orthopaedics: hands Flashcards
what is cubital tunnel syndrome
compression of ulnar nerve at elbow: (medial epicondyle)
what are symptoms of cubital tunnel syndrome
parasthesia in ulnar fingers (medial 1+1/2), weakness in abduction of fingers (interossei muscles), positive tinel’s test, positive froment’s test
what is tinels test
percussion over affected nerve (ulnar or median) which then causes symptoms
what is froment’s test
when hold piece of paper inbetween thumb and finger looks weird
what causes cubital tunnel syndrome
tight fascia band on roof of tunnel (osborne’s fascia)
what investigations are done for cubital tunnel
exam and nerve conduction studies
how can you treat cubital tunnel
surgical release
what forms the carpal tunnel
carpal wrist bones and flexor retinaculum (carpal ligament)
what passes through the carpal tunnel
median nerve and 9 flexor tendons
what happens in carpal tunnel syndrome
increased pressure in the carpal tunnel compresses median nerve and flexor tendons (affects nerves more than flexors)
what can cause carpal tunnel syndrome
idiopathic women, RA, fluid retention, pregnancy, diabetes, renal failure, hypothyroidism, fractures at wrists
what symptoms are there of carpal tunnel syndrome
paraethesia in median nerve digits (thumb index, middle,) which is worse at night, loss of sensation/ function of thumb (themnar muscles)
what investigations are done for carpal tunnel syndrome
Tinel’s, Phalen’s, nerve conduction studies
what treatment can be done for carpal tunnel syndrome
non-operative: wrist splint and steroid injections.
surgical: decompression (division of ligament)
what is dupuytren’s contracture
palmar fascia is hypertrophic
where is palma fascia
separates muscles and skin
what digits are normally affected in dupuytren’s contracture
ring and pinkie finger
what cells proliferate in dupuytren’s contracture
myofibroblast cells: abnormal collagen type III
what can cause dupuytren’s contracture
white men, alcoholic cirrhosis, diabetes, phenytoin therapy, peyronies and ledderhose disease
how do you treat dupuytren’s contracture surgically
fasciotomy (removal of diseased tissue and division of cords), amputation if severe
what is trigger finger
tendonitis of flexor tendon to a digit –> nodular enlargement catches in fascia pulley –> trapped in flexed position
what are symptoms of trigger finger
clicking when moving, painful, finger locked in flexed position, middle and ring finger most common
how do you treat trigger finger
steroid injection around tendon, surgery if recurrence (incision of fascial pulleY)
what is dequervain’s tenosynovitis
spontaneous inflammation of tendons compartment of thumb
what are symptoms of dequervain’s tenosynovitis
swollen, red, painful thumb esp on movement
how do you manage dequervain’s tenosynovitis (mild –> severe)
NSAIDs, splint, steroid injection, surgical decompression
what type of nodes present on DIP’s from OA
herberden’s nodes
what can be associated with DIP OA
dorsal ganglion ycst
how do you manage DIP OA
osteophyte excision and arthrodesis if severe pain
what nodes are associated with PIP OA
Bouchard’s nodes
how do you treat PIP OA
athrodesis or arthroplasty
where do you rarely get OA in the hand
MCPs - usually from previous injury
what joints does RA commonly affect in the hand
MCP’s - spares DIP
what are the 3 stages of hand RA
1) synovitis and tenosynovitis 2) erosion 3) joint instability and tendon rupture
describe synovitis and tenosynovitis in RA
inflamm within joints and tendon sheath causing swelling and pain
describe erosion in RA
inflam pannus (synovium cartilage) which affects articular cartilage
what deformites can occur with RA deformities
Volar MCPJ subluxation, ulnar deviation, swan neck deformity, boutonnière deformity, Z shaped fun
what is a swan neck deformity
PIP drops in RA
what is a boutonniere deformity
PIP raises in RA
how do you treat RA of hands
DMARDs (first), tenosynovectomy (excision of tendon sheath), soft tissue release
what are ganglion cysts
common mucinois filled cysts around tendons or synovial joints
where do ganglion cysts commonly present
DIP, wrist, (knee baker’s cyst)
what are symptoms of ganglion cysts
localised pain and irritation, firm, smooth, rubbery feel, transilluminate
how do you treat ganglion cysts
needle aspiration (high recurrence, surgical excision (only if indicted)
what is tendonitis
acute injury and inflam
what is teninosis
chronic damage at cellular level (no inflamm)
what is enthesopathy
inflam of tendon at insertion to bone
what are tendons made of
fibroblasts producing collagen
