Scaphoid fracture

Question 1

Scaphoid fracture mechanism of injury

Answer 1

• FOOSH
• Pain in anatomical snuffbox
• Pain on telescoping the thumb

Question 2

Ix

Answer 2

Xray

Question 3

Mx

Answer 3

• Scaphoid x-ray
• Place wrist in scaphoid plaster
- fracture may become apparent after 10 days
• pt. returns to clinic after 10 days for re-xray
- # visible → plaster for 6 wks
- Not visible but clinically tender → plaster for 2
wks or MRI
- # not visible and not clinically tender → no plaster

Displaced - internal fixation

Question 4

Complications

Answer 4

AVN of the scaphoid as retrograde blood supply
- stiffness and pain at the wrist

Non union

Question 5

Presentation

Answer 5

Sudden onset wrist pain

May have bruising

Tenderness in the floor of the anatomical snuffbox

Pain on palpating the scaphoid tubercle

Pain on telescoping of the thumb

Question 6

Borders of the anatomical snuffbox

Answer 6

Lateral - abductor pollicus longus and extensor pollicis brevis tendons

Medial - extensor pollicis longus tendon

Floor - scaphoid, trapezium and radial styloid

Roof - flexor retinaculum

Question 7

Contents of the anatomical snuffbox

Answer 7

Radial artery
Superficial radial nerve
Cephalic vein

Question 8

Carpal tunnel syndrome

Answer 8

Compression of the median nerve within the carpal tunnel of the wrist, due to a raised pressure within this compartment

Question 9

Which nerve is affected in carpal tunnel syndrome

Answer 9

Median nerve

Question 10

Presentation of carpal tunnel syndrome

Answer 10

Pain
Numbness
Paresthesia in the lateral 3½ digits
Palm spared

Symptoms worse during the night

Releaved by hanging arm over the side of the bed or shaking

Later:
Thenar eminence wasting
Weak abduction of thumb

Question 11

RF for carpal tunnel syndrome

Answer 11

Pregnancy 
Ages 45-60
Female
Obesity 
Previous wrist injury
Repetitive hand or wrist movements

DM
Hypothyroidism
RA

Question 12

Why is the palm spread in carpal tunnel syndrome

Answer 12

Palmar cutaneous nerve already given off before flexor retinaculum

Question 13

Test for carpal tunnel syndrome

Answer 13

Tinel’s test - tap elicts pain

Phalen’s test - flexion for 60 secs elicits pain

Question 14

Investigations for carpal tunnel syndrome

Answer 14

Clinical diagnosis

Question 15

Mx of carpal tunnel syndrome

Answer 15

Conservative:

• rest
• ice
• NSIADS
• wrist splint at night
• corticosteroid injection

Surgery:
- Carpal tunnel release surgery - cutting through the flexor retinaculum

Question 16

Complications of carpal tunnel surgery

Answer 16

Persistent carpal tunnel syndrome

Infection

Scar formation

Nerve damage

Trigger thumb