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Orthopaedics > Wrist disorder > Flashcards

Wrist disorder Flashcards

1
Q

What is trigger finger known as

A

stenosing flexor tenosynovitis

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2
Q

What other conditions are associated with trigger finger?

A
  • RA
  • Calcific tendinitis
  • Carpal Tunnel Syndrome
  • DM
  • amyloidosis
  • sarcoidosis
  • gout
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3
Q

What is the pathophysiology of trigger finger

A
  1. repetitive movement > inflammation of tendon and sheath > tendonysovitis > localised nodal formation
  2. When finger flexed, node moved proximal to pulley > when finger extend, node failes to pass back under pulley > digit becomes locked
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4
Q

What are the three types of pulley involved in the hands?

A
  • Palmar aponeurosis
  • Annular ligaments (5)
    • A2 & A4 prevent bowstringing
    • A1 commonly affected
  • Cruciate ligament (3)
    • prevent collapsing and expansion of sheath during movement
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5
Q

What are the risk factors of trigger finger

A
  • prolong gripping or use of hands
  • RA
  • DM
  • Female
  • Age
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6
Q

What are the clinical features of trigger finger?

A
  • painless clicking on finger extension
  • gradual onset of pain over volar (palmar) side MCPJ
  • digits lock in flexion
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7
Q

What are the differential for trigger finger?

A
  • 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 >
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8
Q

What Ix would you order for trigger finger?

A
  • diagnosis made clinically
  • Bloods - GH & infection
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9
Q

What are the Mx option for trigger finger?

A

Conservative

  • Splinting, activity modification, NSAIDs
  • Corticosteroid injection

Surgical

  • percutaneous release of A1 pulley
  • surgical decompression of tendon tunnel
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10
Q

What are the Cx of trigger finger?

A
  • adhesion formation post op - if pt doesnt move finger
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11
Q

What is De Quervain’s Tenosynovitis?

A
  • Inflammation of tendons within first dorsal compartment of wrist
  • includes ABL, EPB
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12
Q

What are the RF of DQT

A
  • Age 30-50
  • Female
  • Pregnancy
  • Occupation involving repetitive hand movements
    • golfers, racquet sports
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13
Q

What is the pathophysiology of DQT?

A
  • thickening and swelling of extensor retinaculum causes increased tendon friction
  • may be related to accumulation of mucopolysaccharides
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14
Q

What muscles are in the 6 extensor compartments of the wrist?

A
  • 1
    • EPB
    • APL
  • 2
    • ECRB
    • ECRL
  • 3
    • EPL
  • 4
    • ED
    • EI
  • 5
    • EDM
  • 6
    • ECU
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15
Q

What are the clinical features of DQT

A
  • Pain near base of thumb
  • Swelling
  • Compromised grasping or pinching
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16
Q

On ex, what will you find on pt with DQT

A
  • Sweeling
  • Palpable thickening
    • Finkelstein’s test
  • +Eichhoff maneuver
17
Q

What is Finkelstein’s test and Eichnoff maneuver

A
  • 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
18
Q

What are the differential diagnosis for DQT

A
  • 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
19
Q

What Ix would you order for DQT?

A
  • Diagnosed clinically
  • Hand radiograph - exclude arthritis
20
Q

How would you mx DQT?

A

Conservative (majority)

  • rest, NSAIDS, thumb spica splint, steroid injection

Surgery

  • Surgical release of 1st dorsal compartment
21
Q

What are the cx of surgical decompression for DQT?

A
  • failure to resolve
  • red ROM
  • neuroma formation
  • nerve impingement
22
Q

What are ganglionic cyst?

A
  • non-cancerous soft tissue lumps that occur along any joint or tendon
23
Q

What is the Px for ganglionic cyst?

A
  • arise from degeneration within joint capsule or tendon sheath > filled c synovial fluid
24
Q

What are the RF for ganglionic cyst?

A
  • Female
  • OA
  • ​Hx of joint/tendon injury
25
Q

Where to ganglionic cyst typically occur?

A
  • Hands (dorsal side)
  • feet
26
Q

What are the clinical features of ganglionic cyst?

A
  • Smooth painless lump
  • Lump transilluminate
  • ROM restricted
  • localised parasthesia/weakness - if nerve injured
27
Q

What are the differentials for ganglionic cyst?

A
  • Tenosynovitis
    • swelling tracking along tendon
  • Giant cell tumour of tendon sheath
    • mass is solid, fixed, x transilluminate
  • Lipoma
    • x transilluminate
  • OA
  • Sarcoma
28
Q

What Ix would you order for ganglionic cyst?

A

* clinically diagnosed

  • Imaging
    • USS/MRI to assess cyst
    • radiograph to rule our OA or sarcoma
29
Q

How would you Mx ganglionic cyst?

A

Conservative

  • Self limiting
  • Aspiration +/- steroid injection

Surgical

  • Cyst excision

Orthopaedics (13 decks)

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