HAND + WRIST Flashcards
1
Q
What are some RFs for carpel tunnel?
A
, 45-60 yo. Risk factors: pregnancy, obesity, diabetes, RA, hypothyroidism, repetitive hand or wrist movement
2
Q
What are the sx of carpel tunnel?
A
Pain, numbness, paraethesia in the lateral 3.5 digits, weakness
3
Q
What are some of the clinical features of carpel tunnel>
A
- Wasting of the thenar muscles: flexor pollicus brevis, adductor pollicus, opponens polliicus (late)
- Weakness of thumb abduction (late)
- Palm sparing (innervation by palmar branch of median nerve proximal to carpal tunnel)
- Symptoms worse at night
- Tinels test: percussing over the median nerve
- Fallens test: holding wrist in full flexion for one minute. +ve if pt experiences tingling in sensory distribution of median nerve.
4
Q
How is carpel tunnel managed?
A
- Management: wrist splint; corticosteroid injections/ NSAIDS (to reduce swelling);
- Surgical only if other treatment fails : carpal tunnel release surgery. Cutting through flexor retinaculum, reducing pressure on the median neve
5
Q
How does dupeytrens contracture arise?
A
- contraction of the longitudinal palmar fascia.
- Typically starting as painless nodules, fibrous cords and flexion contractures develop at the MCP and ITP joints, which can severely limiting digital movement
6
Q
What are some of the RFs of dupeytrens contracture?
A
- Smoking*
- alcoholic liver cirrhosis
- diabetes mellitus
- certain occupational exposures (e.g. use of vibration tools or heavy manual work)
- Phenytoin tx
- PMHx of trauma
7
Q
How does dupeytrens present?
A
- Reduced range of motion
- Nodular deformity
- Loss of movement
- Thickened band
- Skin blanching
- Nodules at interphalangeal and MCP joints
8
Q
How is dupeytrens mxd?
A
- Conservative: hand therapy, injectable collagenase clostridium hystolicum (early)
- Surgical:
- Indicated if table top test is +ve
- Excision of disease fascia, fasciotomy – if there are ongoing symtpoms, or flexion >30 degrees:
- Regional fasciectomy - entire cord is removed (most common)
- Segmental fasciectomy, - short segments of the cord are removed
- Dermofasciectomy overlying skin are removed, to be followed by a skin graft
- High rate of recurrence
9
Q
What is de quervains tenosynovitis?
Who is it most likely to affect?
A
- Inflammation of tendons in the first extensor compartment of the wrist
- Extensor pollicus brevis
- Abductor pollicus longus
- Who? Aged 30-50. female. pregnant
10
Q
What are the clinical features of De Quervains tenosynovitis?
A
- Pain near base of thumb
- Associated swelling
- Difficulty grasping and pinching
- Swelling and palpable thickening over the tendon group of fibrous sheath
- +ve if pt reports aggravated pain over the styloid process
- +ve Finkelsteins test - applying** **longitudinal traction and ulnar deviation to the affected thumb.** **Pain specifically at the radial styloid process and along the length of the extensor pollicis brevis and abductor pollicis longus tendons
11
Q
How is tenosynovitis mxd?
A
- Conservative: avoid repetitive actions. Splint. Steroid injections
- Surgical decompression: transverse or longitudinal incision made and the tendon sheath split in the central aspect in a longitudinal direction, thus allowing the tunnel roof to form again as it heals but wider and with more space for the tendons to move
12
Q
What is trigger finger and how does it develop?
A
- Condition where finger/ thumb locks in flexion and cannot extend back
- Can affect one or more tendon in the hand
- Usually after flexor tenosynovitis, repetitive movements cause inflammation of the tendon and the sheath
- Superfical and deep flexor tendons with tenosynotivis develop nodules at the tendon distal to the pully
- When nodules flex the nodule moves proximal to pully, but when they attempt to extend this node fails to pass back under > digit locked in fixed flexed position
13
Q
What are RF for trigger finger?
A
repetitive motion, prolonged grip and use of the hand, RA, DM., female, age
14
Q
How does trigger finger present?
A
- Painless clicking and snapping when trying to extend their finger
- Pain over volar aspect of their MCP joint
- Digit begins to lock in flexion
15
Q
How is trigger finger managed?
A
- Treatment: conservative, steroids, surgical:
- Surgical: percutaneous trigger finger release, if severe: surgical decompression of tendon trial
