Common Wrist-Hand conditions

Question 1

Carpal Tunnel Syndrome (CTS)

Answer 1

Aetiology:
Female sex, age, genetic, high BMI, and anthropometric factors - most important predisposing factors

S&S:
- Pain in the hand
- Numbness and tingling in the the distribution of the median nerve
- Proximal radiation of pain or paraesthesia to the elbow or even the shoulder
- Clumsiness and weakness in the affected hand, worse with activity (eg. driving, reading, typing)
- Night pain and paraesthesia
- Thenar atrophy; a sign go advanced CTS

ST:
Tinel’s sign at the wrist
Phalen’s test
Flick sign
Carpal compression test

Question 2

TFCC (triangular fibrocartilage complex)

Answer 2

TFCC act as a stabiliser for distal radioulnar joint

MOI:
- Traumatic injury:
Fall on extended wrist forearm pronated
- Chronic injuries:
Degenerative changes via repetitive motions

S&S:
- History of trauma to the affected wrist
- ulnar- sided wrist pain that often gets worse with activity (eg. when stirring coffee or other activities requiring rotation)
- Catching or clicking sensation with movement of the wrist and a feeling of weakness

ST:
Piano key sign +
TFCC load test
Chair press test

Question 3

De Quervain Tenosynovitis

Answer 3

Inflammation and thickening of the extensor retinaculum

MOI:
Repetitive wrist motion, specifically motion requiring thumb radial abduction and simultaneous extension and radial wrist deviation

S&S:
> Tenderness and swelling over the tendons along the distal radius
> Tender point over the radial styloid
> Radial-sided wrist pain aggravated by activities such as gripping, wringing of a washcloth, lifting a child

ST:
Finkelstein test

Question 4

OA of the 1st CMCJ

Answer 4

Contributors to OA of the 1st CMC:
- Laxity of the CMC joint
- Excessive repetitive use of the CMC joint of the thumb
- Subluxation
- Lesion of the ligaments
- Fractures

S&S: hand function related
> Pain, tenderness, and stiffness at the base of the thumb with gripping, pinching, or clasping something between the thumb and index fingers
> Reduced grip strength
> Swelling around the base of the thumb
> Deformity - enlarged joint

CT:
Grind test (Axial load test) +