Week 4 Wrist Hand Fingers Flashcards
What is De Quervain’s tenosynovitis, ultrasound appearances
De Quervain’s tenosynovitis affects the extensor pollicis brevis and the abductor pollicis longus.
These tendons are responsible for moving the thumb away from the palm and wrist.
Thickening, Fluid tendon sheath compartment 1
Ultrasound: fusiform tendon swelling and thickening of sheath at level of radial styloid (often due to repetitive overuse), tendon usually normal in echo texture.
Mor common in women, 6:1, occurs between ages 20-50
What is Trigger finger/ thumb/ stenosing tenosynovitis, ultrasound appearances
Condition that affects the tendons in the fingers or thumb. It can cause one or more fingers to catch or lock in a bent position and then suddenly snap straight, like pulling a trigger. This usually occurs due to inflammation of the flexor tendons (digitorum superficialis, digitorum profundus and pollicis longus) sheath or a nodule or thickening in the tendon.
Usually caused by stenosing tenosynovitis at the level of the A1 Pulley on volar aspect of MCPJ
Ultrasound: tendon thickening, synovial sheath fluid and thickening, small possible peritendinous cyst, proximal tendon restriction and slight buckle with flexion
What is a Stener lesion
This is a specific type of injury that can occur in the thumb, involving the ulnar collateral ligament (UCL), commonly associated with a traumatic event, such as a sports-related injury or a fall.
Occurs with rupture and displacement of the UCL at MCPJ of thumb during hyper extension injury. Displaced and tor LCL lies superficial and proximal margin of the abductor aponeruosis. May require surgical repair.
However, if UCL is town but not displaced - it can heal with conservative treatment.
Also known as gamekeepers thumb
What is Tennis Elbow
This is tendonosis of the common extensor tendon origins at the elbow. It is usually produced from repetitive actions under extensor load. The tennis term comes from this appearing large scale in the 1970’s when players moved from heavy wooden racquets to light aluminium racquets. It was the backhand stroke that caused this and the inability of the aluminium racquets to absorb the strike shockwave.
Is also known as lateral epicondylitis
Ultrasound appearances will vary depending on the chronicity of the condition, but can show contour changes with the superficial surface of the extensor origin being convex and bulging, or concave and dipping. The tendon texture may be diffusely or focally hypoechoic, with some loss of fibrillar texture, or even anechoic zones or linear splits where tears have occurred. There may also be bony changes such as small spurs or enthesopathy at the lateral epicondyle. The more acute phase may show increased vascularity.
Describe ulnar nerve neuropathy
The ulnar nerve may bemarkedly enlarged and hypoechoic. This is at the level of the cubital fossa where the ulnar nerve has a propensity to be pathologic.
The ulnar nerve is not shown to sublux in this images however this is likely in this clinical setting. Importantly, this finding can be asymptomatic and thus it is important that there is clinical correlation between the patient’s symptoms and this pathology by the referring physician.
What is golfers elbow
also known as medial epicondylitis, and is a tendinopathy of the common flexor tendon origin. Ultrasound appearances will follow all those described for tennis elbow
What is student’s elbow
olecranon bursitis, when the patient has been leaning on the posterior aspect of their elbow for frequent and extended periods of time. The underlying bursa becomes inflamed and thickened, and can be very painful to touch.
What is radial tunnel syndrome
Entrapment of the PIN branch of the radial nerve by a build up of fibrous tissue at the edge of the supinator muscle, called the Arcade of Frohse.
The build up of fibrous tissue is commonly from small tears of the supinator muscle. These can be seen on ultrasound as small hypoechoic areas within the supinator muscle.
Ultrasound at the tender site during pronation and supination may show jerking of the underlying structures and confirm an entrapment of the PIN.
What is pronator teres syndrome
Entrapment of the median nerve as it passes through the heads of the pronator teres muscle.
Scanning transversely over the tender site and asking the patient to pronate and supinate the forearm, you may be able to see the median nerve being dragged down between the heads of the pronator teres muscle.
What is cubital tunnel syndrome
Entrapment of the median nerve as it passes through the heads of the pronator teres muscle. Scanning transversely over the tender site and asking the patient to pronate and supinate the forearm, you may be able to see the median nerve being dragged down between the heads of the pronator teres muscle.
Describe tenosynovitis, the causes and ultrasound findings
Can occur in single/group of tendons
Caused by inflammation of synovial lining of a tendon sheath
Causes: repetitive over use, RA, gout, amyloidosis, infection
Ultrasound: tendon sheath fluid/debris, modularity, sheath thickening, increased flow
When the tendon becomes involved (not just the sheath), tendinosis occurs and this can progress to a tear or rupture
What is a scapholunate ganglia and the ultrasound appearances?
Arises from dorsum of wrist. Ganglion cyst penetrates through the scapholunate ligament and communicates with the joint.
Large, asymptomatic mass or small painful non palpable.
Ultrasound: non compressible, anechoic, well defined, acoustic enhancement +/- debris, thin spetae
Describe a digital artery aneurysm
Hypoechoic lesion, often volar aspect of the fingers, marked vascularity (which proves it is not a ganglion which generally does not show flow)
What are the 4 tendons that make up the common extensor tendon at lateral epidicondyle
- Extensor carpi radialis brevis
- Extensor digitorum
- Extensor digiti minimi
- Extensor carpi ulnaris
Discuss the radial nerve in elbow
Passes over the CET and divides into two branches
1. Superficial branch: posterolateral forearm
2. Deep branch: PIN
PIN can become entrapped by build up of fibrous tissue on edge of supination muscle. This fibrous tissue can be caused by small tears
Radial tunnel syndrome: has similar symptoms to CET tendinosis. To check, pronate and supinate - watch for any jerking and also look for any mass etc that could be causing compression
