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MSK > Hand Injuries > Flashcards

Hand Injuries Flashcards

1
Q

What is Dupuytren’s contracture

A

AD Palpable fibrosis of palmar aponeurosis
Loss of finger extension
Ring and little finger bend inward and can’t be extended
Fixed flexion deformity
Painless
Can be bilateral

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2
Q

Who is at risk of Dupuytren’s?

A 
M>F
Alcohol 
Liver disease 
Smoking 
HIV 
Epilepsy - phenytoin
DM 
Manual labour
Trauma
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3
Q

What is the treatment of Dupuytren’s

A 
Partial fasiectomy - gold standard
Arthrodesis 
Amputation 
Physio after surgery 
SPLINTS / steroid DONT WOKR
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4
Q

When do you consider surgery

A

When can’t straighten MTP / flatten hand

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5
Q

Percutaneous needle fasciotomy

A

Quick
No wound
High recurrence and risk of nerve injury

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6
Q

What are the symptoms of trigger finger?

A

Clicking sensation when move finger
Lump / nodule in palm where tendon is
Stiffness
May have to unlock fingers

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7
Q

What causes trigger finger

A

Swelling / inflammation in tendon catches on tendon sheath
Causes finger to lock in flexion
RA, DM, gout = more common

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8
Q

How do you Rx

A

Steroid injection + splint after

Percutaneous release if don’t respond

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9
Q

What causes De Quervain’s?

A 
Frequent thumb abduction 
Ulnar deviation 
F>M
Lactating + post-partum
Manual / clerical workers
Inflammatory arthritis
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10
Q

What is De Quervain’s

A

Thickening / inflammation of sheath containing APL and EPB

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11
Q

What are the symptoms

A 
Several weeks pain
Localised to radial wrist
Aggravated by thumb movement / abduction
Localised swelling possible
Tendernes over radial side
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12
Q

How do you Dx

A

Examine thumb

+Ve FInklesein - pain along distal radius with resisted thumb extension

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13
Q

How do you Rx

A 
Analgesia
Rest / splint 
NSAID
Steroid injection
May need decompression
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14
Q

What should you consider

A

Base of thumb OA

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15
Q

What is a ganglion

A

Myxoid degeneration from joint synovium

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16
Q

how does it present

A 
Firm non tender lump
Smooth 
Not fixed to underlying tissue or skin 
Dorsal > volar
70% of discrete swellings in hand
17
Q

How and when do you treat

A

Only treat if pain or pressure on median or ulnar nerve

Excision / aspiration

18
Q

Other swellings in hand - Hebrden, Bouchard, Osler

A

Hebreden - bony outgrowth + chronic swelling on DIP

Bouchards - hard bony outgrowth on PIP

Osler - painful red raised lesion due to immune complex deposition

19
Q

What is Carpal tunnel and what is present in carpal tunnel

A

Compression of median nerve in carpal tunnel
Flexor polices longus
4 tendons flexor digitorium superficalis
4 tendons flexor digitorum profundus

20
Q

What causes carpal tunnel

A 
Developmental 
Trauma - radius fracture
Ganglion
Fibroma
Lipoma
RA
Gout
TB
Amyloid - myeloma
21
Q

What are the symptoms of carpal tunnel

A

Nocturnal pain in thumb / index and middle finger
Paraesthesia in median nerve distribution
Wasting of thenar muscles
Weakness thumb abduction - APB
Often get relief by shaking

22
Q

Who is more at risk

A

Pregnant

Hypothyroid

23
Q

How do you Dx carpal tunnel

What makes diagnosis

A 
Tinnel 
Phalens - makes Sx
APB power - weak
Sensation 
Electrophysiologicl studies / nerve conduction make Dx
24
Q

How do you Rx

A

Steroid injection
Wrist splint
Surgical decompression - division of flexor retinaculum

25
Q

What happens if you damage median nerve at level of elbow

A

Unable to pronate
Weak wrist flexion
Ulnar deviation

26
Q

What are the symptoms of cubital tunnel

A

Numbness 4th + 5th finger
Weakness
Muscle wasting
Pain worse when leaning on elbow

27
Q

What causes

A

OA
RA
Cervical spine / elbow injury
Prior trauma

28
Q

How do you Dx

A

+ve Tinel and Phalens
X-ray
Nerve conduction

29
Q

How do you treat

A

Steroid injection
Physio
Surgery if resistant for debridement

30
Q

What are the cardinal signs of flexor tenosynovitis

A

Kanaval signs
Tenderness over tendon
Pain on passive extension
Universal swelling

31
Q

What else can you get

A

Infection of tendon

May look like a cellulitis

MSK (21 decks)

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