Common conditions of hand and wrist Flashcards
(28 cards)
Scaphoid fracture
- Most common fracture of carpal bones
- More likely in YA and teens
- FOOSH
How does scaphoid fracture present?
- Pain in anatomical snuffbox
- Worsened by moving wrist
- XR might no show fracture immediately - wait 10-14 days to see if fracture line more visible after bone resorption
Complications of scaphoid fracture
- Avascular necrosis if fracture through waist of scaphoid as blood supply from distal to proximal pole
- Displaced fractures through waist of scaphoid have high risk of non-union
- OA more common if malunion, non-union or avascular necrosis
Colles’ fracture
Fracture of distal radial metaphysis w dorsal angulation and impaction = fork.
Risk factors of Colles’ fracture
Osteoporosis = post menopausal women
Presentation of Colles’ fracture
Painful, deformed, swollen wrist. FOOSH normally.
Complications of Colles’ fracture
- Malunion - dinner fork deformity
- Median nerve palsy + post traumatic carpal tunnel syndrome
- Secondary OA
- Tear of extensor policies longs tendon
Smith fracture
Fracture of distal radius w palmar angulation of distal fracture = reverse Colles’ fracture.
Risk factors of Smith fracture
- Young males
- Elderly females
- Fall on dorm of flexed wrist/blow to back of wrist
Complications of Smith fracture
- Garden spade deformity = malunion
- Carpal tunnel syndrome if garden spade deformity
Mechanism of RA
- Autoantibodies attack synovial membrane
- Inflamed synovial cells proliferate to form pannus
- Penetrates through cartilage and adjacent bone = joint erosion and deformity
- Effects multiple joints in symmetrical distribution
Presentation of RA
- Pain and swelling of PIPJ and MCPJ
- Erythema of overlying joints
- Stiffness worse in morning or after inactivity
- Carpal tunnel syndrome
- Fatigue and flu like symptoms - systemic nature
- Late feature = rheumatoid nodules
X ray features of RA
- Joint space narrowing
- Periarticular osteopenia
- Juxta-articular bony erosions
- Subluxation and gross deformity
Swan neck deformity
PIPJ hyperextends and MCPJ and DIPJ flexed
Boutonniere deformity
MCPJ and DIPJ hyperextended and PIPJ flexed
Psoriatic arthropathy
When patients w psoriasis develop arthritis (minority).
- Fusiform swelling of digits = dactylitis
- Stiffened affected joints = widespread joint destruction = arthritis mutilans
- Most commonly affects DIPJ
Nail lesions in psoriatic arthropathy
Nail pitting
Onycholysis - separation of nail from nail bed
OA of 1st CMC joint and DIPJ
Joint in hand most commonly affected by OA is 1st carpometacarpal joint (trapezium and 1st metacarpal).
More common in women.
Pain at base of thumb.
Squaring of hand.
Heberden’s nodes
- Sign of OA in DIPJ
- Run in families
- More common in women
- Begin w chronic swelling or sudden onset on pain, swelling and loss of manual dexterity
- Cystic swelling containing gelatinous hyaluronic acid on dorsolateral aspect of DIPJ
- Initial inflam and pain goes and then osteophyte
Bouchard’s nodes
Same process as Heberden’s nodes but on PIPJ
Carpal tunnel syndrome
Compression of median nerve as passes through carpal tunnel from forearm into hand.
Parasethesia in median nerve distribution. Worse at night and daily activities aggravate paraesthesia.
Pain can also be in forearm, elbow, should and neck.
Risk factors of carpal tunnel syndrome
- Obesity
- Repetitive wrist work
- Pregnancy
- Rheumatoid arthritis
- Hypothyroidism
Motor and sensory in carpal tunnel syndrome
- Sensation to palm spared as palmar cutaneous branch of median nerve doesn’t pass through carpal tunnel
- Motor branch of median nerve passes through carpal tunnel so prolonged carpal tunnel syndrome = muscle weakness and atrophy of thenar muscles
What nerve is compressed in Guyon’s canal?
Ulnar nerve as it passes lateral to pisiform bone over flexor retinaculum.
Paraesthesia in ring and little fingers.
