Hand & Wrist Conditions Flashcards
Scaphoid fracture symptoms, where, diagnosis, complications
Adolescents/ young adults FOOSH (hyperextension and impaction)
Pain anatomical snuffbox, worse moving the wrist, reduced range of motion, swelling,
Most waist 70-80%, proximal pole 20%, distal pole 10% (scaphoid tubercle)
X-rays repeated 10-14days after, fracture line more visible after resorption -> CT/MRI
Waist-> displaced high risk non-union/malunion/ avascular necrosis/ carpal instability/ secondary OA
Colles’ fracture what, who, cause, symptoms, treatment, 4 complications
Extra-articulate distal radial metaphysis with dorsal angulation and impaction (-> 50% associated ulnar styloid fracture)
Common ppl with OA (post-menopausal women). Younger= high impact trauma
FOOSH pronated forearm, wrist dorsiflexion, dorsally angulated and impacted (x-ray)
Painful, deformed, swollen wrist
✅reduction, immobilisation
Malunion -> ‘dinner fork deformity’/ median nerve palsy & post-traumatic carpal tunnel syndrome/ secondary OA (more common intra-articular)/ tear extensor pollocks longus tendon (attrition over sharp fragment)
Smith fracture what, who, cause, 2 complications
Fractures distal radius with volar angulation (palmar) of distal fracture fragments. 85% extra-articular ‘reverse colles’ fracture’
Young males and elderly females
Fall flexed wrist/ direct blow back of the wrist
Malunion with residual volar displacement -> ‘garden spade deformity’ -> carpal tunnel syndrome
Rheumatoid arthritis of metacarpophalangeal joints and interphalangeal joints cause, symptoms, X-Ray features
Autoimmune disease, autoantibodies (rheumatoid factor) attack synovial membrane -> inflamed synovial cells proliferate -> pannus penetrates through cartilage & adjacent bone -> erosion and deformity
. Symmetrical polyarthritis
Pain/ weak king PIPjs and MCPJs, erythema, stiffness (worse morning or after inactivity), carpal tunnel syndrome (compression median never due synovial swelling), fatigue and flu-symptoms, rheumatoid nodules later & deformities
X-ray features: reduction joint space, subluxation (partial dislocation), gross deformity, juxta-articular bony erosions, periarticular osteopenia
Swan neck deformity what, cause
Rheumatoid arthritis, PIPJ hyperextends and MCPJ/ DIPJ flexed
Adjacent synovitis -> Tissues in volar (palmar) aspect proximal interphalangeal joint become lax (muscles forces extension> flexion). DIPJ elongation/ rupture insertion extensor digitorum -> mallet deformity
Boutonniere deformity what, cause
Rheumatoid arthritis- metacarpophalangeal joints & DIPj hyperextend, PIPJ flexes.
Inflammation PIPJ-> lengthening/ rupture central slip extensor digitorum on dorsal surface, lateral bands slip down -> on palmar surface start acting as flexors PIPJ and extensors DIPj
Psoriatic arthropathy who, where, symptoms
Psoriasis - skin condition-> red flaky patches covered silvery scales elbows/ knees/ scalp/ lower back
Some develop arthritis, asymmetrical oligoarthritis (one joint at a time)
Fusiform swellings digits = dactylitis, stiffness, widespread joint destruction = arthritis mutilans, 80% nail lesions (pitting/ onycholysis = separation nail from nail bed also caused by hyperthyroidism and fungus)
Most commonly affects DIPJ
Osteoarthritis 1st carpometacarpal joint and DIPjs where, who, symptoms
Joint between trapezium and first metacarpal
Women >40yrs
Pain base thumb worse movement, stiffness after rest, swelling around thumb, later first metacarpal subluxes in ulnar direction = squaring of the hand
Heberden’s nodes where, symptoms, who
Sign of osteoarthritis. Dipj
Middle aged, women, genetic
Chronic swelling/ sudden onset pain, loss manual Dexterity. Cystic swelling with gelatinous hyaluronic acid on dorsolateral aspect. Subside -> osteophyte
In PIPjs = Bouchard’s nodes
Carpal tunnel syndrome what, risks, cause, symptoms
Compression median nerve
Obesity, repetitive wrist work, pregnancy, rheumatoid arthritis, hypothyroidism
Ischaemia/ focal myelation/ decrease Axonal calibre / atonal loss
Paraesthesia thumb/ index/ middle/ radial half ring finger, worse night may wake, activities wrist aggregate, chronic -> thenar atrophy, pain forearm/ elbow/ shoulder/ neck
Sensation palm spared cutaneous branch branches proximal to carpal tunnel
Ulnar nerve compression in Guyon’s canal where, names, symptoms
Ulnar nerve passes radial to pisiform bone over volar surface of flexor retinaculum ‘ulnar tunnel syndrome’, ‘guyon’s canal syndrome’ ‘handlebar palsy’
Paraesthesia ring and little fingers -> weakness intrinsic muscles hand supplied by ulnar nerve
Dupuytren’s contracture what, symptoms, who, risks
Localised thickening and contracture palmar aponeurosis -> flexion deformity adjacent fingers
Thickening/ nodule palm may have pain -> myofibroblasts contract -> tight bands ‘cords’ in palmar fascia -> fingers stuck flexion ‘fixed flexion’ most ring and little
40-60yrs, males, family history
Conditions increase risk: diabetes type 1, HIV, heart disease, hypercholesterolaemia, trauma hand/ fingers, hypo or hyperthyroidism
