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Clinical Medicine > Med Screen & differential Diagnosis of Forearm, Wrist & Hand > Flashcards

Med Screen & differential Diagnosis of Forearm, Wrist & Hand Flashcards

1
Q

what are special questions for forearm, wrist & hand?

A

Trauma
Osteoporosis
Steroid
Weakness, clumsiness, dropping items
Smoking
RA
Circulatory problems in digits
Systems review
Vascular/arterial insufficiency
Cervical screen & relationships of UE sx

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2
Q

what are the 3 main vascular pathologies?

A

Cardiac Refferal
Raynaud’s disease
Compartment Syndrome

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3
Q

what are some symptoms of cardiac referral?

A

Majority men & women experience an acute coronary syndrome have chest pain
Chest pain & sweating most frequent sx in men & women

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4
Q

what are the sex difference of sx for cardiac referral?

A

2x as likely to have pain b/w shoulder blades
64% more likely to have nausea or vomiting
34% more likely to experience SOB

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5
Q

what is Raynaud’s disease?

A

small artery/arteriole contraction in hands & feet

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6
Q

what are the demographics for raynauds disease?

A

females > males
15-40
typically bilateral
more common w/ RA, occlusive vascular disease, smokers, B-blockers use

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7
Q

what are the symptoms of Raynaud’s disease?

A
  • Hands blanch, become cyanotic, turn red
  • Rubor Stage: pain/paresthesia as blood returns
  • Usually lasts 15-20 min, alleviate w/ warm water
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8
Q

differentiate b/w primary & secondary Raynaud’s disease?

A

Primary –> vasospastic disorder
Secondary –> due to underlying causes

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9
Q

what is Buerger’s Disease?

A

Vasculitis (inflammation & thrombosis) of arteries/veins in hands/feet

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10
Q

what are the demographics of Buerger’s disease?

A
  • High correlation w/ smoking or use of tabacco
  • 20-40 yr old males > females
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11
Q

what is the clinical picture of Buerger’s Disease?

A
  • Pain from claudication/reduced flow (reduced O2)
  • In Hands: digital, palmar, ulnar arteries most affected
  • May also have edema, cold sensitivity, rubor, cyanosis, trophic skin changes, paresthesias
  • May result in progressive disability from pain, functional loss, amputation
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12
Q

what does acute compartment syndrome most commonly affect?

A

volar forearm & hand

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13
Q

what is acute compartment syndrome caused by?

A
  • Fracture
  • Penetrating trauma/ Combat injuries
  • High pressure injection injury
  • Surgery
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14
Q

what are the 5 P’s in regards to Acute Compartment Syndrome?

A

-Pain
- Paresthesia
- Paresis
- Pallor
- Pulselessness

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15
Q

what is acute compartment syndrome & what number indicates it?

A
  • Inadequate perfusion & relative ischemia of the involved extremity
  • Intra-compartmental pressure >30 mmHg
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16
Q

what are all the inflammation/ infection pathologies?

A

Bursitis
Synovitis
Arthritis
Peripheral Neuritis
Epiphysis
Myositis
Osteomyelitis
Septic Arthritis
Cellultitis
Herpes Zoster

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17
Q

what inflammation/infection pathologies that require immediate referral?

A

Osteomyelitis
Septic Arthritis
Cellultitis
Herpes Zoster

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18
Q

what is the clinical picture of osteoarthritis ?

A

Pain
Swelling
Morning Stiffness
Muscle Weakness (Difficulty gripping & twisting objects)
Osteophyte formation at dorsal aspect of IP Joint

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19
Q

what is the meds/ surgery management of OA?

A

NSAIDS
Steroid Injections
arthroplasty

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20
Q

what is heberden’s node?

A

osteoarthritic enlargement of DIP

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21
Q

what is Bouchard’s nodes?

A

osteoarthritic enlargement of PIP

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22
Q

what is RA?

A
  • Systemic Disease involving inflammation of synovial joints & tendon sheaths
  • Autoimmune
  • Wrist & hand biomechanics often adversely affected
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23
Q

what deformities will be seen in RA?

A
  • Ulnar Drift at MCP’s & RD of wrist
  • Bouchard’s Nodes–> swelling & thickening of MCP & PIP synovium
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24
Q

what is the clinical picture of hand infections?

A

-Swelling
-Pain
-Tender
-Redness
-Warmth
-Loss of motion
-Swelling can cause bone splaying

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25
Q

where is the prime area for hand infection?

A
  • Multiple Spaces (prime area for infection development)
    -Hand: mid-palmar space, web space, thenar space
    -Fingers: volar surface spaces (pulp spaces)
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26
Q

why can hand infections be medical emergency?

A
  • Risk of osteomyelitis/septic arthritis, sepsis & amputation
  • Immunosuppressed pts are at greatest risk
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27
Q

what are Kanavel’s 4 Cardinal Signs of Flexor Sheath Infection?

A

-Finger/hand held in slight flexion
-Swelling
-Tenderness over tendon sheath
-Pain on passive extension

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28
Q

what is ascending lymphangitis?

