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Ortho > Wrist and Hand Pathologies > Flashcards

Wrist and Hand Pathologies Flashcards

1
Q

Dupuytren’s contracture presentation

A

Painless thickening of palmar fascia reducing ROM, typically affects ring+little fingers
Often bilateral + symmetrical

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2
Q

Dupuytren’s contracture management

A

Refer to surgery if pt can’t flatten hand on table (Hueston’s table top test)
Difficult to treat if affecting IP joints or little finger
Fasciotomy if on palmar fascia not on finger
Fasciectomy if tightened skin is on finger too

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3
Q

What are ganglia

A

Smooth cyst with fluid related to joint/tendon sheath

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4
Q

Ganglia treatment

A

May disappear spontaneously, with pressure or with aspiration
Surgical dissection if causing pain or pressure (on nerve) or impeding function

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5
Q

Carpal tunnel syndrome presentation

A

Pain/neuropathy along median n. and may include pain at night
Positive Tinnel’s and Phalen’s

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6
Q

Carpal tunnel syndrome treatment

A

Cut flexor retinaculum

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7
Q

What is De Quervain’s disease

A

Stenosing tenosynovitis of 1st extensor compartment

Affects abductor pollicis longus + extensor pollicis brevis in common tendon sheath as they cross radial styloid

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8
Q

De Quervain’s disease presentation

A

Pain at anterior border of snuff box when stretching affected tendons e.g. lifting teapot
Finkelstein’s sign: pain when gripping thumb into palm of same hand with passive ulnar deviation

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9
Q

De Quervain’s disease treatment

A

Immobilise (thumb spica splint), ice + NSAIDs
Corticosteroid injection during 1st 6 mths of symptoms
Decompression by splitting tendon sheaths if conservative fails

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10
Q

What is Volkmann’s ischaemic contracture

A

Rare, follows poorly managed compartment syndrome/interruption of brachial artery near elbow
Results in muscle necrosis -> flexion deformity at wrist + elbow

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11
Q

Volkmann’s ischaemic contracture treatment

A

Treat compartment syndrome

Prevention most important but surgical decompression to release nerves + tendons trapped from fixed flexion

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12
Q

Trigger finger presentation

A

Nodule formation of tendon or swelling of tendon sheath proximal to A1 results in finger locking in flexion at MCP
Commonly affects ring + middle finger
More common in diabetes

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13
Q

Trigger finger treatment

A

Rest + splinting often helps

Steroid into nodule may help but usually surgery to cut A1 sheath (not as essential unlike A2 + A4 sheaths)

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14
Q

Distal radial/ulnar # presentation

A

Osteoporotic post-menopausal women FOOSH

Signs of damage to ulnar/radial/median (especially anterior interosseus) n.

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15
Q

Distal radial/ulnar # treatment

A

Treatment guided by neurovascular status
Closed reduction using Bier’s block (IV regional anaesthetic, inflatable cuff on upper arm)
Sometimes ORIF/K-wires used

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16
Q

What is Colles’ #

A

Extra articular # of distal radius with dorsal displacement of distal radius
With dinner-fork deformity
Avulsion of ulnar styloid process may occur

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17
Q

What is Smith’s #

A

Reverse Colles, volar displacement + angulation of distal radial fragment
Fixation often needed as fracture fragment tends to migrate towards palmar side

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18
Q

What is Barton’s #

A

Intra-articular # involving dorsal aspect of distal radius

19
Q

What is Chauffeur’s #

A

Fracture of radial styloid (used to be seen in drivers when cranking of engine was needed)

20
Q

What is night-stick #

A

Isolated ulnar shaft #, associated with large trauma to forearm which is help up in defense

21
Q

What is Galeazzi #

A

Distal radial shaft # with dislocation of radio-ulnar joint

22
Q

What is Monteggia #

A

of proximal 1/3 of ulna with dislocation of radial head

23
Q

Wrist dislocation presentation

A

Rare, mostly involve carpal bones at scapholunate/lunotriquetrial junctions
Typically young athletes

24
Q

Wrist dislocation treatment

A

Manipulation

Open reduction and plaster immobilisation for 6 wks, ensuring median n. compression isn’t occurring

25
Q

Metacarpal # presentation

A

Typically 5th MC from punch

Rotational # shows abnormal rotation of fingers (they should all point to scaphoid when flexed)

26
Q

Metacarpal # treatment

A

Always wash out + explore wound above metacarpals, often have hit someone’s teeth

Stable closed # - splint/cast for 2 wks with wrist in slight extension, MCP in flexion and extended fingers (splinting for too long can cause stiff hand)
Unstable may need ORIF/K-wires

Rotational # usually require plate + screws
>2 MC # requires plate + screws

27
Q

of proximal phalanx treatment

A

Spiral/oblique often with rotation deformity so ORIF with single compression screw

28
Q

of middle phalanx treatment

A

Manipulate + splint in flexion over malleable metal splint, strapping finger to its neighbour
Aim is to prevent rotation

29
Q

Distal phalanx # treatment

A

Usually due to crush so are open, immobilize + treat wound

30
Q

Mallet finger cause

A

Tip of finger droops due to avulsion of extensor tendor attachment to terminal phalanx

31
Q

Mallet finger treatment

A

Splint for 6 wks, delay in splinting gives poorer outcome

Surgical intervention if fracture fragment <30% of joint surface

32
Q

Gamekeeper’s thumb presentation

A

Laxity of ulnar collateral lig of MCPJ during forced abduction
Occurs in gamekeepers when wringing pheasant’s neck, and skier’s when thumb caught
May be very painful so use lidocaine when examining

33
Q

Gamekeeper’s thumb treatment

A

Partial tears treated with short arm thumb spica cast

Complete tears surgically repaired

34
Q

Finger tip amputation treatment

A

Severed tip should be brought in clear bag near (not directly in) ice
Minor soft tissue loss treated with dressings, should heal in 3-5 wks 2° intention
Skin grafting for major damage

35
Q

Scaphoid # presentation

A 
FOOSH
Tender in anatomical snuff box and over scaphoid tubercle
Pain on axial thumb compression
Ulnar deviation of pronated wrist
XR doesn't always show well
36
Q

Scaphoid # treatment

A

Non-displaced need neutral forearm cast for several weeks

Percutaneous cannulated screw fixation sometimes but not shown to improve long term outcomes, just short

37
Q

Scaphoid # complication

A

AVN, proximal area relies on interosseus supply from distal

38
Q

What is paronychia

A

Infection causing cellulitis around finger nail, fungal and bacterial for often wet hands

39
Q

What is felon

A

Abscess in pulp of distal finger, drain and treat with Abx

Xray to check for foreign bodies causing infection

40
Q

What is Infective flexor tenosynovitis

A

Bacterial infection of flexor tendon sheath, dangerous if spread to forearm via carpal tunnel

41
Q

Infective flexor tenosynovitis signs

A 
Kanavel's 4 signs:
Symmetrical swollen fingers
Tenderness over flexor sheath
Pain on passive extension of finger
So fingers held in slight flexion
42
Q

Infective flexor tenosynovitis treatment

A

IV antibiotics

Repeated catheter irrigation/visits to theatre to irrigate

43
Q

Subungal haematoma treatment

A

Small, pain-free can settle spontaneously
Trephination if painful due to pressure, not if closed fracture is present as it makes it an open fracture
Complex laceration requires suturing

Ortho (13 decks)

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