Upper Limb Flashcards
Which tendons are involved in DeQuervain’s? (2)
Abductor pollicis longus
Extensor pollicis brevis
How may a DeQuervain’s present? (Pt group/Hx)
What is the main DDx
Acute pain base of thumb
After repeated movements
Post-partum/middle-aged
Base of thumb OA
What will be seen O/E in DeQuervain’s?
LOOK: normal / swelling (radial border)
FEEL; normal / tender (radial styloid)
MOVE: painful thumb abduction (against Rx)
TEST: Finklestein’s
How is DeQuervain’s managed? (RASSS)
Rest Analgesia (NSAIDs) Splinting Steroid injections Surgical (longitudinal compartment release)
what tendons are in the carpal tunnel (9)
4 Flexor digitorum profundus
4 Flexor digitorum superficialis
1 Flexor pollicis longus
List the causes of carpal tunnel (6)
Idiopathic Trauma (Colles') Hypothyroid Acromegaly DM RA
Describe the presenting features of carpal tunnel syndrome (3)
Pain/paraesthesia
Shakes hand for relief (esp night, may awaken)
Sensory loss (rarely noticed)
What would be seen O/E in carpal tunnel?
LOOK: thenar wasting
FEEL: reduced thenar bulk
MOVE: weak thumb abduction
TEST: Tinel’s/Phalen’s
How is Carpal Tunnel managed? (RASSS)
Nerve conduction studies
Rest (activity modification) Analgesia (NSAIDs) Splinting (night-time) Steroid injection Surgical: flexor retinaculum division
List some causes of Cubital Tunnel Syndrome (4)
Prolonged elbow flexion (eg typing at desk)
Valgus deformity
Tight fascial bands
Ulnar fracture
What are the features of cubital tunnel syndrome?
Pain at elbow
Paraesthesia in ulnar distrib
Weak pinch
Severe: clawing (hypothenar/inteross wasting)
What would be seen O/E in cubital tunnel syndrome?
LOOK: hypothenar / 1st dorsal inteross wasting (gutter)
FEEL: cubital tunnel tenderness
MOVE: weak ext DIPJs / weak ab/add 5th
TEST: Tinel’s / Elbow Flexion test
How is cubital tunnel syndrome managed? (RASS)
Nerve conduction studies
XR (osteophytes)
Rest (activity modification)
Analgesia (NSAIDs)
Splints (night-time)
Surgical: decompression / anterior transposition of nn
What does a ganglion cyst contain?
Where can they appear in the hand? (4)
What pt grps/cause
Degenerative myxoid fluid of underlying structure
Dorsal scapholunate
Volar scaphotrapezial
Volar Finger base
Dorsal DIPJ
How do ganglion cysts present? (Sx/features in Hx)
Young women (20–40) Idiopathic / trauma
Lump in hand ± pain
How are ganglion cysts managed? RAASS
Reassurance
Analgesia (NSAIDs)
Aspiration ± Steroid injection (works in 40%)
Surgical excision (40% recurrence)
What may be seen O/E in trigger finger?
LOOK: PIP/DIPJ flexion
FEEL: Nodule at finger base when flexed
MOVE: jerky active flex/ext
TEST: n/a
How is trigger finger managed? RASS
Rest (activity modification)
Analgesia (NSAIDs)
Steroid injection (into tendon sheath)
Surgical: A1 pulley release / tenosynovectomy (RA pts)
What are some RFs for Dupuytren’s?
Male
Nordic
Alcoholic
Liver disease
Phenytoin
DM
Trauma
What may be seen O/E in Dupuytren’s?
LOOK:
Nodule/cord in palm
Fixed MCP-PIP flexion (3rd/4th)
Garrod’s pads (dorsal PIPJs)
FEEL: thickened palmar fascia
MOVE: loss active/passive flexion/extension
TEST: n/a
How is Dupuytren’s managed?
Conservative if no func problem
Surgical:
Needle aponeurotomy
Fasciotomy
Fasciectomy
What are the features of Thumb Base OA?
Pain on gripping/pinching
Tenderness at CMCJ
Swelling/deformity
What may be seen O/E in thumb base OA
LOOK:
Thumb base swelling
Thumb base subluxation (fixed flex-add)
Thenar wasting
FEEL:
Warmth / swelling / crepitus
Reduced thenar bulk
MOVE:
Pain/stiffness at CMCJ movements (add/abd/opp)
TEST: n/a
How is Base of the Thumb OA managed?
As per OA conservatively
Surgical: Denervation Trapeziectomy Joint fusion Arthroplasty
