Hand & wrist Flashcards
Scaphoid fracture
How does it occur?
What are the symptoms?
Which part of the scaphoid commonly fractures?
Xrays taken immediately x show fracture. When will the follow up be and why?
What is the complication and why?
- fall onto outstretched hand - hyperextension and impaction of scaphoid against rim of radius
- Pain in anatomical snuffbox, swelling around radial aspect of wrist
- waist of scaphoid
- 10-14 days. Fracture line will be visible after bone resorption
- Avascular necrosis - retrograde and tenous blood supply
Colle’s fracture
What is it?
Which aged group is commonly seen with this fracture?
Which young group is seen with this fractrue?
What are the treatments?
What are the complications?
- extra-articular fracture of distal radial metaphysis with dorsal angulation and impaction
- osteoporosis, post menopausal women
- high impact trauma - skiing (fall onto outstretched hand, forearm pronated, wrist dorsiflexion)
- reduction and immobilisation in cast
- dinner fork deformity, median nerve palsy, tear of EPL, secondary OA
Smith fracture
What is it?
What causes it?
What are he complication?
- fractures of distal radius with palmar angulation of distal fracture fragment
- fall onto flex wrist
- garden spade deformity, carpal tunnel syndrome
RA of MCPJ & IPJ
What is symmetrical polyarthritis?
How do patients present?
What are the common deformities in advanced RA?
- affects multiple joints in a symmetrical distribution
- pain & swelling of PIPJs and MCPJs, erythema overlying the joints, stifness that worsens in the morning, carpal tunnel syndrome
- Swan neck deformity & boutonniere deformity
RA of MCPJ & IPJ
Describe the pathophysiology of swan neck deformity
- Muscles on the palmar aspect of PIPJs become lax due to synovitis > Extensor muscles on PIPJs greater than flexor muscles > joint on palmar surface hyperextends
- At DIPJ, rupture of ED > mallet deformity
RA of MCPJ & IPJ
How is boutonniere deformity presented?
- MCPJ and DIPJ hyperextended, PIPJ flexed
Psoriatic arthropathy
What is it?
What is it’s nature of presentation?
Which joints are commonly affected?
What are the symptoms?
What are the complications?
- arthritis developed from psoriasis
- asymmetrical oligoarthritis
- small joints of hands and feet
- dactylitis, nail lesions
- arthritis mutilans
OA of 1st CMCJ and DIPJ
What are the symptoms?
Describe the deformity at later stages
- pain at base of thumb, pain exacerbated by movement, relieved by rest, stiffness inccrease after rest, swelling at base of thumb
- 1st metacarpal sbluxes in ulnar direction > squaring of hand
herberden’s nodes
What is it a classic sign off?
What are the risk factors?
Describe the pathophysiology
What is it called if the pathophysiology occurs in PIPJs?
- OA and affect DIPJ of fingers
- Middle age, women, family history
- Chronic swelling > cystic swelling containing hyaluronic acid on dorsolateral aspect of DIPJ developed > inflammation subside > patient left with osteophyte
- Bouchard’s nodes
Carpal tunnel syndrome
What is it?
What are the risk factors?
What does it cause?
What are the symptoms?
Why will the sensation to the palm be spared?
What is the compliction?
- compression of median nerve as it passes through carpal tunnel from forearm into hand
- obesity, pregnancy, RA, repetitive wrist work
- Ischaemia, focal demyelination, axonal loss
- parasthesia at median nerve distribution, worsens at night
- palmar cutaneous branch of median nerve branches proximal to the carpal tunnel and passes superficial to it into palm
- Bilateral thenar muscle wasting
Ulnar tunnel syndrome/guyon’s canal syndrome/Handlebar palsy
Why is the nerve easily compressed?
What are the symptoms?
- it passes lateral to pisiform bone over palmar surface of flexor retinaculum
- paresthesia in ring & little finger, weakness of intrinsic muscles of hand supplied by ulnar nerve
Dupuytren’s contracture
What is it?
Which digits are commonly affected?
Commonly affects?
Risk factors?
- Localised thickening of plamar aponeurosis > flexion deformity of adjacent fingers
- ring and little finger
- 40-60 yrs, males, northern european
- T1 diabetes, Epilepsy with barbiturates, smoking, Trauma to hand,
