HT: Referral to Surgeon Flashcards
What makes up the carpal tunnel
- Carpal bones
- Transverse carpal ligament
- 9 flexor tendons
- Median nerve
Why is there night pain with CTS?
- synovium more swollen at night
+ wrist slightly flexed - less room for the nerve
What are the signs of CTS?
- Thenar muscle atrophy
- APB weakness
- Tinnels, phalens, durkans
When should you call hand surgeon for CTS?
- Constant symptoms
- Thenar muscle atrophy or weakness
- “failed” conservative management - symptoms progressing, interfering with function
What is Cubital Tunnel Syndrome
- Ulnar nerve compression at elbow
- Second most common neuropathy
What are the symptoms of cybital tunnel syndrome?
- Medial/ Ulnar 1 and 1/2 digits
- Pins and needles
- Numbness
- Pain
- Sleep disturbance
- Loss of dexterity
What are the signs of cubital tunnel syndrome?
- Claw deformity
- Interossei wasting
- Wartenburg sign (LF abduction)
- Weakness (test 1st muscle interosseus, abd index)
- Altered sensation
- Provocation test: tinel, forced elbow flexion
Conservative management of Cubital Tunnel syndrome?
- Nerve gliding exercises
- Avoid prolonged elbow flexion
- Avoid pressure on cubital tunnel
- Night elbow splint < 30deg flexion
When to refer for cubital tunnel syndrome?
- Constant symptoms
- Muscle atrophy or weakness
- Rapid onset and progression
- Failed conservative management
When to call a hand surgeon for trigger finger?
- Failed conservative management
- Ongoing symptoms despite splint/ 2 corticosteroid injections over 12 months
SAME CONCEPT FOR DEQUERVAINS
Whats conservative management of PIP joint injuries
- Assess stability
- Mobilise
- Dorsal extension blocking splint
- Buddy strap
When to call a hand surgeon for PIP joint injuries?
- Unstable
- Open injury
- Incongruent reduction on X-ray
- Pilon fracture
When to call a hand surgeon for a DIP joint injury
- Irreducible dislocation
- Open dislocation
- Associated flexor digitorum profundus avulsion
- Reduction not maintained by splint
- Pilon fracture
When to refer to hand surgeon following mallet finger?
- Delayed presentations
- Large mallet fracture fragment
- Joint subluxation
What is Rugger Jersey finger
- FDP tendon avulsion at insertion
- Forced DIP joint extension while FDP is contracting
ALWAYS CALL HAND SURGEON
What are different type of fracture displacements?
- angulation
- translation
- shortening
- rotation/ malrotation
- Articular congruity
Review table of type of fractures that need surgery
Aim to operate to improve position of fracture/ and or hold the fracture in position as it heals
What are implant choices for stabilisation
- K-wires
- Screws
- External fixators
- Intramedullary Nail
- Plates
- Locking plates
When to refer to surgeon for OA?
- Surgery still symptomatic treatment
- Failure of conservative management
- persistent pain, stiffness and functional impairment
- Arthoplasty
What is paronychia?
- Infection involving proximal or lateral nail fold
- Refer to GP
- +/- splint to rest area
- Call hand surgeon if not responding to non-operative treatment
What is a felon?
- Infection of the pulp
- Call if not responding to conservative and tense pulp
How to manage flexor sheath infection?
- Infection of flexor tendon within finger
- Semi-flexed, fusiform swelling, tenderness along flexor sheath, exquisit pain with passive finger extension
- Always call surgeon
Fight Bite: how to manage
Always call a hand surgeon
- Septic arthritis
- surgical exploration
- Washout
- IV antibiotics
Skiers thumbs: when to call a hand surgeon
Grade 1/2: non operative, splint for 6 weeks
Strengthening at 6-8 weeks, with unrestricted activity at 12 weeks
Grade 3: surgery within 6 weeks
- Immediate IPJ movement,
- thermoplastic splint at day 3-5
- start MCP movement at 3-4 weeks
- Cease daytime splintat 6 weeks
- Cease night splint at 10 weeks
