Upper extremity Flashcards
Wrist: Ganglion Cyst
general
Common causes
Pathophysiology: soft tissue lump or a “bleb” near a joint or tendon sheath; filled with synovial fluid
Common after trauma or result of OA
can resolve on its own
wrist: ganglion cyst
Sx/complaints
Common symptoms/complaints:
Tightness, soft and usually mobile
Can be painful
Minimal decrease in motion
wrist ganglion cyst
PE, testing
Physical Exam:
Soft/hard, mobile, sometimes painful, fluid filled lump
Tests: not necessary
US if needed:
NEAR RADIAL ARTERY
wrist: ganglion cyst
Tx
Treatment:
Depends on pain
NSAIDs/rest
Aspiration and/or injection
Surgical excision
Most common site is the wrist
Cysts can come and go
US if needed:
NEAR RADIAL ARTERY
Wrist: DeQuervain’s Tenosynovitis
general and causes
Pathophysiology: tenosynovitis of the tendons/tendon sheaths of the first dorsal compartment at the wrist
Causes: result of increase/repetitive wrist motion/activity
Can be caused by repetitive motion (factory work)
Wrist: DeQuervain’s Tenosynovitis
common Sx/complaints
Common symptoms/ complaints:
Wrist pain/swelling
Difficulty w/wrist motion
Wrist: DeQuervain’s Tenosynovitis
PE/tests
Physical Exam:
TTP adjacent to snuffbox and proximal to the 1st CMC joint
Little to no swelling
+ Finkelstein
Tests: no testing needed but x-rays can help to r/o differentials
Wrist: DeQuervain’s Tenosynovitis
Tx
Treatment:
Rest/thumb spica/ immobilization
Topicals/NSAIDs or Tylenol
Steroid injection
Surgical release of tendon sheath
Wrist: TFCC Tear
What the TFCC is: Triangular fibrocartilage complex
Ulnocarpal ligaments
Subsheath of extensor carpi ulnaris tendon
Radioulnar ligaments
Central fibrocartilaginous disk
Wrist: TFCC Tear
patho
Pathophysiology: Tear from a fall onto an outstretched hand or other high-force wrist loading trauma. Can also be the result of degeneration.
Wrist: TFCC Tear
Common symptoms/ complaints:
Mostly just c/o deep pain at ulnocarpal joint
trouble supinating/pronating/shaking hands
Wrist: TFCC Tear
Physical Exam:
Tender to palpation just distal to the ulnar head
Rotation of the wrist> painful catch or clunk
Testing the DRUJ in pronation/supination
One hand on radius/ulna-just proximal to wrist-
manip back/forth(Always compare to contralateral)
Passive ulnar deviation of the wrist may worsen their pain
Wrist: TFCC Tear
Imaging Tests:
MRI should confirm TFCC tear; might need arthrogram,
CT or MRI with contrast
Arthroscopy can also be performed
TFCC tear
Tx
Treatment:
Bracing/ immobilization for a couple of months
Physical therapy
Surgical repair
TFCC
contrast should not be freely flowing, should be contained
Wrist: Arthritis
general
Pathophysiology:
Mechanical/degenerative loss of articular cartilage of the wrist
Causes: trauma, RA, heredity
wrist arthritis
Common symptoms/ complaints:
Joint pain
Pain with activity
Grinding/ crepitus
Swelling/Stiffness
wrist arthritis
PE/Tests
Physical Exam:
TTP within the wrist joint at the distal radius
Limited motion
Crepitus
Tests:
X-rays (joint space narrowing, osteophytes, sclerosis, subchondral cysts, malalignment, etc)
Wrist: Arthritis
Tx
Treatment:
Topical creams –Salonpas/CBD
NSAIDs/Tylenol
Bracing
Gentle exercise/PT
Steroid injection
Surgical repair has 2 options:
Arthrodesis
Joint replacement
Carpal Tunnel Syndrome
general
Pathophysiology: compression of the median nerve within the carpal tunnel> the “roof” or transverse carpal ligament (AKA flexor retinaculum)
Causes-repetitive hand use, or hand/wrist motion, pregnancy, DM,RA
carpal tunnel
common complaints
Common complaints from patients are numbness, tingling and weakness in the hand and fingers –not always specific
Wrist: Carpal Tunnel Syndrome
PE/Tests
Numbness/tingling through the median nerve distribution
Pain
Weakness/thenar wasting (atrophy)
+ Tinel and Phalen signs
Tests:
EMG/ NCV
https://youtu.be/ztQPvUk-Z8E
US will sometimes show flattening of the nerve within the tunnel
carpel tunnel
Tx
Treatment:
Rest
Bracing/ immobilization
NSAIDs/Tylenol
Steroid injection
Surgery (open or scope)
Misc:
If muscle wasting has started, prognosis is not as good
Wrist: Ulnar Nerve Entrapment
general
Pathophysiology:
Ulnar nerve within Guyon canal is compressed
Often involves a small mass like a lipoma or ganglion
Causes are similar to CTS (repetitive hand/wrist activity)
Ulnar Nerve Entrapment
Common symptoms/ complaints:
Pain
Numbness, burning, tingling in ulnar nerve distribution but only volar (not dorsal)
Ulnar Nerve Entrapment
Tx
Treatment:
Splinting/ bracing is not usually helpful
Steroid injection is not a good option
(accuracy is difficult)
Straight to surgery usually
Ulnar Nerve Entrapment
PE/Tests
Physical Exam:
Pain
Numbness, burning, tingling in ulnar nerve distribution but only volar (not dorsal)
+ Tinel over Guyon canal
Tests:
EMG/NCV
US or MRI to look for masses
Wrist: Radial Neuropathy
General and causes
Pathophysiology: at the wrist- compression of the superficial radial nerve (dorsal-lateral hand)
Causes include: trauma, tight clothes/accessories (watch)
Can also occur due to compression at the axilla from crutches, someone sleeping on the arm, sleeping with arm over a chair (Saturday night palsy)
radial neuropathy
common Sx
Common symptoms/ complaints:
Numbness and possibly weakness
Superficial radial nerve distribution
radial neuropathy
PE/Tests
Physical Exam:
Numbness to dorsal-lateral hand (see pic)
Depending on location of compression, different areas of weakness may develop
+Tinel at area of compression
Tests: EMG/NCV only if symptoms don’t resolve within a few days of stopping the compression
wrist:radial neuropathy
Tx
Treatment:
Splinting with thumb spica (immobilizes thumb)
Can try NSAIDS/PT
Treatment: a lot of times nothing
