Upper limb (3) pathologies Flashcards
Describe a scaphoid fracture
FOOSH
Presentation: pain in the anatomical snuffbox, swelling is common
Difficult to see on x-ray (if a fracture is suspected clinically, the patient should be treated as if they have a fracture) – order another in 10-14 days’ time
Complications: avascular necrosis (due to retrograde blood supply), non-union, malunion & secondary OA
Describe Colles’ fractures
Extra-articular fracture of the distal radial metaphysis, with dorsal angulation and impaction (associated ulnar styloid fracture present in half of cases)
Most common type of distal radial fracture – common in patients with osteoporosis, post-menopausal women, high-impact trauma in younger patients
FOOSH with a pronated forearm & wrist in dorsiflexion
Presentation = painful, deformed & swollen wrist (fracture clearly seen on x-ray)
Complications = malunion (dinner fork deformity), median nerve palsy & post-traumatic carpal tunnel syndrome, secondary OA, tear of EPL tendon
Describe Smith fractures
Fractures of the distal radius with palmar angulation of the distal fracture fragments
Typically occur in young males & elderly females (a fall onto the dorsum of a flexed wrist/a direct blow to the back of the wrist)
Malunion = ‘garden spade’ deformity – narrows & distorts the carpal tunnel -> carpal tunnel syndrome
Describe rheumatoid arthritis of the metacarpophalangeal joints (MCPJs) and proximal interphalangeal joints (PIPJs)
Presentation = pain or swelling of joints, erythema overlying the joints, stiffness (worst in the morning/after periods of inactivity), carpal tunnel syndrome & fatigue/flu-like symptoms
Rheumatoid nodules are late feature of the disease
Describe Swan Neck deformity
Deformity seen in patients with advanced rheumatoid arthritis
Occurs when the PIPJ hyperextends & MCPJ and DIPJ are flexed
Describe Boutonniere deformity
Deformity seen in patients with advanced rheumatoid arthritis
Occurs when MCPJ & DIPJ are hyperextended & PIPJ are flexed
Describe psoriatic arthropathy
Only a minority of patients with psoriasis will develop arthritis
Presentation = fusiform swelling of the digits
Most commonly affects the DIPJs & most patients also have nail lesions
Describe osteoarthritis of the 1st CMC joint and distal interphalangeal joints (DIPJs), including Heberden’s nodes
Joint most commonly affect by OA in the hand is 1st CMC joint
Presentation = pain at base of the thumb (exacerbated by movement & relieved by rest)
Heberden’s nodes = classic sign of OA & affect the DIPJ of the fingers
-begin with chronic swelling of the affected joints/sudden onset of pain, swelling & loss of manual dexterity
-cystic swelling containing hyaluronic acid
-initial inflammation & pain eventually subside and patient is left with an osteophyte
(when this process occurs in the PIPjs = Bouchard’s nodes)
Describe carpal tunnel syndrome
Compression of the median nerve as it passes through the carpal tunnel from the forearm into the hand = MOST COMMON NERVE ENTRAPMENT IN THE BODY
Presentation = paraesthesia in the distribution of the median nerve (symptoms often worse at night because wrist drifts into flexion during sleep, narrowing the tunnel)
Long-standing carpel tunnel syndrome = muscle weakness & atrophy of the thenar muscles (branch exits the median nerve distal to the carpal tunnel syndrome)
Describe compression of the ulnar nerve in Guyon’s canal
Presentation = paraesthesia in the ring & little fingers, progressing to weakness of the intrinsic muscles of the hand
Describe Dupuytren’s contracture
Common condition in which there is localised thickening & contracture of the palmar aponeurosis leading to a flexion deformity of the adjacent fingers
Most common digits to be affected are the ring & little finger
Rick factors: type 1 diabetes, having had adhesive capsulitis of the shoulder, smoking & HIV
