Wrist disorder Flashcards
What is trigger finger known as
stenosing flexor tenosynovitis
What other conditions are associated with trigger finger?
- RA
- Calcific tendinitis
- Carpal Tunnel Syndrome
- DM
- amyloidosis
- sarcoidosis
- gout
What is the pathophysiology of trigger finger
- repetitive movement > inflammation of tendon and sheath > tendonysovitis > localised nodal formation
- When finger flexed, node moved proximal to pulley > when finger extend, node failes to pass back under pulley > digit becomes locked
What are the three types of pulley involved in the hands?
- Palmar aponeurosis
- Annular ligaments (5)
- A2 & A4 prevent bowstringing
- A1 commonly affected
- Cruciate ligament (3)
- prevent collapsing and expansion of sheath during movement
What are the risk factors of trigger finger
- prolong gripping or use of hands
- RA
- DM
- Female
- Age
What are the clinical features of trigger finger?
- painless clicking on finger extension
- gradual onset of pain over volar (palmar) side MCPJ
- digits lock in flexion
What are the differential for trigger finger?
- Dupuytren’s contracture
- painless felxion, fixed, cannot be passively corrected
- Tendon sheath infection
- Hx of trauma
- swollen, erythematous, tender, pain on passive movement
- Ganglion
- Acromegaly
- Excess GH > flexor synovium swell >
What Ix would you order for trigger finger?
- diagnosis made clinically
- Bloods - GH & infection
What are the Mx option for trigger finger?
Conservative
- Splinting, activity modification, NSAIDs
- Corticosteroid injection
Surgical
- percutaneous release of A1 pulley
- surgical decompression of tendon tunnel
What are the Cx of trigger finger?
- adhesion formation post op - if pt doesnt move finger
What is De Quervain’s Tenosynovitis?
- Inflammation of tendons within first dorsal compartment of wrist
- includes ABL, EPB
What are the RF of DQT
- Age 30-50
- Female
- Pregnancy
- Occupation involving repetitive hand movements
- golfers, racquet sports
What is the pathophysiology of DQT?
- thickening and swelling of extensor retinaculum causes increased tendon friction
- may be related to accumulation of mucopolysaccharides
What muscles are in the 6 extensor compartments of the wrist?
- 1
- EPB
- APL
- 2
- ECRB
- ECRL
- 3
- EPL
- 4
- ED
- EI
- 5
- EDM
- 6
- ECU
What are the clinical features of DQT
- Pain near base of thumb
- Swelling
- Compromised grasping or pinching
On ex, what will you find on pt with DQT
- Sweeling
- Palpable thickening
- Finkelstein’s test
- +Eichhoff maneuver
What is Finkelstein’s test and Eichnoff maneuver
- On grasping the patient’s thumb and quickly abducting the hand ulnarward, the pain over the styloid tip is painful
- ulnar deviated wrist while patient clenches thumb in fist. Pain relieved when thumb is extended
What are the differential diagnosis for DQT
- Arthritis of CMCJ
- Finkletsein’s test
- Intersection syndrome (tendons from first compartment cross over second compartment)
- Wartenberg’s syndrome
- neuritis of superficial radial nerve
- tight jewllery
What Ix would you order for DQT?
- Diagnosed clinically
- Hand radiograph - exclude arthritis
How would you mx DQT?
Conservative (majority)
- rest, NSAIDS, thumb spica splint, steroid injection
Surgery
- Surgical release of 1st dorsal compartment
What are the cx of surgical decompression for DQT?
- failure to resolve
- red ROM
- neuroma formation
- nerve impingement
What are ganglionic cyst?
- non-cancerous soft tissue lumps that occur along any joint or tendon
What is the Px for ganglionic cyst?
- arise from degeneration within joint capsule or tendon sheath > filled c synovial fluid
What are the RF for ganglionic cyst?
- Female
- OA
- Hx of joint/tendon injury
Where to ganglionic cyst typically occur?
- Hands (dorsal side)
- feet
What are the clinical features of ganglionic cyst?
- Smooth painless lump
- Lump transilluminate
- ROM restricted
- localised parasthesia/weakness - if nerve injured
What are the differentials for ganglionic cyst?
- Tenosynovitis
- swelling tracking along tendon
- Giant cell tumour of tendon sheath
- mass is solid, fixed, x transilluminate
- Lipoma
- x transilluminate
- OA
- Sarcoma
What Ix would you order for ganglionic cyst?
* clinically diagnosed
- Imaging
- USS/MRI to assess cyst
- radiograph to rule our OA or sarcoma
How would you Mx ganglionic cyst?
Conservative
- Self limiting
- Aspiration +/- steroid injection
Surgical
- Cyst excision
