Clinical conditions of the hand Flashcards
(27 cards)
What are the functional needs for a hand?
- Sensation
- Mobility
- Strength
What are the common conditions of the hand?
- Carpal tunnel syndrome
- Ulnar nerve compression
- Dupuytren’s disease
- Rupture of the ulnar collateral ligament of the thumb
- Osteoarthritis
- Rheumatoid arthritis
What is carpal tunnel syndrome?
- Pressure on the median nerve at the wrist
- Alteration in median nerve function due to pressure on the nerve in the tunnel where it enters the hand
- May lead to permanent loss of nerve function
Describe the relationships within the carpal tunnel
- Ulnar n. and artery (Guyon Canal)
- Median n.
- Tendon of flexor carpi radialis
- Division of flexor retinaculum
What are the associated risk factors of carpal tunnel syndrome?
-Gender: more common in women
-Age
-White race
-Diameter of carpal tunnel
-Obesity
-Hormonal (fluid retention)
=Hypothyroidism
=Menopause
=Diabetes
=Contraceptive pill
What are the signs, symptoms and investigations for carpal tunnel syndrome?
Symptoms: -Paraesthesia (tingling in nerve distribution) -Nocturnal symptoms** -Provocative features* =Wrist flexion, hand elevation, Phalen’s test -Relieving features* =Shaking hand, running under cold tap Signs: -Hypoaesthesia (diminished sensation) -Muscle wasting*** Investigations: -Neurophysiology (measuring speed of conduction in nerve) ADVANCED LOSS OF MEDIAN NERVE FUNCTION
What is the treatment for carpal tunnel syndrome?
-Night splint
-Inject
-Operation
=Open
=Endoscopic
(open release of the flexor retinaculum- nerve still has to recover)
What is Ulnar Nerve Dysfunction?
Usually due to irritation/compression at the elbow
What occurs in ulnar nerve dysfunction?
- It is exposed to direct pressure over the medial epicondyle
- It is stretched when the elbow flexes
- When the elbow flexes it is compressed beneath the fibrous band between the two heads of FCU
- When the elbow flexes it may sublux medially
Describe the presentation of ulnar nerve dysfunction
- Paraesthesia (tingling)
- Hypoaesthesia (numbness)
- Weakness of grip
- Paralysis of affected muscles
- “Clawing” of hand
- Froment’s sign (flexed thumb)
What is the treatment for ulnar nerve dysfunction?
- Release of compression at elbow
- Occasionally transposition to front of elbow
What is Dupuytren’s Disease?
Thickening and contracture of the palmar and digital fascia of unknown cause
-Variable patterns
Describe Dupuytren’s disease
- Cord-like contractures in the bands of the longitudinal fibres of the palmar and digital fascia
- A cellular process involving myofibroblasts
- Collagen is abnormal
- Normally type I but in DD type III predominates
- The cause/s are unknown but there are some associated factors
What are the causes associated with in Dupuytren’s disease?
-Genetic influences =Familial =Racial -Systemic disease =Diabetes =Cirrhosis of liver -Trauma =Site of injury More common in men
What is the treatment ladder for Dupuytren’s disease?
- Amputation
- Dermofasciectomy
- Fasciectomy
- Fasciotomy
- Advice
What advice can be given for Dupuytren’s disease?
-No contracture (surgery unnecessary)
-Contracture (indications for surgery)
=Getting in the way
=Interfering with function
=Patient wants operation
Which joints are easier to be corrected in Dupuytren’s disease?
-MCPJ contractures can usually be corrected (no capsular contracture)= metacarpophalangeal joint
-PIPJ contractures may be difficult (established capsular contracture)
= proximal interphalangeal joint
What is Fasciotomy?
Division of cords either by surgical release or injection of collagenase
What is Fasciectomy?
Excision of fascia
Describe rupture of the ulnar collateral ligament of the thumb
Hill end thumb (matting)
Pull thumb back
Cannot grip
What is the treatment for rupture of the ulnar collateral ligament of the thumb ?
- Repair the ligament
- It may have flipped out from beneath the adductor pollicis tendon
Describe OA in the trapeziometacarpal joint
- Double saddle joint
- Laxity may cause abnormal wear at edges of joint because of incongruity
- Common in middle-aged women
- Various treatments- most can be controlled without operation (analgesics, rest, spontaneous improvement)
Describe the trapeziometacarpal joint
(a) Neutral position
(b) Pommels fitted edge to edge (adducted position 1st MC)
(c) Cantles fitted edge to edge (abducted position 1st MC)
(d) Flexion with medial rotation, extension with lateral rotation
What is the treatment for OA in the trapeziometacarpal joint?
-Rest
-Analgesia
-Surgery
=Excision of trapezium
=Joint replacement
