Wrist and Hand Flashcards
What is trigger finger (in general terms)?
stenosing tenosynovitis which causes pain and difficulty moving a finger
What is the pathophysiology of trigger finger?
Thickening of the flexor tendon sheaths of the fingers - if thickens enough there will be a nodule of the tendon. As the finger is extended from a flexed position, the tendon nodule can get stuck at the entrance to the A1 pulley. This causes the finger to lock or get stuck in the bent position. It may release suddenly with a painful pop or click.
What is the most commonly affected area for trigger finger?
first annular pulley (A1) at the metacarpophalangeal (MCP) joint.
How does trigger finger present?
middle aged woman Painful and tender on MCP palmar side Not smooth movement Pops Stuck in flexed position Worst in the morning
How is trigger finger mx?
Rest splint analgesia steroid injection surgery if bad to release A1
What is a ganglion cyst?
Sacs of synovial fluid that originate from herniation in the synovial membranes in tendon sheaths (synovial fluid collects there)
How do ganglion cysts present?
Can be rpaid or gradual
Non-painful
palpable lump
How are ganglion cysts mx?
Conservatively
Can have needle aspiration or surgical excision
What is Dupuytrens contracture?
Plamar fascia of the hand thickens to cause a shortening which restricts finger movement - tightened into flexed position and are unable to extend
What are the RF for dupuytrens contracture?
Fhx Alcohol smoking Age Male Vibration tools DM Epilpesy
What is the presentation of dupuytrens contracture?
Hard nodules along the finger and palm which become thicker over time until you
Can’t straighten finger (table top test)
Not painful
What finger is most commonly affected by Dupuytrens contracture?
Ring finger!
What is the mx of Dupuytrens?
conservative or Surgery!
Where is the carpal tunnel located anatomically?
between the flexor retinaculum (fibrous band) and the carpal bones
The palmar digital cutaneous branch of the median nerve is compressed in carpal tunnel syndrome. What is its sensory innervation?
Thumb
Index and middle finger
The lateral half of ring finger
What is the motor innervation of the median nerve?
Thenar muscles: Abductor pollicis brevis (thumb abduction)
Opponens pollicis (thumb opposition – reaching across the palm to touch the tips of the fingers)
Flexor pollicis brevis (thumb flexion)
What are RF for carpal tunnel syndrome?
Repetitive strain Obesity Perimenopause Rheumatoid arthritis Diabetes Acromegaly Hypothyroidism
How does carpal tunnel syndrome present?
Weakness of thumb movements
Weakness of grip strength
Difficulty with fine movements involving the thumb
Wasting of the thenar muscles (muscle atrophy)
Sensory sx worse at night that improves with shaking hand
Positive Phalens/ Tinnels
What are the ix for carpal tunnel?
Nerve conduction study shows reduced potentials in motor and sesnsory
What is the mx for carpal tunnel?
Rest and altered activities
Wrist splints that maintain a neutral position of the wrist can be worn at night (for a minimum of 4 weeks)
Steroid injections
Surgery
What is DeQuevarian’s tenosynovitis?
Inflammation of the tendon sheath covering Abductor pollicis longus (APL) tendon and
Extensor pollicis brevis (EPB) tendon
What is a big RF for DeQuervain’s Tenosynovitis?
One notable cause of bilateral De Quervain’s tenosynovitis is in new parents repetitively lifting newborn babies in a way that stresses the tendons of the thumb
What does abductor pollicus longus do? What does extensor pollicis brevis do?
Abduct thumb and wrist for both!!
How does DeQuervians tendosynovitis present?
Sensory sx/ weakness in radial aspect of the wrist near the base of the thumb
Positive Finkelstein’s test
