MSK 21 - Common Conditions of the Hand + Wrist

Question 1

How do scaphoid fractures usually occur?
How does the patient present?
What is the main complication?

Answer 1

• FOOSH in mainly children + adolescents
• Pain + wrist swelling, pain in anatomical snuff box, pain on scaphoid compression
• Retrograde blood supply (only) in 10%, fractures cause AVN to proximal part.

Question 2

What is a “Colles” fracture?
What is the nickname for this fracture?
How do these fractures occur?

Answer 2

• Extra-articular fracture of distal radius where the distal fragment displaces dorsally (posteriorly).
• Dinner fork deformity, caused by FOOSH (pronation + extension) in a high energy impact (e.g.: skiing). Common in patients w/osteoporosis or post-menopausal women

Question 3

What is a “Smith” fracture?
What is the nickname for this fracture?
Who are they common in?

Answer 3

• Extra-articular fracture of the distal-radius where the distal fragment displaces volarly (anteriorly)
• Garden spade deformity, common in young males and elderly females (much less common than Colles fracture)

Question 4

Which joints in the hand are commonly affected by OA?

Which 2 nodes are characteristic of OA in the hand?

Answer 4

• Thumb (1st CMCJ) and DIPJ’s in the hand

1) Heberden’s nodes (presence of osteophytes causes bony swellings in DIPJ’s)
2) Bouchard’s nodes (presence of osteophytes causes swellings of PIPJ’s)

Question 5

Which joints in the hand does RA commonly affect?
What does the patient present with?
What 2 hand deformities can RA lead to?

Answer 5

• Affects MCPJ + PIPJ (sparing of DIPJ’s, if DIPJ’s involved consider OA)
• Pain + swelling in joints, erythema overlying the joints, stiffness, fatigue/flu-like symptoms. usually a sign of late stage of rheumatic disease.

1) Swan-neck deformity - PIPJ in hyper-extension, DIPJ in flexion
2) Boutonniere’s deformity - PIPJ in flexion, DIPJ in extension

Question 6

What are the classical X-ray features of RA?

Answer 6

LESS

1) Loss of joint space
2) Erosions
3) Soft-tissue swelling
4) See through bones (osteopenia)

Question 7

What is psoriatic arthropathy?
What joints are affected?
What are the usual signs/presentations?

Answer 7

• A small minority of patients w/psoriasis will develop arthritis, usually affecting joints of hands + feet.
• Typically DIPJ’s are affected (unlike RA)
• Swelling of whole digits (dactylitis). 80% have nail lesions such as pitting or onycholysis (separation of nail from nail bed).

Question 8

What is carpal tunnel syndrome (CTS)?
What are the usual signs/symptoms?
What are common risk factors?

Answer 8

• Compression of median nerve through carpal tunnel
• Paraesthesia in areas supplied by median nerve (thumb, index, middle, lateral side of ring), worsening at night when wrist moves into flexion.
• Wrist work, pregnancy, RA + hypothyroidism

Question 9

What is Ulna nerve compression at Guyon’s canal?

How does it present?

Answer 9

• Compression of ulna nerve at wrist
• Paraesthesia of all intrinsic muscles of hand apart from LOAF (supplied by medina)
• Leads to claw like deformity

Question 10

What is Dupuytren’s contracture?
How does it present?
Who does it commonly affect?

Answer 10

• Thickening and contracture of palmar aponeurosis leading to flexion deformity in adjacent fingers
• With nodules/cords in the palm of the hand, usually starting with little finger.
• Common in 50-70 Y/O’s, sometimes painful.