Hand Problems Flashcards by Anna McCallum

What is the most common carpal fracture?

Scaphoid

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What is the most common location for scaphoid fracture?

Waist of scaphoid

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What is the presentation of scaphoid fracture?

Fall onto outstretched hand
Localised pain
Tenderness in anatomical snuffbox

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What investigations are done for suspected fractured scaphoid?

XR- specifically ask for scaphoid

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What is the management of scaphoid fracture?

Cast immobilisation 6-8 weeks

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What are the complications of scaphoid fracture?

Non unon

Avascular necrosis

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What is there a risk of avascular necrosis in scaphoid fracture?

Blood supply to distal scaphoid closely associated with the waist of scaphoid

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What is a boxer’s fracture?

Fracture of 5th metacarpal

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What is th presentation of a boxer’s fracture?

Pain

Depressed knuckle

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What is the management of a Boxer’s fracture?

<70 degrees= buddy taping, or tensor bandage/splint

>70 degrees= reduction and splint

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What is Dupytrens?

Thickening and contracture of palmar aponeurosis due to change in type of collagen produced

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What are the strong risk factors for Dupytrens?

Men
>40
FH
DM

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What are the weak risk factors for Dypytrens?

Alcohol
Tobacco
HIV
Epilepsy

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What is the early presentation of Dypytrens?

Palmar nodules and cords

Skin changes

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What is the progression of Dypytrens?

Functional al difficulties
Contracture- classically ring finger first, and pinkie
Loss of finger extension, active or passive

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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?

1. NSAIDs, rest and splint 2. Steroid injection 3. 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