Wrist and Hand pathology Flashcards
Colles
Extra articular fractures (not within the wrist joint)
Low energy FOOSH - dorsal displacement of distal fragment
Always in anatomical position
Smiths
Extra articular fractures (not within the wrist joint)
Flexion-compression - volar displacement (usually younger patient, higher energy and more unstable)
Neurovascular status important
Barton Fracture
Intra articular - goes into the joint space
Management Colles/Smith
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
Scaphoid fracture
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
Investigations
X ray (scaphoid series)
Management
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
Metacarpal and phalangeal fractures
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
Tendon injuries
Cuts on hand - unable to bend fingers
FDP goes to distal phalangeal
responsible for flexion of DIP
FDS - flexion of whole interphalangeal joint
Carpal tunnel syndorme
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
Wrist ganglions
painless cystic lesion from joint capsule or tendon sheath
Benign
Can transilluminate if large enough
Management - leave alone, can aspirate if annoying (may recur)
De Quervain tenosynovitis
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
Dupuytrens contracture
proliferative thickening and therefore contracture of palmar fascia
Risk factors - Scandinavian, male, age, smoking, alcohol
Management
Surgery- indicated if symptomatic
Trigger finger
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
