Upper Limb Conditions- HAND

Question 1

Causes of carpal tunnel

Answer 1

More common in females can be idiopathic, secondary to RA, fluid retention (pregnancy, diabetes, chronic renal failure, hypothyroidism), consequences of Colles fracture

Question 2

What makes up the carpal tunnel

Answer 2

Carpal bones + flexor retinaculum and contains flexor pollucis longs, flexor digitorum profundus, flexor digitorum superficialis and median nerve

Question 3

Symptoms of carpal tunnel

Answer 3

Numbness in the thumb, index and half of ring finger, worse at night, relieved by shaking hands, muscle wasting and loss of sensation of thénar eminence

Question 4

Diagnosis of carpal tunnel

Answer 4

Positive Tinel's test over median nerve 
APB examination (hand flat on table and abduct thumb towards ceiling) 
Phalen's test (positive in upside down praying position)

Question 5

Treatment of carpal tunnel

Answer 5

Splints at night prevent flexion, corticosteroid injection, carpal tunnel decompression

Question 6

Pathogenesis of Dupuytren’s contracture

Answer 6

Proliferation of myofibroblasts and abnormal collagen production (type 3 >type 1) causing hyperplasia of specialised palmar fascia causing the skin to adhere and pucker forming nodules and cords on fascial bands giving contractors of MCP and PIP

Question 7

Causes of Dupuytren’s contracture

Answer 7

Idiopathic, genetics (Viking genes), alcoholic cirrhosis, diabetics, phenytoin therapy (anti-seizure), Dupuytrens diathesis (aggressive + early onset)

Question 8

Epidemiology of Dupuytren’s contracture

Answer 8

50-60 year old males, high prevalence in Northern European/Scandinavians

Question 9

Symptoms of Dupuytren’s contracture

Answer 9

Painless, gradual progress affecting ringer finger, pinkie, middle

Question 10

Give some other places you can get Dupuytren’s contracture

Answer 10

Peyronies= Penis
Ledderhose= Feet

Question 11

Diagnosis of Dupuytren’s contracture

Answer 11

Feel cords, MCP, PIP joint involvement (measure angles), table top test (if hand can go flat= OK)

Question 12

Treatment of Dupuytren’s contracture

Answer 12

Fasciotomy = division of cords
Fasciectomy= Removal of diseased tissue 
Severe= amputation

Question 13

Risk factors of trigger finger

Answer 13

Anything with prolonged gripping of hand, RA, amyloidosis, diabetes

Question 14

Pathogenesis of trigger finger

Answer 14

Tendonitis of the flexor tendon within flexor tendon sheath –> fibrocartilaginous metaplasia –> nodular formation on the tendon distal to the pulley (usually A1 pulley) –> nodule catches on the pulley and give a clicking noise

Question 15

Symptoms of trigger finger

Answer 15

Finger locked in flexed position and pain on movement (inability to move back without manually moving it with other hand)

Question 16

Treatment of trigger finger

Answer 16

Steroid injection around tendon WITHIN sheath then surgery if recurrent, incision of the pulley (A1 pulley incision doesn’t affect function)

Question 17

Where do Herberden nodes form

Answer 17

DIP joints

Question 18

Where do Bouchards nodes form

Answer 18

PIP joints

Question 19

Pathogenesis of mucous cysts

Answer 19

At mild arthritis joints synnoival fluid proliferation and osteophyte formation punctures the capsule causing an out pouching of synovial fluid

Question 20

Symptoms of mucous cysts

Answer 20

The cyst itself is not painful but the underlying arthritis is, usually left alone but can excise

Question 21

Pathogenesis of DeQuervain’s tenosynovitis

Answer 21

Inflammation and swelling of the tendon sheath of the first extensor compartment (surrounds the tendons of the thumb APL and EPB)

Question 22

Symptoms of DeQuervain’s tenosynovitis

Answer 22

Pain and swelling in thumb, over radial styloid process, sore twisting jars, ulnar deviation

Question 23

Diagnosis of DeQuervain’s tenosynovitis

Answer 23

Finklestein’s test and Eickhoff’s test

Question 24

Treatment ofDeQuervain’s tenosynovitis

Answer 24

Splint for 4-6 weeks, rest, physio, analgesia, DeQuervain’s release=surgical decompression

Question 25

Pathogenesis of giant cell tumour of tendon sheath

Answer 25

Regeneratve hyperplasia within the tendon sheath on the palmar surface around PIP joints of index and middle fingers

Question 26

Symptoms or treatment of giant cell tumour of the tendon sheath

Answer 26

May/may not be painful, can erode bone or surround digital nerve/artery can be let alone or excised

Question 27

Cardinal signs of flexor tendon sheath infection

Answer 27

Finger held in flexion, swollen, pain on percussion over sheath, painful on passive extension

Question 28

Treatment of flexor tendon sheath infection

Answer 28

SURGICAL EMERGENCY- immediate surgical washout

Question 29

What is a pilon fracture

Answer 29

Fracture of the base of the middle phalanx (common when catching balls)

Question 30

What is a boxer’s fracture

Answer 30

Fracture of the pinkie metacarpal, if minimal displacement and no rotation then buddy strap + early mobilisation

Question 31

What is a skiers/gamekeeper thumb fracture

Answer 31

Injury to ulnar collateral ligament of the MCP joint

Question 32

What is mallet finger

Answer 32

Caught a ball/hit against door, can present with late tenderness/bruising must stabilise joint, resisted finger extension on examination treated with splint for 6 weeks

Question 33

What is a Bennett’s fracture

Answer 33

Intraarticular fracture at the base of the first metacarpal due to axial blow to thumb