Ulnar nerve and Dupuytrens Flashcards

1
Q

Sensory nerve supply to hand - draw it

A

Remember median comes over fingers

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2
Q

What does this image show?

A

Dorsal interossei wasting - supplied by ulnar nerve

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3
Q

Muscles supplied by ulnar nerve in hand

A

All apart from LOAF =
* Adductor pollucis
* Opponens digiti minimi
* Flexor digiti minimi
* Abductor digiti minimi
AND
* Medial (ulnar) two lumbricles
* Palmer interossei
* Dorsal interossei

All For One And One For All

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4
Q

Nerve root value brachial plexus

A
  • Musculocutaneous - C5, C6, C7
  • Radial - C5, C6, C7, C8, T1
  • Axillary - C5, C6
  • Ulnar - C8, T1
  • Median - C5, C6, C7, C8, T1

3 muscketerrs, 2 assaniated by 5 rats, 5 mice and 2 unicorns

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5
Q

What is Froment’s test?

A
  • Test adductor pollucis of thumb
  • Supplied by ulnar nerve
  • Hold paper between thumb and index finger
  • Examiner tries to pull paper
  • Positive test = compensation by contracting flexor pollucis longus = flexed thumb
  • = ulnar nerve injury
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6
Q

Where is entrapment most likely to occur of ulnar nerve?

A
  • Cubital tunnel at elbow
  • OR Guyons canal at wrist
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7
Q

Investigation to confirm ulnar nerve entrapment

A

Nerve conduction studies

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8
Q

Patho-anatomy of ulnar claw hand

A
  • Lumbricles 3+4 (medial/ulnar) are paralysed due to ulnar nerve entrapment
  • These usually flex at MCPJs and extend IPJs
  • = MCPJs have unapposed extension by extensor digitorum
  • = IPJs have unapposed flexion from FDP and FDS
  • Extensor digitorum cannot appose FDS and FDP as energy is dissipated at MCPJ

FDP/S - flexor digitorum profundus and superficialis

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9
Q

Treatment for ulnar nerve entrapment/cubital tunnel syndrome

A
  • Avoid exacerabting acitivites
  • Physio
  • Steroid injections
  • Splint at night
  • Surgery if resistent - ulnar nerve release by cutting away tight tissue
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10
Q

Risk factors for Dupuytrens contracture

A
  • Male
  • Smoker
  • Increasing age
  • FH of condition
  • Northern european
  • Occupational - heavy manual work or vibrating tools
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11
Q

Other diseases associated with Dupuytrens contracture

A
  • HIV
  • Vascular disease
  • Diabetes
  • Alcoholic liver cirrhosis
  • Hypercholesterolaemia
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12
Q

Cells that cause Dupuytrens

A

Fibroblasts

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13
Q

Risk of surgical correction of Dupuytrens

A
  • 66% have post of recurrence
  • Digital nerve injury
  • Digital blood vessel injury
  • Infection
  • Stiffness
  • Loss of finger
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14
Q

Patho phys of Dupuytrens

A
  • Fibroblastic hyperplasia
  • Altered collagen matrix
  • = thickening and contraction of palmar fascia
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15
Q

Disease progression of Dupuytrens

A
  • Pitting and thickening of palmar skin, loss of mobility of overlying skin
  • Firm, painless nodule appears - fixed to skin and deeper fascia, increasing in size
  • Cord then develops - resembles tendon, contracts over months-years
  • Contraction of cord pulls on MCPJ and PIPJ = flexion deformity in fingers
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16
Q

Test for Dupuytrens

A
  • Huestons test
  • If patient unable to lay palm flat on tabletop = +ve
17
Q

Differentials for dupuytrens

A
  • Stenosing tenosynovitis - painful and overuse/trauma
  • Ulnar nerve palsy - reduced movement and sensation
  • Trigger finger - nodule with finger motion
18
Q

Investigations Dupuytrens

A
  • Clinical diagnosis
  • BUT should have routine bloods to assess for RF eg:
  • HbA1C
  • LFT
  • Can do USS for accuracy in applying intralesional injections
19
Q

Management for Dupuytrens

A
  • Depends on stage
  • No functional disability = monitor and conservative
  • Functional disability/rapidly progressive = surgery
20
Q

Conservative management Dupuytrens

A
  • Hand therapy - stretches
  • Injectable collagenase clostridium histolyticum - good for early disease
21
Q

Surgery for Dupuytrens

A

Excision diseased fascia - fasciectomy. Either:
* Regional - entire cord removed
* Segmental - short segments of cord removed
* Dermofasciectomy - cord and overlying skin removed followed by skin graft
* Closed - good for those unsuitable for major surgery, percutaenous with LA
* Finger amputation - rarely needed

22
Q

When is surgery indicated for Dupuytrens?

A
  • Functional impairment
  • MCP contracture >30 degrees
  • Any PIP contracture
  • Rapidly progressive disease
23
Q
A