Hand Problems Flashcards
What is the most common carpal fracture?
Scaphoid
What is the most common location for scaphoid fracture?
Waist of scaphoid
What is the presentation of scaphoid fracture?
Fall onto outstretched hand
Localised pain
Tenderness in anatomical snuffbox
What investigations are done for suspected fractured scaphoid?
XR- specifically ask for scaphoid
What is the management of scaphoid fracture?
Cast immobilisation 6-8 weeks
What are the complications of scaphoid fracture?
Non unon
Avascular necrosis
What is there a risk of avascular necrosis in scaphoid fracture?
Blood supply to distal scaphoid closely associated with the waist of scaphoid
What is a boxer’s fracture?
Fracture of 5th metacarpal
What is th presentation of a boxer’s fracture?
Pain
Depressed knuckle
What is the management of a Boxer’s fracture?
<70 degrees= buddy taping, or tensor bandage/splint
>70 degrees= reduction and splint
What is Dupytrens?
Thickening and contracture of palmar aponeurosis due to change in type of collagen produced
What are the strong risk factors for Dupytrens?
Men
>40
FH
DM
What are the weak risk factors for Dypytrens?
Alcohol
Tobacco
HIV
Epilepsy
What is the early presentation of Dypytrens?
Palmar nodules and cords
Skin changes
What is the progression of Dypytrens?
Functional al difficulties
Contracture- classically ring finger first, and pinkie
Loss of finger extension, active or passive
What are the management options for Dupytrens?
Non operative
Operative
Percutaneous needle fasciotomy
What are the non operative management options for Dupytrens?
Steroid injection
Collagenase fasciotomy
Radiotherapy
What are the operative management options for Dupytrens?
Partial fasciotomy- common, 50% recurrence at 5 years
Dermo-fasciotomy= more radical, intensive physiol
What is trigger finger?
Digital flexor tendinitis at A1 pulley
What are the risk factors for trigger finger?
Women 40-60yo RA DM Gout
What is the presentation of trigger finger?
Palpable ndule at base of digit- most often ring finger or thumb
Painful popping sensation with movement
Need to “unlock” tinder
What is the management of trigger finger?
Non op- splint, NSAIDs, steroid injection
Operative- percutaneous release, open surgery
What is DeQuervain’s?
Inflammation and thickening of tendon sheath/tendon at distal radius
What i the presentation of DeQuervain’s?
Pain, tenderness and swelling at radial side of wrist, aggravated by movement
Palpable nodule
Positive Finkelstein’s test
What is FInklestein’s test?
Thumb clasped in palm, and ulnar deviation
PAin= +
What is done to diagnose De Quervain’s?
Characteristic history
+ Finkestein’s
US if necessary
What are the management options for DeQuervain’s?
- NSAIDs, rest and splint
- Steroid injection
- surgical decompression
What is the presentation of OA of base of thumb?
Pain, stiffness and swelling
Deformity- squared off or Z thumb
Loss of function
What causes squared off thumb and Z thumb?
Attenuation of ligaments and subluxation of joints
What investigations are done for OA of base of thumb?
XR -Loss of joint space -osteophytes -sclerosis -subchondral cysts Bilat= check for haemachromatosis
What is the management of OA base of thumb?
Lifestyle NSAIDs Splinting Steroid injection Operative
What are the operative management options for OA base of thumb?
Trapeziectomy= gold standard but last resort
Fusion
Replacement
What is carpal tunnel syndrome?
Compression of median nerve in carpal tunnel
What re the risk factors for carpal tunnel?
Female >30 High BMI DM RA fractured write/carpal bones Thyroid pathology
What is the presentation of carpal tunnel?
Numbness, paraestoesia with night time worsening of thumb and radial 2.5 digits Weakness and wasting of thenar muscles Clumsiness Aching of arm \+ Tinel's and Phalen's
How is carpal tunnel diagnosed?
What is the management of carpal tunnel?
Dx=Characteristic history, Nerve conduction studies
Splint and steroids
Steroid injection
Surgical decompression
