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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
Q

Why is there not sensory loss in the lateral palm?

A

Lateral palm is supplied by palmar cutaneous branch of median nerve
branches off median nerve before it enters the carpal tunnel

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26
Q

What are the symptoms of carpal tunnel syndrome?

A

Pain

  • radiates to forearm
  • worse in mornings
  • wakes patient up from sleep
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27
Q

What forms Guyon’s canal?

A

Space between pisiform and hook of hamate

overlying piso-hamate ligament

28
Q

What passes through Guyon’s canal?

A

Ulnar nerve

29
Q

What are the sensory and motor consequences of compression of the ulnar nerve in Guyon’s canal?

A

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
Q

Why is there no loss of sensation in the medial palm with compression of the ulnar nerve in Guyon’s canal?

A

Medial palm is supplied by palmar cutaneous branch of ulanr nerve
branches off before ulnar nerve enters guyon’s canal

31
Q

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?

A

Is supplied by dorsal cutaneous branches of ulnar nerve

branches off before ulnar nerve enters guyon’s canal

32
Q

What is a dupuytren’s contracture?

A

Fibrosis of palmar fascia and aponeurosis

Makes it thicker and shorter

33
Q

What are the consequences of dupuytren’s contracture?

A

Pulling on fingers

giving partial flexion at MCP and PIP joints

34
Q

Why is the median nerve injured by lacerations to the wrist?

A

Because it’s superficial at the wrist

35
Q

What are the sensory losses of median nerve lesions at the wrist?

A

Loss of sensation in palmar surface of lateral 3.5 fingers

Tips of lateral 3.5 fingers on dorsal surface

36
Q

What are the motor losses of median nerve lesions at wrist?

A

Paralysis of thenar muscles, lateral two lumbricals

37
Q

What is the sign of median nerve lesions at wrist?

A

Hand of benediction

38
Q

When does hand of benediction show on a patient?

A

When they’re asked to make a first

39
Q

What is the hand of benediction?

A

Only little and ring fingers are flexed completely

40
Q

In lacerations to wrist, which branches of the ulnar nerve are severed? Which branch is unaffected?

A

Main ulnar nerve
Palmar cutaneous branch of ulnar nerve

Dorsal branch is unaffected

41
Q

What are the sensory losses of ulnar nerve lesions at the wrist?

A

Loss of sensation in palmar surface of medial 1.5 fingers and palm area below them

42
Q

What are the motor losses of ulnar nerve lesions at the wrist?

A

Paralysis of hypothenar muscles, medial two lumbricals, interossei, adductor pollicis, palmaris brevis

43
Q

What is the sign of ulnar nerve lesions at the wrist?

A

Ulnar claw

44
Q

What is the ulnar claw?

A

Hyperextension at 4th and 5th MCP joints

Flexion of 4th and 5th IP joints

45
Q

What causes the ulnar claw to form?

A

Loss of function of medial two lumbricals
Unopposed extension of MCP joints by extensor muscles
Unopposed flexion of IP joints by flexor muscles

46
Q

What commonly causes an ulnar nerve lesion at the elbow?

A

Fracture of medial epicondyle

47
Q

What are the sensory losses of ulnar nerve lesions at the elbow?

A

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
Q

What are the motor losses of ulnar nerve lesions at the elbow?

A

Paralysis of flexor carpi ulnaris, medial half of FDP, medial two lumbricals, interossei, hypothenars, adductor pollicis, palmaris brevis

49
Q

What happens to the wrist when it is flexed, with an ulnar nerve lesion at the elbow?

A

It will be abducted when it’s flexed

due to unopposed action of flexor carpi radialis

50
Q

What will the ulnar claw look like with ulnar nerve lesions at elbow? What is this known as? Why?

A

The ulnar claw will be less severe

Called the ulnar paradox
because have actually lost function of more muscles

51
Q

What causes the ulnar claw to look less severe with ulnar nerve lesions at the elbow?

A

Loss of function of medial half of FDP

loss of flexion of DIP joints of medial two fingers

52
Q

How is the radial nerve injured in the axilla?

A

Dislocation of shoulder joint

Fracture of proximal humerus

53
Q

Which branches of the radial nerve are affected by radial nerve injury in axilla?

A

All of them

54
Q

What are the sensory losses of radial nerve injury in the axilla?

A

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
Q

What are the motor losses of radial nerve injury in the axilla?

A

Loss of function in posterior arm

posterior forearm

56
Q

How does a patient with radial nerve injury at the axilla present?

A

Can’t extend elbow joint

Wrist drop

57
Q

What causes wrist drop?

A

Unopposed flexion of wrist by anterior forearm muscles

58
Q

How is the radial nerve injured in the arm?

A

By mid-shaft fracture of humerus

59
Q

Which branches of the radial nerve are unaffected in radial nerve injury at arm?

A

Branches to triceps brachii

Lower lateral cutaneous nerve of arm
Posterior cutaneous nerve of arm
Posterior cutaneous nerve of forearm

60
Q

What are the sensory losses of radial nerve injury at arm?

A

Dorsal surface of lateral 3.5 fingers and area below them

but not tips of fingers = median nerve

61
Q

What are the motor losses of radial nerve injurt at arm?

A

Loss of function of posterior forearm muscles

62
Q

What is the sign of radial nerve injury at arm?

A

Wrist drop

63
Q

What causes the hand of benediction to form?

A

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
Q

Which branches of the median nerve are affected in carpal tunnel syndrome? What do they supply?

A

Palmar digital branches

Recurrent branch

65
Q

What causes dupuytren’s contracture?

A

Unknown cause

maybe genetic predisposition

66
Q

Is dupuytren’s contracture more commonly unilateral or bilateral?

A

Bilateral i.e. both hands

Upper Limb (23 decks)

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