A

-inflammation of lymphatic channels that occur as a result of infection at a distal site
-Bacterial lymphangitis in severe cases can lead to tacteramei, sepsis & death

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29
Q

what are some neoplasm pathologies?

A

-Ganglion cyst (Benign)
-Neuromas
-Skin Cancer (Malignant melanoma & basal cell carcinoma)
-Pancoast Tumors
-Axillary Masses (Lymphatic, Metastatic tumors, Abscess, Hodgkin’s, Leukemia)

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30
Q

what is a Pancoast tumor?

A

-Tumor of pulmonary apex
-Lung Cancer defined primarily by location
-Spreads to nearby tissues such as ribs & vertebrae

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31
Q

what are the demographics of Pancoast Tumor?

A

-Cigarette smoking
-Average age is in 60’s
-Men > women

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32
Q

what are the symptoms of Pancoast Tumor?

A

-Severs & unrelenting shoulder & arm pain along distribution of 8th cervical & 1st + 2nd thoracic nerve trunks
-Horner’s Syndrome
-Atrophy of intrinsic hand muscle

33
Q

what is a ganglion cyst?

A

-Benign thin walled, cystic, synovial lined lesion containing thick, clear mucinous fluid
-Cyst on dorsal of hand
-Soft swelling that tends to enlarge gradually
-May become painful

34
Q

what is the treatment for ganglion cyst?

A

-Nothing
-Aspiration
-Surgical excision

35
Q

what is the classification of nerve injuries (Seddon)?

A

-Neurapraxia
-Axonotmasis
-Neurotmesis

36
Q

What is neurapraxia?

A

compressed myelin so single can not get across

37
Q

what is axonotmesis?

A

prolonged compression of the axon for a long period of time

38
Q

what is neurotmesis?

A

-Grade III (start to lose endometrium)
-Grade IV (start to lose perineum)
-Grade V (complete transaction)

39
Q

what are the neurologic pathologies?

A

-Carpal Tunnel Syndrome (Median N)
-Guyon’s Canal (Ulnar N)
-Superficial Radial Neuritis (Radial N)
-Wartenberg Syndrome (Radial N)

40
Q

what is carpal tunnel syndrome?

A

-Median Neuropathy at wrist
-Most prevalent entrapment neuropathy

41
Q

what are the most important intrinsic risk factor for carpal tunnel syndrome?

A

-Obesity, Age & female sex

42
Q

what are extrinsic risk factors for carpal tunnel syndrome?

A

-Forceful hand exertions

43
Q

what are the symptoms of carpal tunnel syndrome/

A

-Paraethsia and/or pain in palmar surface of thumb, index, middle finger & lateral border of 4th digit
-Nocturnal Paresthesia
-Pain at wrist (may extend up to elbow & shoulder)
-Weakness in thenar muscles (APB, Opposes Pollicis, FPB)
-May have wasting or atrophy in thenar eminence
-Hypoesthesia D1-D4 (lateral border)

44
Q

what is the clinical examination presentation of carpal tunnel syndrome?

A

-Sensory (decreased or absent sensation in thumb, index finger, middle finger & lateral border of 4th digit)
-Motor (weakness or atrophy in ABP, OP, FPB)
-Reflex (normal)

45
Q

what is the management of carpal tunnel syndrome?

A

-PT/OT
-Splinting/bracing
-Edema inflammatory in nature-cortisone injections
-Surgical decompression (longitudinal division of transverse carpal ligament)

46
Q

what are the symptoms for ulnar nerve entrapment at guyon’s canal?

A

-Complaints of weakness & atrophy of ulnar intrinsic hand muscles
-Complaints of numbness on palmar aspect of hand as well as digits 5 & medial border of digit 4

47
Q

what is the clinical examination presentation of ulnar nerve entrapment at guyon’s canal?

A

-Sensory (decreased or absent sensation in ulnar half of palm, digit 5, medial border of digit 4)
-Motor (significant weakness of ADM, FDI & intrinsic including interossei & ulnar innervated lumbricals & atrophy of ADM/FDI/Intrinsic)
-Ulnar Clas Hand, Wattenberg’s Sign
-Reflex (normal)

48
Q

what is wartenberg syndrome?

A

-Entrapment of superficial radial nerve
-Wrist watch or handcuff neuropathy

49
Q

what is the moi for wartenberg syndrome?

A

-Trauma
-Prolonged compression
-Operative complication during fracture reduction

50
Q

what are the symptoms of wartenberg syndrome?

A

-Paraethsia and/or pain along anatomic snuff box, thumb, & dorm of digits 2-3 & lateral border of 4
-May be worse w/ gripping or use of hand
-No weakness as this is only sensory

51
Q

what is the clinical examination presentation for the wartenberg syndrome?

A

-Sensory (decreased of absent sensation in snuff box & dorsal surfaces of thumb, index finger, middle finger, & lateral border of 4th digit)
-Motor (no weakness)
-Reflex (normal)

52
Q

what is wrist drop-radial nerve at elbow & proximal?

A

-Paralysis of the wrist & finger extensor muscles from temporary compression of radial nerve

53
Q

Differentiate between ischemic & demyelinating for wrist drop-radial nerve at elbow & proximal?

