The Wrist And Hand

Question 1

De Quervain’s Tenosynovitis clinical features

Answer 1

Stenosing tenosynovial inflammation of the first dorsal compartment -> abductor policis longus and extensor policis brevis

Female, 30-50, dominant hand 
Overuse / post traumatic / post partum
Gradual onset radial wrist pain 
Exacerbated by gripping with the wrist in neutral 
Localise tenderness

Question 2

De Quervain’s Tenosynovitis specific tests

Answer 2

X Ray if suspected arthritis

Question 3

De Quervain’s Tenosynovitis management

Answer 3

Conservative

• rest
• NSAID’s
• thumb spica splint
• steroid injection

Surgery
-release tendons

Question 4

Carpal tunnel syndrome clinical features

Answer 4

Most common 
Repetitive motions/vibrations
Radial 3 digits parasthesia
Clumsiness
Night waking
Thenar wasting

Question 5

Carpal tunnel syndrome specific tests

Answer 5

Tinnels

Phalens

Question 6

Carpal tunnel syndrome investigations

Answer 6

Nerve conduction studies

Question 7

Carpal tunnel syndrome management

Answer 7

Conservative

• NSAIDs
• night splints
• activity modification
• amitriptyline
• steroid injection

Surgery
-release

Question 8

MCP Dislocations clinical features

Answer 8

Dorsal index finger most common
Hyper extension injury

Abnormal posture
History of trauma
Pain
Swelling

Question 9

MCP dislocations investigations

Answer 9

Lateral X Ray

Question 10

MCP dislocations management

Answer 10

Conservative

• closed reduction-> simple dislocation
• direct pressure over the proximal phalanx with wrist in flexion
• avoid longitudinal traction

Surgery
-open reduction-> complex

Question 11

Phalanx dislocation dorsal PIPJ

Answer 11

More common than volar

Volar plate and collateral lig damage -> Schwann neck
Reduce and buddy tape 3-6 w
Open reduction if complex