Wrist and Hand pathology Flashcards

1
Q

Colles

A

Extra articular fractures (not within the wrist joint)

Low energy FOOSH - dorsal displacement of distal fragment

Always in anatomical position

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2
Q

Smiths

A

Extra articular fractures (not within the wrist joint)

Flexion-compression - volar displacement (usually younger patient, higher energy and more unstable)

Neurovascular status important

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3
Q

Barton Fracture

A

Intra articular - goes into the joint space

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4
Q

Management Colles/Smith

A

Conservative - if post reduction shows adequate reduction
Surgical - if open fracture, comminuted, young patient - use K wires or locking plates

Elderly - fragility fractures require Ix

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5
Q

Scaphoid fracture

A

Hyperextension of the wrist

Commonly fractures through its waist
=> Leads to avascular necrosis of the proximal pole due to retrograde blood supply from the distal pole

Presents with anatomical snuffbox pain, pain on axial compression of the thumb

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6
Q

Investigations

A

X ray (scaphoid series)

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7
Q

Management

A

CAST if clinical signs of fracture even if X ray normal
- bring back in 2 weeks for repeat X ray

Conservative - scaphoid cast if minimally displaced fracture for 6-8 weeks (follow up)

Surgical - if patient choice (young, quicker recovery), displaced fracture or AVN

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8
Q

Metacarpal and phalangeal fractures

A

Phalangeal
treat with buddy strap if not rotated (scissoring)
If intra articular - ORIF

Metacarpal - punching injury
Treat with buddy strap (stick 2 fingers together) if not rotated

Surgical if rotated or multiple fractures

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9
Q

Tendon injuries

A

Cuts on hand - unable to bend fingers

FDP goes to distal phalangeal
responsible for flexion of DIP

FDS - flexion of whole interphalangeal joint

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10
Q

Carpal tunnel syndorme

A

Parasthesia in distribution of the medial nerve due to compression
May have wasting of thenar muscle, Tinnel and Phalen postiive
Associated with Colles fracture, RA, Diabetes, Cushings, SLE

Ix - EMG

Mx
Conservative nocturnal splints, steroid injections
Surgical - open decompression of the transverse carpal ligament

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11
Q

Wrist ganglions

A

painless cystic lesion from joint capsule or tendon sheath

Benign

Can transilluminate if large enough

Management - leave alone, can aspirate if annoying (may recur)

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12
Q

De Quervain tenosynovitis

A

Affects thumb (extensor pollicis brevis and abductor pollicis brevis

‘Pregnant woman with swelling and pain over dorsal compartment of the thumb’

Management
Conservative - rest, NSAID, splint
Surgical - release the compartment

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13
Q

Dupuytrens contracture

A

proliferative thickening and therefore contracture of palmar fascia

Risk factors - Scandinavian, male, age, smoking, alcohol

Management
Surgery- indicated if symptomatic

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14
Q

Trigger finger

A

Nodular thickening on flexor tendon and stenosis of the A1 (proximal) pulley
Usually thumb, middle or ring finger

Presents with thickening, locking of the finger in flexion/extension, needs to be forcibly straightened

Management
Conservative - night splint in extension, steroid injection
Surgical - if conservative fails, surgical release of A1 pulley

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