MSK - Hand Flashcards
What muscles of the hand are supplied by the median nerve
Lateral 2 lumbricals
Opponens Pollicis
Abductor pollicis brevis
Flexor pollicis brevis
Saturday night palsy
Transient radial nerve palsy due to compression of the radial nerve commonly due to falling asleep with arm over chair (compression of radial nerve)
Causes/Sx of radial neuropathy
Wrist drop
Numbness over dorsal hand
Pinching/grasping problems
Saturday night palsy
Humeral shaft fracture
Extrinsic compression (tumour, soft tissue swelling)
Peripheral neuropathy (B12/Thiamine/alcohol)
Causes of carpal tunnel syndrome
Pregnancy Acromegaly Obesity Hypothyroidism Diabetes
Signs of psoriasis
Pitting
Onycholysis
Subungual Hyperkeratosis
Psoriatic plaques
Joint swelling/erythema
Dactylitis
Hand signs of RA
Ulnar deviation Z-thumb/squaring of thumb Symmetrical MCP/PIP swelling Rheumatoid nodules Swan-neck/Boutonniere deformity
Ulnar nerve palsy presentation
Ulnar claw
Tingling/paraesthesia in ulnar nerve distribution
Hypothenar wasting
Weakness of grip strength
Froment’s sign (can’t strongly grip a piece of paper due to adductor pollicis weakness)
2 Types of ulnar nerve palsy
At the wrist (Guyon’s canal syndrome)
At the elbow (Cubital tunnel syndrome): Get a less pronounced claw as paralysis of FDP
Causes Trauma Overuse injury (cyclists, handlebar palsy) Swelling Vascular pathologies
De quervain’s tendinopathy vs carpometacarpal arthritis of the thumb
Arthritis: Pain and tenderness at base of thumb on palpation - causes difficulty grasping and pinching
DQT: Pain and tenderness on radial aspect of wrist, Finkelstein’s test +ve
Mallet finger
Deformity of the finger due to the disruption of the extensor tendon distal to the DIP
CMC arthritis diagnosis and Mx
Diagnosis
Examination - CMC grind test
XR
Mx
NSAIDS
Thumb spica bracing
Intraarticular steroids
Arthrodesis/osteotomy
Cubital tunnel syndrome
Compression neuropathy of the ulnar nerve at the medial elbow, causing:
Hypothenar wasting
Loss of sensation over 4th and 5th fingers (NO LOSS in forearm)
Slight ulnar claw
Night symptoms (if sleeping with arm in flexion)
Dupuytren’s contracture
Proliferative thickening of palmar fascia (+painful nodules), causing fixed flexion of fingers (ring > small > middle > index)
Causes
Dupuytren’s contracture Mx
ROM exercises
Needle aponeurotomy
Surgical resection
Hip dislocation complications
- Femoral head fractures
- Osteonecrosis
- Sciatic nerve injury
- Ipsilateral knee injury
*Must do post-reduction CT for traumatic hip dislocations
