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MC > Hand Pain > Flashcards

Hand Pain Flashcards

1
Q

_______ known as ‘effort thrombosis’, causes swelling in the arm with pain high in the axilla

A

Subclavian or axillary vein thrombosis,

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2
Q

The commonest cause of the thoracic outlet
syndrome is sagging musculature related to ageing, obesity, and heavy breasts and arms, aptly described by Swift and Nichols as ‘the _______

A

droopy shoulder syndrome’

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3
Q

Arm claudication is also rare. It can occur with

arterial obstruction due to occlusion of the _________

A

proximal left subclavian artery or the innominate artery.

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4
Q

Sleep DO associated with hand pain

  • thoracic outlet syndrome—______
  • CTS—______
  • cervical spondylosis—wakes the patient with pain and stiffness that persists well into the day
A

patients cannot fall asleep

patients wake in the middle of the night

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5
Q

Arm pain in children

The main concerns with children are the _______

A

effects of trauma, especially around the elbow

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6
Q

This typically occurs in children under 8 years of age, usually at 2–5 years, when an adult applies sudden traction to the child’s extended and pronated arm

A

Pulled elbow

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7
Q

Signs of pulled elbow

A

• The elbow is flexed slightly (any flexion will be strenuously resisted).
• The forearm is pronated or held in mid-position.
• The arm is tender around the elbow (without
bruising or deformity).

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8
Q

Types of tennis elbow

‘backhand’ tennis elbow, or_______, and ‘forehand’ tennis elbow, or _________ which is also known as golfer’s or pitcher’s elbo

A

lateral epicondylitis

medial epicondylitis,

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9
Q

In ‘forehand’ tennis elbow, or golfer’s elbow, the lesion is the _________

A

common flexor tendon at the medial epicondyle

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10
Q

The pain is felt on the inner side of the
elbow and does not radiate far. The main signs are localised tenderness to palpation and pain on resisted
flexion of the wrist.

A

Medial tennis elbow (medial

epicondylitis

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11
Q

Difference in the treatment of medial and lateral epicondylitis

A

The treatment is similar to that for lateral

epicondylitis except that in a dumbbell exercise program that palm must face upwards.

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12
Q

What to avoid in lateral and medial epicondylitis

A

During a game they should avoid elbow bending and ‘wristy’ shots

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13
Q

Acute olecranon bursitis with redness and warmth can occur in
1
2
3

A

rheumatoid arthritis, gout, pseudogout,

haemorrhage and infection (sepsis). 13

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14
Q

Chronic recurrent traumatic olecranon bursitis with a synovial effusion may require surgery but most cases can resolve with ___________

A

partial aspiration of the fluid and then injection of corticosteroid through the same needle.

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15
Q

What syndrome?

Pain is often experienced in the belly of a muscle, such as the flexors and extensors, following unaccustomed use of the wrists and elbows.

There is pain on contraction and stretching of the muscles and
tenderness on palpation.

A

Overuse syndromes of forearm

muscles

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16
Q

A positive ___________produces a tingling sensation (usually without pain) in the
distribution of the median nerve

A

Tinel sign

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17
Q

What test?

  • The patient approximates the dorsum of both hands, one to the other, with wrists maximally flexed and fingers pointing downwards.
  • This position is held for 60 seconds
A

Phalen test

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18
Q

The test that has the highest specificity of all basic clinical tests is______________, but it has low sensitivity for CTS.

A

two point discrimination

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19
Q

Sx management of CTS

A 
Surgical release (flexor retinaculotomy) is necessary for patients with sensory or motor deficits and those
with recalcitrant CTS
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20
Q

In the fingers the common work-induced condition is stenosing flexor tenosynovitis, also known as

A

trigger thumb and finger

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21
Q

Associations of trigger finger

A

It is associated with type 1 diabetes,

rheumatoid arthritis, gout, hypothyroidism and amyloidosis

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22
Q

Tx gof trigger finger

A

Although surgery is simple and effective, treatment by injection is often very successful

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23
Q

Where to inject in pts with trigger finger?

A

The injection is made under the tendon sheath and not into the
tendon or its nodular swelling.

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24
Q

This contracture, which causes discomfort and dysfunction rather than pain, is fibrous hyperplasia of palmar fascia leading to nodular formation and contracture over the fourth and fifth fingers in particular

A

Dupuytren contracture

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25
Q

Associations of Dupuytren

A

It is associated with smoking, alcoholism, liver cirrhosis, COPD, diabetes
and heavy manual labour.

26
Q

Triad for Dupuytren

A
  • Tenderness to palpation over and just proximal to radial styloid
  • Firm tender localised swelling in area of radial styloid (may be mistaken for exostosis)
  • Positive Finkelstein sign
27
Q

pathognomonic test for Dupuytren

A

Positive Finkelstein sign

28
Q

It is an overload injury caused by excessive strain on the extensor muscles
of the forearm resulting from wrist extension

A

lateral tennis elbow

29
Q

Physical signs of lateral tennis elbow

A

1 localised tenderness to palpation over the
anterior aspect of the lateral epicondyle

2 pain on passive stretching at the wrist with the elbow held in extension and the forearm prone

3 pain on resisted extension of the wrist with the elbow held in extension and the forearm prone

30
Q

_______ and _______exercises for the forearm muscles represent the best management for tennis elbow.

A

Stretching and strengthening

31
Q

______may occur in other extensor compartments of the wrist and hand with unusual repetitive stressful actions, such as power drills jamming, and in conveyor quality control where an object is picked up with the forearm prone, supinating to examine it
and pronating to replace it

A

Tendonitis

32
Q

Tx of Tendonitis

A

Treatment is rest from the provoking activity,
splintage and tendon sheath injection with longacting corticosteroid in a manner similar to that described for de Quervain tenosynovitis.

