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Wrist and hand conditions Flashcards

1
Q

What is Allen’s test?

A

Physical examination testing function of ulnar artery supplying blood to hand

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2
Q

How is Allen’s test carried out?

A 
Hand is elevated
Patient clenches fist for 30 seconds
Apply pressure over both radial and ulnar arteries
Patient opens first
Ulnar pressure released
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3
Q

What is a normal result of the Allen’s test?

A

Colour returns to hand in 5-15 seconds

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4
Q

What is an abnormal result of Allen’s test?

What does this mean?

A

Colour doesn’t return to hand in 5-15 seconds

Ulnar blood supply to hand is insufficient
shouldn’t cannulate or needle radial artery

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5
Q

What is rheumatoid arthritis?

A

Autoimmune disease
antibodies against synovial membrane
gives inflammation

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6
Q

Which joints are commonly affected by rheumatoid arthritis?

A

MCP joints

PIP joints

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7
Q

What are the X ray features of rheumatoid arthritis?

A

Peri-articular osteopenia
Joint space narrowing
Juxta-articular bony erosions
Subluxation, gross deformity

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8
Q

What is peri-articular osteopenia?

A

Loss of bone adjacent to joints

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9
Q

What is juxta-articular bony erosions?

A

Erosion of bone not protected by articular cartilage

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10
Q

What is subluxation?

A

Partial dislocation of joint

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11
Q

Does rheumatoid arthritis affect more males or females?

A

Females

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12
Q

What age group is mostly affected by rheumatoid arthritis?

A

40-50 year olds

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13
Q

What are Herbeden’s nodes?

A

Swelling of DIP joints

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14
Q

What causes Herbeden’s nodes?

A

Osteoarthritis of DIP joints

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15
Q

What is fractured in a Boxer’s fracture?

A

5th metacarpal

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16
Q

How does the 5th metacarpal displace in a Boxer’s fracture?

A

Head of 5th metacarpal rotates

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17
Q

What are the signs of a Boxer’s fracture?

A

Shortening of little finger

Flexion deformity

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18
Q

What is De Quervain’s tenosynovitis?

A

Inflammation of the synovial sheath containing abductor pollicis longus and extensor pollicis brevis tendons

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19
Q

What causes De Quervain’s tenosynovitis?

A

Repetitive forcefeul use of thumb e.g. gripping

causes friction of tendons in the sheath

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20
Q

What are the symptom’s of De Quervain’s tenosynovitis?

A

Pain over lateral side of wrist

radiates to forearm and thumb

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21
Q

What causes carpal tunnel syndrome?

A

Anything that reduces the size of the carpal tunnel

Or increases the size of the structures passing through it

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22
Q

What are some examples of causes of carpal tunnel syndrome?

A

Infection
Repetitive use of muscles, friction of tendons
Inflammation of tendons, synovial sheaths

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23
Q

What is the most sensitive structure of the carpal tunnel?

A

Median nerve

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24
Q

What are the sensory and motor consequences of carpal tunnel syndrome?

A

Sensory loss - paraesthesia, hypothesia, anaesthesia
in palmar surface of lateral 3.5 fingers
tips of these fingers on dorsal surface