A

Ischemic (temporary - min to hours)
Demyelinating/Axonal (weeks to months)

54
Q

what is the clinical examination presentation for wrist drop - radial nerve at elbow & proximal?

A

-Sensory (decreased or absent sensation in snuff box & dorsal surfaces of thumb, index & middle fingers and lateral border of 4th digit)
-Motor (significant weakness of wrist & finger extension)
-Reflex (diminished or absent brachioradialis reflex)

55
Q

what are degenerative pathologies?

A

OA
Osteochondroses
Osteochondritis dessicans
Loose Bodies
Cervical spondylosis
Osteroporosis
Stenosing tenosynovitis
DeQuervain’s Tenosynovitis
Dupuytren’s Disease

56
Q

what is trigger finger?

A

-Stenosing flexor tenosynovitis, digital tenovaginitis stenosans
-Thickening of flexor tendon sheath (as pt flexes finger tendon sticks)

57
Q

what are the symptoms of trigger fingers?

A

-Palpable nodular enlargement
-Unable to extend finger activity, can flex actively & extend passively
-Usually worse in morning
-Idiopathic, RA/DM

58
Q

what is De Quervain’s Tenosynovitis?

A

-Tenosynovitis of 1st dorsal compartment (EPB, APL)

59
Q

what are the symptoms of De Quervain’s Tenosynovitis?

A

-Pain & edema
-Wrist pain radiating from radial side of wrist up proximal forearm & distally into thumb
-Firm local tenderness in areas of common fibrous sheath over radial styloid

60
Q

what is the care for De Quervain’s Tenosynovitis?

A

Conservative (rest, NSAIDs, spine, modality, eduction, jt mobs)
Surgical (last resort)

61
Q

what are the demographics of De Quervain’s Tenosynovitis?

A

-Pos Finkelstein test
-Women > Men
- Peak age 40-60 yrs old

62
Q

what is Duputren’s Contracture?

A

-Fibroproliferative disorder resulting in contracture of palmar fascia
-Hyperproliferation of type 3 collagen scar tissue in palms & digits
-Nodules or cords that can progress to contraction at the MCP & PIP joints with hyperextension of DIP joints
-Early nodular thickening in palmar fascia which becomes adherent to overlying skin

63
Q

what is the demographics of Duputren’s Contracture?

A

-Older men of Northern European descent
-55yrs
-Associations include: alcohol, smoking, manual labor, diabetes, & epilepsy

64
Q

what is the medical/surgical management of Duputren’s Contracture?

A

-Surgical excision of all abnormal palmar fascia
-Indication >30 degrees MCP flexion deformity & 10 degree of DIP flexion deformity
-CPM hand device may help to maintain finger joint range gained in surgery

65
Q

what is Kienbock’s disease (AVN of Lunate)?

A

-Isolated collapse of lunate due to vascular insufficiency or AVN

66
Q

what is the demographics of Kienbock’s disease?

A

-Low incidence
-Young adults 15-40 yrs

67
Q

what is the moi of Kienbock’s disease?

A

-Single injury or multiple compression forces disrupting blood supply
-Cause dorsal wrist pain (generally indistinguishable from other wrist pain)

68
Q

what is Presier’s Disease (AVN of Scaphoid) clinical presentation?

A

-Wrist pain at rest & motion
-Tenderness over scaphoid (snuffbox)
-Decreased strength common
-Collapse common as bone becomes more necrotic

69
Q

what is the management of Presier’s disease?

A

-Immobilization
-Surgical debridement, pinning, closed wedge osteotomy

70
Q

what is Presier’s disease demographics?

A

-Occurs in 15-30% of scaphoid fx
-Proximal pole fx
-MRI or puncture bleeding during surgery will help differential

71
Q

what is gout?

A

-Metabolic disorder of uric acid leading to hyperuricemia
-Damage to hand raised in chronic phase of disease
-Usually remain asymptomatic for several year

72
Q

what are some things that causes gout?

A

-Uric Acid is product of purine breakdown
-Diet causes: red meat, seafood, dark chocolate

73
Q

what is the acute phase of gout?

A

-Acute monarthritis mainly in 1st metatarsophalangeal jt
-Damage in hand is rarely the 1st manifestation

74
Q

what is the recurrent phase of gout?

A

-Onset of new acute phases

75
Q

what is chronic phase of gout?

A

-Untreated disease may evolve towards chronic tophaceous gout stage
-Most often hand is affected at a later stage when levels of uric acid in blood become very high

76
Q

what is syndactyly?

A

-Webbing of fingers (variable, 3rd & 4th fingers most common)
-Simple to complex
-Most common congenital anomaly

77
Q

what is the management of syndactyly?

A

-Surgical repair (skin grafts/z-plasty)
-Surgery before 1 yr due to development of grasp

78
Q

what is clinical presentation of radial club hand (radial deficiency)?

A

-Radial deviation of hand; shortening and/or curvature of ulnar
-Absent thumb

79
Q

what is the surgery for radial club hand (radial deficiency)?

A

-Hand Centralization (resection of carpal bones, shortening of ECU & angular osteotomy of ulna)

Clinical Medicine (12 decks)

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