications like AVN
Has to be identified, MRI and immobilised
What is a colles fracture
Fracture of distal radius with dorsal displacement of wrist
Presentation of colles fracture
Pain, swelling etc….
Fall onto outstretched hand (FOOSH)
Elderly and osteoporosis more likely
Dinner fork deformity
Colles fracture treatment
Straighten deformity then immobilisation in cast
What is a Smiths fracture
Opposite of colles fracture
Fracture of distal radius by falling onto flexed wrists therefore less common
What nerve runs through carpal tunnel and what does this nerve do
Median nerve
Gives sensation to first 3.5 fingers in the front and some of back
What is the pathophysiology of carpal tunnel syndrome
Carpal tunnel becomes swollen / inflamed due to fluid retention (e.g during pregnancy, hypothyroidism, diabetes or overuse of hands)
Median nerve compressed
Compression causes symptoms
How does carpal tunnel syndrome present
Aching + pain
Pins and needles - tingling
Swollen
Burning
Numbness
Only fingers supplied by median nerve affected but symptoms can spread up arm
Sx worse at night or first thing in morning
Worse with strenuous wrist movements
Temporary relief when hanging arm out of bed at night or by shaking hand vigorously with flicking actio
Can affect one or both hands to different degrees
Clinical tests for carpal tunnel syndrome
Phalen’s test
Tinel’s sign
Nerve conduction studies if unsure of diagnosis
Carpal tunnel syndrome treatment
NSAIDs
Splint
Steroid injection
Surgical decompression
Presentation and diagnosis of trigger finger
Pain, stiffness, locking and catching when straightening and bending finger
Clinical diagnosis
Treatment for trigger finger
If less than 3 months of symptoms - steroid injection into tendon sheath and hand therapy
If more than 3 months - surgical referral
What is avulsion fracture
Tendon tears and pulls bone causing fracture
What is mallet finger
Baseball finger
Injury to EDC tendon that straightens DIP joint so distal joint now can’t straighten
Usually seems with avulsion fracture