33
Q

_______ is caused by a bursitis that develops at the site where the extensor pollicis brevis and abductor pollicis longus tendons cross over the extensor carpi radialis tendons

A

Intersection syndrome

34
Q

Where is the tenderness in intersection syndrome?

A

palpation tenderness is found dorsally on the radial side with swelling and crepitus

35
Q

Look for a _________________

(which causes wrist instability) with tenderness 2 cm distal to the tubercle on the radial side of the lunate.

A

scapholunate ligament tear

36
Q

_______ particularly of the scaphoid, can occur following failure to recognise a fracture

A

Ischaemic necrosis,

37
Q

Tenderness in the ‘anatomical snuff box’ following trauma should be treated as a ________until repeated
X-rays prove negative

A

scaphoid

38
Q

In children, chronic pain in the

region of the lunate suggests avascular necrosis— _________, presenting with dorsal wrist pain

A

Kienböck disease

39
Q

usual location of ganglionic tumors

A

The vast majority arise from the dorsal scapholunate ligament.

40
Q

The basic feature of _______which is a vasospastic disorder, is sequential discolouration of the digits from pallor to cyanosis to rubor upon exposure to cold and other factors

A

Raynaud phenomenon,

41
Q

Aggravating factors for Raynaud

A
  • Smoking
  • Cold, wet weather
  • Stress or emotional upset
42
Q

Tx of severe Raynaid

A

topical glyceryl trinitrate 2% ointment—applied to the base of the affected fingers two to four times daily or applied over the radial artery or dorsum of the hand

43
Q

Tx of severe Raynaid

A 
amlodipine 5–20 mg (o) once daily
or
nifedipine SR 30–60 mg (o) once daily
or
diltiazem SR 180–240 mg (o) once daily
44
Q

This condition is characterised by erythema (redness), a burning sensation and swelling of the hands (and feet) after exposure to heat and exercise

A

Erythromelalgia (erythermalgia)

45
Q 
Treatment of primary erythromelalgia includes trials of
1
2
3
4
A

aspirin, phenoxybenzamine (Dibenyline), methysergide or sympathectomy.

46
Q

This unusual syndrome involves the sudden onset of pain and cyanosis of the ventral aspect of the digit initially, and then the entire digit

A

Acute blue fingers syndrome

in women

47
Q

cause of Acute blue fingers syndrome

in women

A

The cause is probably spontaneous rupture of a vein at the base of the finger

48
Q

Precautions in Chilblains (perniosis

A
  • Think Raynaud phenomenon
  • Protect from trauma and secondary infection
  • Do not rub or massage injured tissues
  • Do not apply heat or ice
49
Q

Tx of Chilblains (perniosis

A

Apply glyceryl trinitrate vasodilator spray or

ointment or patch (use plastic gloves and wash hands for ointment)

50
Q
  • Throbbing, burning pain, worse at night
  • Paraesthesia
  • Initial: red, swollen hand; warm, dry skin
  • Later: cold, cyanosed and mottled, moist skin; shiny and stiff finger
A

Regional pain syndrome

51
Q

______ is avascular necrosis of the carpal lunate bone which may fragment and
collapse, eventually leading to osteoarthritis of the wrist

A

Kienböck disease

52
Q

Osteoarthritis commonly involves the ____ and _______

A 
interphalangeal joints of the fingers (especially the DIP joints)  and
the carpometacarpal (CMC) joint of the thumb
53
Q

Osteoarthritis of the thumb

This is very common, especially in women. Pain is felt at the _____, and tenderness on palpation of the______ is typical

A

base of the thumb

CMC joint

54
Q 
In rheumatoid arthritis the\_\_\_\_\_\_\_\_ are
often spared (only about 30% involved) but the
metacarpophalangeal and proximal interphalangeal joints and wrist joints are generally affected symmetrically and bilaterally
A

DIP joints

55
Q

More frequently see in osteoarthritic joints

of the hand (especially DIP joints) in elderly people taking diuretics. This clinical feature is known as

A

nodular gout.

56
Q

What is the etiology

infected wounds with superficial cellulitis or
lymphangitis _________

A

( Streptococcus pyogenes )

57
Q

_______—this is a specific infection in one
finger of fishermen or meat handlers, caused
by Erysipelothrix insidiosa.

There is a purplish erythema that gradually extends over days. It is rapidly cured by penicillin

A

erysipeloid

58
Q

tendon sheath infection (__________—this is a dangerous and painful
infection that can cause synovial adhesions with severe residual finger stiffness

A

suppurative

tenosynovitis)

59
Q

aquarium’ or ‘swimming pool’ granuloma—nonpainful infection of the tendon sheath due to ____________following a minor cut of
the finger

A

Mycobacterium marinum

60
Q

__________(gardener’s arm)—a chronic
fungal infection from contaminated spikes of
wood or rose thorns presenting as hard nontender nodules in the skin of the hand and
extending along the lymphatics of the arm

A

sporotrichosis

61
Q

Mx of Streptococcus pyogenes (mild to moderate cellulitis, lymphangitis

A

procaine penicillin 1.5 g IM daily, 3 to 7 days
or
phenoxymethylpenicillin 500 mg (o) 6 hourly for 10 days

62
Q

Mx of severe Streptococcus pyogenes

A

If severe to cover both S. pyogenes and

Staphylococcus aureus infection (suspected or proven

MC (90 decks)

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