orthopaedics: hands

Question 1

what is cubital tunnel syndrome

Answer 1

compression of ulnar nerve at elbow: (medial epicondyle)

Question 2

what are symptoms of cubital tunnel syndrome

Answer 2

parasthesia in ulnar fingers (medial 1+1/2), weakness in abduction of fingers (interossei muscles), positive tinel’s test, positive froment’s test

Question 3

what is tinels test

Answer 3

percussion over affected nerve (ulnar or median) which then causes symptoms

Question 4

what is froment’s test

Answer 4

when hold piece of paper inbetween thumb and finger looks weird

Question 5

what causes cubital tunnel syndrome

Answer 5

tight fascia band on roof of tunnel (osborne’s fascia)

Question 6

what investigations are done for cubital tunnel

Answer 6

exam and nerve conduction studies

Question 7

how can you treat cubital tunnel

Answer 7

surgical release

Question 8

what forms the carpal tunnel

Answer 8

carpal wrist bones and flexor retinaculum (carpal ligament)

Question 9

what passes through the carpal tunnel

Answer 9

median nerve and 9 flexor tendons

Question 10

what happens in carpal tunnel syndrome

Answer 10

increased pressure in the carpal tunnel compresses median nerve and flexor tendons (affects nerves more than flexors)

Question 11

what can cause carpal tunnel syndrome

Answer 11

idiopathic women, RA, fluid retention, pregnancy, diabetes, renal failure, hypothyroidism, fractures at wrists

Question 12

what symptoms are there of carpal tunnel syndrome

Answer 12

paraethesia in median nerve digits (thumb index, middle,) which is worse at night, loss of sensation/ function of thumb (themnar muscles)

Question 13

what investigations are done for carpal tunnel syndrome

Answer 13

Tinel’s, Phalen’s, nerve conduction studies

Question 14

what treatment can be done for carpal tunnel syndrome

Answer 14

non-operative: wrist splint and steroid injections.

surgical: decompression (division of ligament)

Question 15

what is dupuytren’s contracture

Answer 15

palmar fascia is hypertrophic

Question 16

where is palma fascia

Answer 16

separates muscles and skin

Question 17

what digits are normally affected in dupuytren’s contracture

Answer 17

ring and pinkie finger

Question 18

what cells proliferate in dupuytren’s contracture

Answer 18

myofibroblast cells: abnormal collagen type III

Question 19

what can cause dupuytren’s contracture

Answer 19

white men, alcoholic cirrhosis, diabetes, phenytoin therapy, peyronies and ledderhose disease

Question 20

how do you treat dupuytren’s contracture surgically

Answer 20

fasciotomy (removal of diseased tissue and division of cords), amputation if severe

Question 21

what is trigger finger

Answer 21

tendonitis of flexor tendon to a digit –> nodular enlargement catches in fascia pulley –> trapped in flexed position

Question 22

what are symptoms of trigger finger

Answer 22

clicking when moving, painful, finger locked in flexed position, middle and ring finger most common

Question 23

how do you treat trigger finger

Answer 23

steroid injection around tendon, surgery if recurrence (incision of fascial pulleY)

Question 24

what is dequervain’s tenosynovitis

Answer 24

spontaneous inflammation of tendons compartment of thumb

Question 25

what are symptoms of dequervain's tenosynovitis

Answer 25

swollen, red, painful thumb esp on movement

Question 26

how do you manage dequervain's tenosynovitis (mild --> severe)

Answer 26

NSAIDs, splint, steroid injection, surgical decompression

Question 27

what type of nodes present on DIP's from OA

Answer 27

herberden's nodes

Question 28

what can be associated with DIP OA

Answer 28

dorsal ganglion ycst

Question 29

how do you manage DIP OA

Answer 29

osteophyte excision and arthrodesis if severe pain

Question 30

what nodes are associated with PIP OA

Answer 30

Bouchard's nodes

Question 31

how do you treat PIP OA

Answer 31

athrodesis or arthroplasty

Question 32

where do you rarely get OA in the hand

Answer 32

MCPs - usually from previous injury

Question 33

what joints does RA commonly affect in the hand

Answer 33

MCP's - spares DIP

Question 34

what are the 3 stages of hand RA

Answer 34

1) synovitis and tenosynovitis 2) erosion 3) joint instability and tendon rupture

Question 35

describe synovitis and tenosynovitis in RA

Answer 35

inflamm within joints and tendon sheath causing swelling and pain

Question 36

describe erosion in RA

Answer 36

inflam pannus (synovium cartilage) which affects articular cartilage

Question 37

what deformites can occur with RA deformities

Answer 37

Volar MCPJ subluxation, ulnar deviation, swan neck deformity, boutonnière deformity, Z shaped fun

Question 38

what is a swan neck deformity

Answer 38

PIP drops in RA

Question 39

what is a boutonniere deformity

Answer 39

PIP raises in RA

Question 40

how do you treat RA of hands

Answer 40

DMARDs (first), tenosynovectomy (excision of tendon sheath), soft tissue release

Question 41

what are ganglion cysts

Answer 41

common mucinois filled cysts around tendons or synovial joints

Question 42

where do ganglion cysts commonly present

Answer 42

DIP, wrist, (knee baker's cyst)

Question 43

what are symptoms of ganglion cysts

Answer 43

localised pain and irritation, firm, smooth, rubbery feel, transilluminate

Question 44

how do you treat ganglion cysts

Answer 44

needle aspiration (high recurrence, surgical excision (only if indicted)

Question 45

what is tendonitis

Answer 45

acute injury and inflam

Question 46

what is teninosis

Answer 46

chronic damage at cellular level (no inflamm)

Question 47

what is enthesopathy

Answer 47

inflam of tendon at insertion to bone

Question 48

what are tendons made of

Answer 48

fibroblasts producing collagen