wrist and hand conditions Flashcards
what is a tenosynovitis?
an inflammation of the fluid filled synovium within the tendon sheet
what age group and profession is most at risk to develop DeQuervain’s tenosynovitis?
female 30-40
hairdressers
what is the DeQuervain’s tenosynovitis?
a tenosynovitis of the abductor pollicis longus and the extensor pollicis brevis
usually due to overuse and repetitive strain of the hand (hairdresser, gardener)
what are s&s of DeQuervain’s tenosynovitis?
pain at the base of thumb
worse with movement
TTP over abductor pollicis longus and extensory pollicis brevis
palpable tendon crepitus
which special test is positive in DeQuervain’s tenosynovitis?
finkelstein
what is the management for DeQuervain’s tenosynovitis?
rest and splinting
NSAIDS
manual therapy
surgery
what ligament is injured in the dorsal wrist syndrome?
the scapholunate ligament
what are s&s in dorsal wrist syndrome?
pain over dorsal wrist
pain on passive wrist extension
which tests are positive in dorsal wrist syndrome?
finger extension test
scapholunate instability test
what is Dupuytren’s contracture?
fibrous proliferation of the palmar fascia of the hand
which fingers are most commonly affected with Dupuytren’s contracture?
4th and 5th digit
what are s&s for Dupuytren’s contracture?
flexion deformity of MCP and PIP joints
inability to straighten fingers
which conditions is Dupuytren’s contracture often associated with?
alcoholism
diabetes
epilepsy
what is the management for Dupuytren’s contracture?
Surgery
which ligament is ruptured in a gamekeepers/skiers thumb?
the ulnar collateral ligament of the thumb
what are s&s for a gamekeepers/skiers thumb?
laxity to abduct the 1st metacarpal
tenderness on thumb palpation
pain and/or inflammation of ulnar aspect of metacarpal phalangeal joint
weakness to make pinch sign
which test is positive in a gamekeepers/skiers thumb?
ulnar collateral ligament test
what is the adviced management for a gamekeepers/skiers thumb?
4-6 weeks in a thumb spica cast
if highly unstable refer for surgery
what is a ganglion?
a fluid-filled swelling developing near a joint or tendon (synovial fluid leaks out and forms a cyst)
what are the s&s of a ganglion in the wrist/hand?
cystic lump on dorsum of hand (feels hard)
mildly tender
mostly harmless (can resolve from itself in one year)
what is the intersection syndrome?
inflammation of the crossover between:
abductor pollicis longus
extensor pollicis brevis
extensor carpi radialis longus
extensor carpi radialis brevis
what is the cause of intersection syndrome?
repetitive wrist extension
what are s&s of intersection syndrome?
swelling and point tenderness (6-8cm proximal to radial styloid process)
crepitus on wrist extension
worse on resisted thumb extension
which tests are positive in intersection syndrome?
intersection syndrome test
finkelstein (association with DeQuervain’s)
what is Kienbock’s disease?
avascular necrosis of the lunate
in which population is Kienbock’s disease most common?
people between 18-40 yrs, manual labourers (most of them have light wrist trauma)
what are s&s of Kienbock’s disease?
wrist swelling and tenderness
reduced flexion and extension
normal pronation and supination
reduced grip strength
on x-ray: increased density, lucent areas, articular collapse, decrease lunate size
what is the treatment for Kienbock’s disease?
surgery
which tendon is rupture in a Mallet finger?
the extensor tendon at the base of the distal phalax
what is the most common site for a Mallet finger?
4th and 5th digit
what are the most common causes of Mallet finger?
blow on fingertip (sports injury)
RA
what are s&s for mallet finger?
finger held in flexion
active and resisted extension are impossible
passive movement is normal
can be inflamed (red hot swollen) when acute
chronic: no pain
what is the imaging of choice for a mallet finger?
x-ray: may show avulsed fragment of bone
what is the management for a mallet finger?
splint finger
ice
4-6 weeks to heal
what are the s&s of OA of the 1st carpo-metacarpal joint?
constant aching pain around base of thumb
crepitus with movement
decreased ROM (difficulty holding a mug or turning a doorknob)
which joints are most commonly affected in RA of the hands?
MCP
PIP
carpals
ulnar styloid process
radiocarpal joint
what are the s&s of RA in the hands?
symmetrical and bilateral symptoms
fusiform swelling
stiffness (takes a long time to ease of with movement)
redness & warmth
fatigue & weightloss
what are the x-ray findings of RA in the hands?
uniform loss of joint space
marginal (rat bite) erosion
subchondral cyst at the distal radius
ulnar styloid erosion
widened scapho-lunate joint space
what characterises boutonniere deformity?
PIP flexion and DIP extension
what characterises a swan neck deformity?
PIP extension and DIP flexion
what what is a scapholunate dissociation?
abnormal orientation of the scaphoid relative to the lunate due to injury of the stabilising scapholunate ligament (more severe than dorsal wrist syndrome)
what is the injury mechanism of a scapholunate dissociation?
fall onto dorsiflexed hand
what are s&s of scapholunate dissociation?
tenderness around dorsal wrist and hand
pain in anatomical snuffbox
limited grip strength and ROM
which test is positive in scapholunate dissociation?
the scapholunate instability (watson) test
what is the management for scapholunate dissociation?
surgery
which tendons in the wrist and hand are commonly affected by tendinopathies?
extensor carpi radialis longus
extensor carpi radialis brevis
flexor carpi radialis
extensor carpi ulnaris
flexor carpi ulnaris
how to test for a tendinopathy?
check resisted ROM, if painful it might indicate a tendinopathy
where is the triangular fibrocartilage situated?
between the ulnar head, the lunate and the triquetrium
what causes a tear in the triangular fibrocartilage?
sudden, forcible supination or pronation of the forearm (racquet sports)
what are s&s of a triangular fibrocartilage tear?
pain over distal end of ulna
pain and clicking
weakness and instability of the wrist
painful resisted extension and ulnar deviation
reduced grip strengths
which tests are positive in triangular fibrocartilage tear?
press test
triangular cartilage load test
what is the imaging of choice for a cartilage tear?
ultrasound
MRI
what is the treatment for a fibrocartilage tear?
conservative
NSAIDS
rest
what is trigger finger?
inflammation and constriction of the retinacular sheat, the irritation causes nodules to form on the tendon
which fingers are commonly affect in trigger finger?
ring and little finger
what are s&s of trigger finger?
pain over nodules
pain, stiffness and a sensation of locking and catching when trying to straighten finger
pain over base of affected fingers
which other condition does a trigger finger commonly associate with?
carpal tunnel syndrome
what is the most common population for trigger finger?
diabetic
female
>60 years
what is the treatment of choice for trigger finger?
immobilisation
NSAIDS
taping
