Hand & Wrist - blue boxes

Question 1

man > 50 years of age comes in with 4th and 5th digits in partial flexion at MP and PIP joints. dad had similar thing.. what is it? disease process? treatment?

Answer 1

Dupuytren contracture!
- resulting from progressive shortening, thickening and fibrosis of palmar fascia and aponeurosis
- fibrous degeneraiton of longitudinal bands of palmar aponeurosis on medial side of hand pulls 4th and 5th fingers in
- hereditary predispostion
- painless nodular thickenings that progress into raised ridges
- treatment: surgical excision of all fibrotic parts of palmar fascia to free the fingers
[ washington D. C. always asking for handouts with that gesture!!! - Dupuytren Contracture!! ]

Question 2

which side of hand more likely to be infected? why?

Answer 2

dorsum of hand

- thinner fascia

Question 3

depending on site of hand infeciton, pus can accumulate in…? path of infection if untreated?

Answer 3

• thenar
• hypothenar
• midpalmar or adductor compartments
• untreated spreads proximally from midpalmar space through carpal tunnel into forearm, anterior to pronator quadratus and its fascia

Question 4

puncture of a finger by rusty nail can cause

Answer 4

infection of the digital synovial sheaths, leading to

• inflammation of the tendona dn synovial sheath (tenosynovitis)
• digit swells and movement becoems painful
• 2nd 3rd adn 4th finger tendons have separate synovial sheaths so infeciton usually confined

Question 5

tenosynovitis in which digits can spread and why?

Answer 5

little finger and thumb
little finger is continuous with the common flexor sheath
thumb via the continuous synovial sheath of the FPL

Question 6

patient uses repetitive forceful use of hands during gripping and wringing e.g. squeezing water out of clothes|now pain in wrist radiating proximally to forearm and distally toward the thumb
local tenderness felt over common flexor sheath on lateral side of the wrist
condiition name? disease mechanism?

Answer 6

quervain’s tenovaginitis stenosans
- excessive friction of tendons on common sheath resulting in fibrous thickening of sheath and stenosis of osseofibrous tunnel.

Question 7

person unable to extend finger
when finger extended passively, snap audible
flexion produces another snap as hickened tendon moves
condition called? which tendons affected?

Answer 7

trigger finger/ snapping finger

• tendons of FDS and FDP enlarging proximal to the tunnel
• stenosis of osseofibrous tunnel due to thickening of fibrous digital sheath on palmar aspect of digit - due to repetitive, forceful use of fingers

Question 8

laceration of palmar arch, treatment?

Answer 8

compress brachial artery and its branches proximal to the elbow e.g. sing pneumatic tourniquet

Question 9

intermittent bilateral attacks of ischemia of digits, marked by cyanosis and often accompanied by paresthesia and pain… usual cause? if cause idiopathic or primary, called?
treatment?

Answer 9

Raynaud syndrome!

• usually from cold and emotional stimuli
• cervicodorsal presynaptic sympathectomy (excision of a segment of a sympathetic nerve) to dilate the digital arteries

Question 10

where do lesions of median nerve usually occur? what is the most commons ite?

Answer 10

• forearm and wrist

- most common site is where nerve passes through the carpal tunnel

Question 11

most sensitive structure passing through carpal tunnel?

results if affected?

Answer 11

median nerve - one of its terminal sensory branches goes through carpal tunnel
can lead to paresthesia, hypoesthesia (diminished sensation) or anesthesia

Question 12

carpal tunnel s/s if untreated, what is the treatment?

Answer 12

• progressive loss of coordination and strength of thumb (owing to weakness of the APB and opponens pollicis)
• unable to oppose their thumbs, have difficulty buttoning a shirt or blouse as well as gripping things such as a com
• as progresses, sensory changes radiate into the forearm and axilla
• releive compression and symptoms by partial or complete surgical division of the flexor retinaculum, procedure called carpal tunnel release

Question 13

often lose thumb opposition if median n. injured, what nerves and muscles try to make up for it?

Answer 13

APL (posterior interosseous n.)
adductor pollicis (ulnar n.)

Question 14

deformity in which thumb movements limited to flexion and extension of thumb in plane of palm
condition caused by inability to oppose and by limited abduction of the thumb

Answer 14

• simian hand

Question 15

hypoesthesia in median one and half finger and weakness of intrinsic muscles of hand
clawing of 4th and 5th fingers maybe but ability to flex unaffected and no radial deviation of hand
what condition? mechanism? what would it have if flexion was affected

Answer 15

ulnar canal syndrome/ guyon tunnel syndrome

• ocmpression of ulanr nerve at wrist where it passes between pisiforma dn hook of hamate
• depression betweeen these bones converted by pisohamate ligament into an osseofibrous tunnel, the ulnar canal/ guyon tunnel
• if flexing afffected, would have been proximal ulnar n. injury

Question 16

patient rides bikes a lot of, has sensory losso n medial side of hand, weakness of intrinsic hand muscles

Answer 16

handlebar neuropathy!

hand always extended — puts pressure on hooks of their hamates, which compresses their ulnar nerves

Question 17

patient has wrist drop - hand flexed at wrist and lies flaccid, fingers of relaxed hadn also remain in flexed position at MCP joints; tiny bit of anesthesia on lateral part of dorsum of hand

Answer 17

• injury to radial nerve!

- paralysis of extensor muscles of the forearm

Question 18

science of studying ridge patterns of palm?

Answer 18

dermatoglyphics

- down syndrome have simian crease

Question 19

incisions or wounds along medial surface of thenar eminence may injury the

Answer 19

recurrent branch of median n. to thenar muscles