Wrist and Hand Pathologies Flashcards
Dupuytren’s contracture presentation
Painless thickening of palmar fascia reducing ROM, typically affects ring+little fingers
Often bilateral + symmetrical
Dupuytren’s contracture management
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
What are ganglia
Smooth cyst with fluid related to joint/tendon sheath
Ganglia treatment
May disappear spontaneously, with pressure or with aspiration
Surgical dissection if causing pain or pressure (on nerve) or impeding function
Carpal tunnel syndrome presentation
Pain/neuropathy along median n. and may include pain at night
Positive Tinnel’s and Phalen’s
Carpal tunnel syndrome treatment
Cut flexor retinaculum
What is De Quervain’s disease
Stenosing tenosynovitis of 1st extensor compartment
Affects abductor pollicis longus + extensor pollicis brevis in common tendon sheath as they cross radial styloid
De Quervain’s disease presentation
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
De Quervain’s disease treatment
Immobilise (thumb spica splint), ice + NSAIDs
Corticosteroid injection during 1st 6 mths of symptoms
Decompression by splitting tendon sheaths if conservative fails
What is Volkmann’s ischaemic contracture
Rare, follows poorly managed compartment syndrome/interruption of brachial artery near elbow
Results in muscle necrosis -> flexion deformity at wrist + elbow
Volkmann’s ischaemic contracture treatment
Treat compartment syndrome
Prevention most important but surgical decompression to release nerves + tendons trapped from fixed flexion
Trigger finger presentation
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
Trigger finger treatment
Rest + splinting often helps
Steroid into nodule may help but usually surgery to cut A1 sheath (not as essential unlike A2 + A4 sheaths)
Distal radial/ulnar # presentation
Osteoporotic post-menopausal women FOOSH
Signs of damage to ulnar/radial/median (especially anterior interosseus) n.
Distal radial/ulnar # treatment
Treatment guided by neurovascular status
Closed reduction using Bier’s block (IV regional anaesthetic, inflatable cuff on upper arm)
Sometimes ORIF/K-wires used
What is Colles’ #
Extra articular # of distal radius with dorsal displacement of distal radius
With dinner-fork deformity
Avulsion of ulnar styloid process may occur
What is Smith’s #
Reverse Colles, volar displacement + angulation of distal radial fragment
Fixation often needed as fracture fragment tends to migrate towards palmar side
What is Barton’s #
Intra-articular # involving dorsal aspect of distal radius
What is Chauffeur’s #
Fracture of radial styloid (used to be seen in drivers when cranking of engine was needed)
What is night-stick #
Isolated ulnar shaft #, associated with large trauma to forearm which is help up in defense
What is Galeazzi #
Distal radial shaft # with dislocation of radio-ulnar joint
What is Monteggia #
of proximal 1/3 of ulna with dislocation of radial head
Wrist dislocation presentation
Rare, mostly involve carpal bones at scapholunate/lunotriquetrial junctions
Typically young athletes
Wrist dislocation treatment
Manipulation
Open reduction and plaster immobilisation for 6 wks, ensuring median n. compression isn’t occurring
