Wrist and hand Flashcards
What is the carpal tunnel?
Combination of carpal bones posteriorly and flexor retinaculum anteriorly
Contents of the carpal tunnel
Median nerve
4 x flexor digitorum superficialis tendons
4 x flexor digitorum profundus tendons
1 x flexor pollicis longus tendon
Carpal tunnel syndrome - definition
Occurs when swelling in the carpal tunnel results in compression of the median nerve
- note that the central palm sensation is preserved as the palmar cutaneous branch of the median nerve is given off proximal to the tunnel (therefore it is not affected)
Carpal tunnel syndrome - who gets it
Young women
Carpal tunnel syndrome - clinical features
paraesthesia (numbness and tingling) of the digits supplied by median nerve - thumb - index finger - middle finger - lateral half of ring finger This is worst at night time
Carpal tunnel syndrome - examination findings
Muscle wasting of the thinner eminence
+ve Tinnels test
+ve Phalens test
Carpal tunnel syndrome - management
Wrist splint at night
Steroid injection
Carpal tunnel decompression (surgery)
Cubital tunnel syndrome - definition
Ulnar nerve gets compressed behind the medial epicondyle
Cubital tunnel syndrome - clinical features
Paraesthesia in ulnar nerve innervated digits
- medial half of ring finger
- pinky
Cubital tunnel syndrome - examination findings
Muscle weakness
+ve Tinnels test
Ganglion cyst
Out pouching of synovial cavity found next to a tendon or synovial joint
Skin coloured
Firm smooth and rubbery
Self limiting
Mucous cyst
Type of ganglion cyst which occurs at the DIP joint area. May have discharge or deform the nail
Trigger finger - definition
Sticking/locking of the finger in flexion
Need to use unaffected hand to extend the affected finger
Dupuytrens contracture - pathology
Due to thickening of the palmar fascia
Dupuytrens contracture - clinical features
Painless nodules form on the palm which affects MCP or PIP joints
If these nodules extend they form cords which leads to a fixed flexion deformity