Motor function loss - weakness, atrophy
in thenar muscles

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25
Why is there not sensory loss in the lateral palm?
Lateral palm is supplied by palmar cutaneous branch of median nerve branches off median nerve before it enters the carpal tunnel
26
What are the symptoms of carpal tunnel syndrome?
Pain - radiates to forearm - worse in mornings - wakes patient up from sleep
27
What forms Guyon's canal?
Space between pisiform and hook of hamate | overlying piso-hamate ligament
28
What passes through Guyon's canal?
Ulnar nerve
29
What are the sensory and motor consequences of compression of the ulnar nerve in Guyon's canal?
Sensory loss - paraesthesia, hypothesia, anasthesia in palmar surface of medial 1.5 fingers Motor function loss - weakness, atrophy in hypothenar muscles, medial two lumbricals, interossei, adductor pollicis, palmaris brevis
30
Why is there no loss of sensation in the medial palm with compression of the ulnar nerve in Guyon's canal?
Medial palm is supplied by palmar cutaneous branch of ulanr nerve branches off before ulnar nerve enters guyon's canal
31
Why is there no loss of sensaton in the dorsal surface of the medial 1.5 fingers and the dorsal area below them with compression of the ulnar nerve in Guyon's canal?
Is supplied by dorsal cutaneous branches of ulnar nerve | branches off before ulnar nerve enters guyon's canal
32
What is a dupuytren's contracture?
Fibrosis of palmar fascia and aponeurosis | Makes it thicker and shorter
33
What are the consequences of dupuytren's contracture?
Pulling on fingers | giving partial flexion at MCP and PIP joints
34
Why is the median nerve injured by lacerations to the wrist?
Because it's superficial at the wrist
35
What are the sensory losses of median nerve lesions at the wrist?
Loss of sensation in palmar surface of lateral 3.5 fingers | Tips of lateral 3.5 fingers on dorsal surface
36
What are the motor losses of median nerve lesions at wrist?
Paralysis of thenar muscles, lateral two lumbricals
37
What is the sign of median nerve lesions at wrist?
Hand of benediction
38
When does hand of benediction show on a patient?
When they're asked to make a first
39
What is the hand of benediction?
Only little and ring fingers are flexed completely
40
In lacerations to wrist, which branches of the ulnar nerve are severed? Which branch is unaffected?
Main ulnar nerve Palmar cutaneous branch of ulnar nerve Dorsal branch is unaffected
41
What are the sensory losses of ulnar nerve lesions at the wrist?
Loss of sensation in palmar surface of medial 1.5 fingers and palm area below them
42
What are the motor losses of ulnar nerve lesions at the wrist?
Paralysis of hypothenar muscles, medial two lumbricals, interossei, adductor pollicis, palmaris brevis
43
What is the sign of ulnar nerve lesions at the wrist?
Ulnar claw
44
What is the ulnar claw?
Hyperextension at 4th and 5th MCP joints | Flexion of 4th and 5th IP joints
45
What causes the ulnar claw to form?
Loss of function of medial two lumbricals Unopposed extension of MCP joints by extensor muscles Unopposed flexion of IP joints by flexor muscles
46
What commonly causes an ulnar nerve lesion at the elbow?
Fracture of medial epicondyle
47
What are the sensory losses of ulnar nerve lesions at the elbow?
Loss of sensation in palmar surface of medial 1.5 fingers and palm below them also loss of sensation in dorsal surface of medial 1.5 areas and area below them
48
What are the motor losses of ulnar nerve lesions at the elbow?
Paralysis of flexor carpi ulnaris, medial half of FDP, medial two lumbricals, interossei, hypothenars, adductor pollicis, palmaris brevis
49
What happens to the wrist when it is flexed, with an ulnar nerve lesion at the elbow?
It will be abducted when it's flexed | due to unopposed action of flexor carpi radialis
50
What will the ulnar claw look like with ulnar nerve lesions at elbow? What is this known as? Why?
The ulnar claw will be less severe Called the ulnar paradox because have actually lost function of more muscles
51
What causes the ulnar claw to look less severe with ulnar nerve lesions at the elbow?
Loss of function of medial half of FDP | loss of flexion of DIP joints of medial two fingers
52
How is the radial nerve injured in the axilla?
Dislocation of shoulder joint Fracture of proximal humerus
53
Which branches of the radial nerve are affected by radial nerve injury in axilla?
All of them
54
What are the sensory losses of radial nerve injury in the axilla?
Loss of sensation in lower lateral arm posterior arm posterior forearm dorsal surface of lateral 3.5 fingers and area below them - but not tips of fingers = median nerve
55
What are the motor losses of radial nerve injury in the axilla?
Loss of function in posterior arm | posterior forearm
56
How does a patient with radial nerve injury at the axilla present?
Can't extend elbow joint | Wrist drop
57
What causes wrist drop?
Unopposed flexion of wrist by anterior forearm muscles
58
How is the radial nerve injured in the arm?
By mid-shaft fracture of humerus
59
Which branches of the radial nerve are unaffected in radial nerve injury at arm?
Branches to triceps brachii Lower lateral cutaneous nerve of arm Posterior cutaneous nerve of arm Posterior cutaneous nerve of forearm
60
What are the sensory losses of radial nerve injury at arm?
Dorsal surface of lateral 3.5 fingers and area below them | but not tips of fingers = median nerve
61
What are the motor losses of radial nerve injurt at arm?
Loss of function of posterior forearm muscles
62
What is the sign of radial nerve injury at arm?
Wrist drop
63
What causes the hand of benediction to form?
Loss of innervation to lateral two lumbricals, can't flex 2nd and 3rd MCP joints Loss of innervation of lateral half of FDP, can't flex 2nd and 3rd DIP joints
64
Which branches of the median nerve are affected in carpal tunnel syndrome? What do they supply?
Palmar digital branches Recurrent branch
65
What causes dupuytren's contracture?
Unknown cause | maybe genetic predisposition
66
Is dupuytren's contracture more commonly unilateral or bilateral?
Bilateral i.e. both hands

Upper Limb (23 decks)

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