Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CP3 @ UoN - Musculoskeletal & MDD > Regional Peri-Articular Pain - Hand/Wrist > Flashcards

Regional Peri-Articular Pain - Hand/Wrist Flashcards

1
Q

What are the common presenting features of overusage/strain injuries?

A 
Exact time/mechanism of injury identifiable
Pain non-progressive
Pain produced by one/few movements
Localised tenderness
Pain on active movement/stress testing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the peri-articular syndromes affecting the wrist/hand?

A 
De Quervain's Tenovaginitis
Median Nerve Compression
Cubital Tunnel Syndrome
Ganglion Cyst
Trigger Finger
Dupuytren's Contracture
Base of thumb OA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is De Quervain’s Tenovaginitis?

A

Painful inflammation of abductor pollicis longus & extensor pollicis brevis tendons in 1st dorsal compartment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What causes De Quervain’s Tenovaginitis??

A

Unkown
Most common after unaccustomed intensive activity
-classically middle aged/post-partum women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the 1st dorsal compartment?

A

Area just proximal to anatomical snuff box

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How does De Quervain’s Tenovaginitis present?

A

Acute pain over 1st dorsal compartment

  • worse when using thumb
  • tenderness/swelling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the signs on examination of De Quervain’s Tenovaginitis ?

A

LOOK - normal/swelling over radial border
FEEL - normal/tender over radial border
MOVE - active thumb abduction/ulnar deviation affected
TEST - Finkelstein’s +ve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is Finkelstein’s test?

A

Thumbs across palm, ulnar deviation causes pain over the tunnel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the key differential for De Quervain’s Tenovaginitis?

A

Base of thumb OA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the conservative management of De Quervain’s Tenovaginitis?

A

Rest
Analgesia
Splintage w/ thumb immobilisation (3wks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the surgical management of De Quervain’s Tenovaginitis ?

A

Longitudinal compartment release

-required if recurrence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What structures make up the carpal tunnel?

A

Carpal bones

Covered by flexor retinaculum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the carpal bones?

A

Proximal row = Scaphoid, Lunate, Triquetrum, Pisiform
Distal row = Trapezium, Trapezoid, Capitate, Hamate
SOME LOVERS TRY POSITIONS THAT THEY CAN’T HANDLE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What structures does the Carpal Tunnel contain?

A 
Nine flexor tendons
   -4 flexor digitorum profundus
   -4 flexor digitorum superficialis
   -1 flexor pollicus longus
Median nerve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is Carpal Tunnel Syndrome?

A

Compression neuropathy of median nerve as it passes through the carpal tunnel
-technically median nerve compression until there is thenar eminence wasting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What causes Carpal Tunnel Syndrome?

A 
Idiopathic (95%)
Entrapment in other conditions
   -DM
   -RA
   -hypothyroidism
   -acromegaly
   -trauma (Colles' fracture)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

In which group is Carpal Tunnel Syndrome more common?

A

Women

-3x more common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does Carpal Tunnel Syndrome present?

A

Pain/paresthesia in hand, worst in morning
-due to wrist flexion when asleep
-may wake pt/sleep w/ hand over bed
Thenar muscle weakness
-noticed as clumsiness
Sensory loss in palm/radial 3 1/2 fingers
-often not noticed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the signs on examination of Carpal Tunnel Syndrome?

A

LOOK - normal/thenar wasting
FEEL - reduced thenar bulk
MOVE - active thumb abduction/opposition affected
TEST - Tinel’s +ve, Phalen’s +ve, dec sensation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is Tinel’s test?

A

Tapping over carpal tunnel leads to paraesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is Phalen’s test?

A

Flexion for 60s leads to pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What investigations may be appropriate in suspected carpal tunnel syndrome?

A

Nerve conduction studies

  • slowed at wrist
  • may be normal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the conservative management of Carpal Tunnel Syndrome?

A

Rest
Night time splinting
NSAIDs/steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the surgical management of Carpal Tunnel Syndrome?

A

Division of flexor retinaculum

-scar in palm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is Cubital Tunnel Syndrome?

A

Compression neuropathy of ulnar nerve at cubital tunnel of elbow

26
Q

What is the Cubital Tunnel?

A

Area medial & posterior on elbow joint (in anatomical position)

27
Q

What causes Cubital Tunnel Syndrome?

A

Flexion of elbows for long periods
Tight fascial bands
Ulnar fracture
Valgus deformities

28
Q

How does Cubital Tunnel Syndrome present?

A

Pain near elbow joint
-may radiate down ulnar forearm
Paraesthesia/sensory loss over ulnar distribution
Hand clumsiness/reduced pinch/grip strength
Clawing of hand
-if severe
-due to wasting of hypothenar/interosseus muscles

29
Q

What are the signs on examination of Cubital Tunnel Syndrome?

A

LOOK - guttering b/w metacarpals, hypothenar wasting
FEEL - tenderness around cubital tunnel
MOVE - elbow movements limited, unable to actively extend IPJs, or avtively abduct/adduct finger
TEST - loss of sensation, reduced 1st dorsal interosseus power, Tinels +ve, elbow flexion +ve

30
Q

What is the elbow flexion test?

