Wrist and hand Flashcards
Red flag: Rheumatoid arthritis
- Metacarpalphalangeal joints mainly affected
- Swelling and stiffness
- Nodules
- MCPs- when making a fist they will lose the contours of knuckles
Red flag: Psoriatic arthritis
- Affects DIP mainly and on the same finger
- Dactylitis
- Nail bed pitting
- Nail bed separation
Red flag: Kienbock’s Disease (lunate AVN)
- Swelling on the dorsal side of the wrist
- Pain over the crucifixion fossa
- Stiffness and tenderness may develop over the lunate bone
- Pain mainly on extension
- Loss of grip strength
Red flag: Preiser’s disease (Scaphoid AVN)
- Palpation of anatomical snuff box
- Prolonged use of corticosteroid, chemo, trauma
- Slight swelling and loss of strength
Carpal tunnel syndrome: pathophysiology and risk factors
When the median nerve is compressed as it passes through the carpal tunnel in the wrist
It occurs as a result of a reduction in the available space within the tunnel as a result of pathologies like OA
- Seen three times more in females than males
Risks: - OA and RA
- Wrist trauma
- Wrist repetition activities
- Computer occupation
- Obesity
Signs and symptoms of carpal tunnel
- Burning pain
- Gradual tingling or numbness in the median nerve distribution
- Having to shake their hand to alleviate symptoms
- Aggr factors: static gripping, sustained positions, repetitive movements, sleeping with hand in T-rex position
Special tests: phalens, tinels, compression test
Management of Carpal tunnel
- Direct to GP to manage underlying pathologies e.g OA, RA
- Advise on lifestyle modifications e.g regular postion breaks
- Workstation assessment
- Advise on wrist splint specifically at night. Found to be good at controlling symptoms
- therapy (rest, modification, mobilisation of carpal bones is supported)
Consider onward referral if interferring with ADLs and sleep for injection good option in primary care or splinting
OR if they have reduced sensation permanently or muscle wasting
Research= Scott D Middleton
De Quervains Stenosing Tenosynovitis: pathophysiology and risk factors
Inflammation of the tendon sheath or synovium of the first dorsal compartment of the wrist. Containing tendons of Abductor Pollicis Longus and Extensor Pollicis Brevis
More prevalent in females than males
Risks:
- Overuse
- Local trauma
- Post partum
Signs and symptoms of De Quervains
- Radial sided wrist pain whichcan radiate up into the forearm
- Aggrs factor: thumb and wrist motions
- Pain on gripping
- Tenderness on palpation of the tendons overlying the radial styloid
- Tenderness on palpation of the base of the thumb
Special tests: finklesteins
Managment of De Quervains
- Education
- Avoid aggr factors
- Ice application and topical anti-inflammatory gel
- Advise on thumb/wrist splint. Immobilisation using a semi-rigid splint may be more helpful so not fully immobilised
- Direct to GP for NSAID’s
- Consider corticosteriod into tendon sheath. Reported to provide near complete relief with one of two injections in up tp 90% patients
If symptoms persist potential surgical release. Also if symptoms fail to improve or recur after 2 injections
Research: Ellen Satteson
Triangular fibrocartilage complex injury: pathophysiology and risk factors
Is a cartilaginous structure which is located between the lunat, triquetrum and head of the ulnar. Acts as a stabiliser for the ulnar wrist
Commonly injured by:
Trauma
Twisting forcefully into ulnar deviation
Fracture of distal radius
Risks:
- Increased age
- Activities involving ulnar deviation
- Sports
Signs and symptoms of Triangular Fibrocartilage Complex Injury
- Ulnar sided wrist pain
- Aggr factors: unlar deviation
- Weakness in wrist and grip
- Description of clicking and giving way when under load
- Swelling around the TFCC
- Noticeable drop (subluxation of ulnar)
- Reduced ROM of ulnar deviation
Special tests: TFCC load, compression test
Management of Triangular Fibrocartilage Complex Injury
- Education
- Advise on rest and lifestyle modifications
- Direct to GP for NSAIDs
- Heat advice for pain relief
- Consider wrist supports for short term
- Physio: mobility, stability and strengthening
Persisting: Corticosteriod injection and surgery if injection not helpful
Trigger finger/thumb: pathophysiology and risk factors
Stenosing tenosynovitis
Is the inflammation, hypertrophy and narrowing of the A1 pulley flexor sheath. Affecting fingers 3 and 4 and thumb
Usually caused by repetitive use of the fingers or compression forces
Affects adults above 50 and children between 6m or 3 years
Risks:
- Diabetes
- Females
- Previous carpal tunnel
Signs and symptoms of trigger finger
- Pain
- Reduced ROM
- Locking - occuring during flexion to extension movement
- Catching and clicking
- Swelling in line with the affected digit in the palm of the hand or base of thumb
- Palpable nodule in the palm in line with the affected digit along the first crease or base of thumb
