Hand pain

Question 1

Tenosynovitis : Definition

Answer 1

A condition that affects the tendons in the fingers or thumb, causing them to catch or lock when they are bent

Question 2

Tenosynovitis : Pathophysiology

Answer 2

Tendons : fibrous tissues that connect muscles to bones
Encased in a proteective sheath

1 . Flexor tendons
* Responsible for bending fingers
* Travel through tendon sheath

2 . Inflammation of flexor tendon and sheath
* Due to repetitive movement or Rheumatoid arthritis

3 . Narrowing of sheath and tendon nodules
* Develop in response to inflammation

4 . Restricted movement of tendon within sheath
* Tendon may get stuck in narrow sheath before suddenly releasing
* Causing - popping or snapping sensation

Question 3

Tenosynovitis : Risk factors

Answer 3

more common in women than men
rheumatoid arthritis
diabetes mellitus

Question 4

Tenosynovitis : Clinical features

Answer 4

stiffness and snapping (‘trigger’) when extending a flexed digit
* More common in the thumb, middle, or ring finger
* Nodule may be present

Question 5

Tenosynovitis : Management

Answer 5

Steroid injection - effective in majority

Question 6

Radial nerve

Answer 6

1. travels behing humerus
2. Lateral epicondyle of humerus
3. Innervates radial (outeraspect/lateral) of arm/forearm
4. and extensor (back) of forearm and wrist
5. Extention of BEST muscles
   innervates “BEST”
   Brachioradialis
   Extensors of wrist, fingers
   Supinator
   Triceps
6. Innervates sensation at back of hand except 4th and 5th digits and tips of 1-3 digits

Question 7

Median nerve - ‘middle’

Answer 7

Innervates anterior anspect - palmar side of forearm and wrist
Wirst flexion
lateral fingers flexion (just the tips of the back) and thumb muscles (opposition/adduction)

Question 8

Ulnar nerve

Answer 8

travels along medial aspect of arm/forarm ie. Ulnar side
Motor : medial fingers (4th and 5th) flexion both motor and sensation on both sides
Adduction and abduction of finger

Question 9

Musculocutaneous nerve

Answer 9

upper trunk of brachial plexus compression
Motor deficit
flexion of arm at elbow
Sensory deficit
lateral forearm

Question 10

AXILLARY NERVE (C5 AND C6)

Answer 10

AXILLARY NERVE (C5 AND C6)
Cause of injury
fractured surgical neck of humerus
dislocation of humeral head
Motor deficit
arm abduction at shoulder
Sensory deficit
over deltoid muscle
Sign
flattened deltoid

Question 11