A

Sustained elbow flexion, w/ forearm supinated & wrist extended will reproduce sx

31
Q

What investigations may be appropriate in Cubital Tunnel Syndrome?

A

X-rays - pathogenic osteophyte

Nerve conduction studies - slowed at elbow

32
Q

What is the conservative management of Cubital Tunnel Syndrome?

A

Night time splinting
NSAIDs
Activity modification

33
Q

What is the surgical management of Cubital Tunnel Syndrome?

A

Simple cubital tunnel decompression

Anterior transposition of nerve

34
Q

What is a ganglion cyst?

A

Soft tissue swelling filled w/ degenerative myxoid fluid stemming from underlying joint capsule, ligament or tendon sheath

35
Q

How does a ganglion cyst present?

A

Lump in hand/wrist

Cosmetic concerns/associated pain

36
Q

What are the causes of Ganglion cysts?

A

Idiopathic

Post trauma

37
Q

In which group are ganglion cysts most common?

A

Women 20-40yrs

38
Q

What are the signs on examination of ganglion cysts?

A

LOOK - swelling
FEEL - hard/soft, not fixed to skin
MOVE - obvious w/ joint movements/limit end range of movement
TEST - transilluminate

39
Q

What are the common sites of ganglion cyst formation?

A

Scapholunate joint (dorsum of wrist)
Scaphotrapezial joint (volar aspect of wrist)
Base of finger (seed ganglion)
DIPJ (mucous cyst)

40
Q

What is the conservative management of ganglion cysts?

A

Reassurance
NSAIDs
Aspiration +/- steroid injections

41
Q

What is the surgical management of ganglion cysts?

A

Excision

-40% recurrence rate

42
Q

What is Trigger Finger?

A

Idiopathic fibrosis of flexor tunnel leading to intratendinous nodule interrupting normal finer movement

43
Q

How does Trigger Finger usually present?

A 
Ring/middle finger affected
Finger gets stuck in flexion
   -on further effort can snap into extension
May be permanently locked
   -if severe
44
Q

In which group is Trigger Finger most common?

A

Women >40yrs

RA & DM

45
Q

What are the signs on examination of Trigger Finger?

A

LOOK - flexion at PIPJ/DIPJ
FEEL - can feel triggering on flexion, nodule at base of finger
MOVE - jerky/hesitant active flexion/extension, full extension limited
TEST - n/a

46
Q

What is the conservative management of Trigger Finger?

A

Activity modification
NSAIDs
Tendon sheath corticosteroid injection

47
Q

What is the surgical management of Trigger Finger?

A

Release of A1 pulley
Tenosynovectomy
-in RA pts

48
Q

What is Dupuytren’s Contracture?

A

Progressive, painless thickening of palmar fascia, causing flexion deformities in fingers & functional difficulties

49
Q

What are the risk factors for Dupuytren’s Contracture?

A 
Males
Nordic
Family hx
Trauma
DM
Alcoholism
Phenytoin
Liver cirrhosis
50
Q

How does Dupuytren’s Contracture present?

A

Flexion deformities of fingers

Functional difficulties

51
Q

What are the signs on examination of Dupuytren’s Contracture?

A

LOOK - nodules/cords in palm/fingers w/ flexion of MCP/PIP (middle/ring)
FEEL - thickened palmar fascia, Garrod’s pads on dorsum of PIPJs
MOVE - loss of active/passive extension
TEST - n/a

52
Q

What is the conservative management of Dupuytren’s Contracture?

A

No treatment req if no functional impairment

53
Q

What is the surgical management of Dupuytren’s Contracture?

A 
Needle aponeurotomy
Enzymatic fasciotomy
Fasciotomy
Fasciectomy
Dermofasciectomy
54
Q

How does Base of Thumb OA present?

A

Pain on activities involving gripping/pinching

Swelling, deformity, tenderness at CMCJ

55
Q

What are the signs on examination of Base of Thumb OA?

A

LOOK - shoulder sign +ve, base of thumb swelling, thenar wasting
FEEL - pain/warmth, thenar wasting
MOVE - global pain/stiffness of CMCJ movements (add, palmar/radial abd, opposition)

56
Q

What is the conservative management of Base of Thumb OA?

A

As for any OA pt

57
Q

What is the surgical management of Base of Thumb OA?

A

Denervation
Trapeziectomy
Basal thumb arthroplasty
Joint fusion

58
Q

What is the Shoulder Sign?

A

Radial prominence at base of thumb from dorsal subluxation

-sign of base of thumb OA

59
Q

What is the Tuck sign?

A

Combined finger & wrist extension causes abnormal tenosynovium/dorsal skin to “tuck” under the extensor retinaculam of the wrist

60
Q

What causes the Tuck Sign?

A

Inflamed synovial sheaths pressed up against flexor retinaculum
-disappears on flexion

61
Q

What is the Tuck Sign characteristic of?

A

Extensory Tynosinovitis

CP3 @ UoN - Musculoskeletal & MDD (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions