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MSK > Conditions Of Hand And Wrist > Flashcards

Conditions Of Hand And Wrist Flashcards

1
Q

What is the most common cause of a Distal radius fracture?

A

Fall Onto Outstretched Hand (FOOSH)

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2
Q

What type of trauma causes distal radius fractures in young people?

A

High energy trauma

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3
Q

What type of trauma causes distal radius fractures in older people?

A

Low energy trauma

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4
Q

What is a risk factor for distal radius fracture?

A

Osteoporosis

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5
Q

What end of the forearm bones are the Styloid processes of the ulnar and radius?

A

Distal end

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6
Q

What is a fragility fracture?

A

A fracture that usually occurs in Older people with a lower energy trauma

Suggests potential osteoporosis

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7
Q

What perecentage of distal radius fractures are Intra articular?

A

50%

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8
Q

What is a Colles Fracture?

A

A type of distal radius fracture

An extra articular distal radius fracture with dorsal angulation (distal part goes dorsally)

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9
Q

What is a common cause of a Colles’ fracture?

A

FOOSH with Forearm pronated wrist dorsiflexed

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10
Q

How is a Colles fracture treated?

A

Always check neurovascular status by checking pulses distal to damage
Analgesia
Then:
Reduce
Hold
Rehab

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11
Q

What are some ways that the Colles fracture can be fixed?

A

Closed reduction with immobilisation (plaster)
Closed reduction with Percutaneous pinning
Open reduction internal fixation
External fixation

Just Know Reduce, immobilise.

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12
Q

What is a Smiths fracture?

A

Type of distal radius fracture

Distal radius fracture with volar/palmar angulation of the distal fragment

THE REVERSE OF A COLLES FRACTURE

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13
Q

What causes a Smiths fracture?

A

Fall onto the dorsum of the palm

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14
Q

What can a smiths fracture lead to?

A

Carpal tunnel syndrome

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15
Q

What makes the digital (finger) side border of the anatomical snuff box?

A

Extensor pollicis longus tendon

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16
Q

What makes the thumb side border of the anatomical snuff box?

A

Extensor pollicis brevis tendon
And
Abductor pollicis longus tendon

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17
Q

What pulse can be palpated in the anatomical snuff box?

A

Radial pulse/artery

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18
Q

What carpal bone is at risk of Avascular necrosis if fractured?

A

Scaphoid

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19
Q

Why is the scaphoid at risk of Avascular necrosis if fractured?

A

Its blood supply is retrograde

Radial artery branches off to the distal part of the scaphoid supplying this part first, proximal part after

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20
Q

What part of the scaphoid is at risk of Avascular necrosis?

A

The proximal part of the scaphoid to the point of the fracture

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21
Q

How does Rheumatoid arthritis cause damage?

A

Autoantibodies attack synovium, inflamed synovial cells proliferate forming a pannus
Pannus penetrates through the cartilage and adjacent bone eroding the joint deforming it

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22
Q

What joint of the hand is commonly affected by osteoarthritis?

A

1st Carpometacarpal joints

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23
Q

What are the symptoms of osteoarthritis of the 1st Carpometacarpal joint?

A

Pain
Stiffness
Swelling

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24
Q

What changes on an xray can be seen with osteoarthritis of the 1st Carpometacarpal joint?

A

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cactuses

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25
Q

How can you treat osteoarthritis of the 1st Carpometacarpal joint?

A

Activity modification
Analgesia
Interarticular steroid injections
Surgery

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26
Q

What carpal bone articulates with the thumb?

A

Trapezium

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27
Q

When is pain of osteoarthritis exacerbated and relieved?

A

Exacerbated by movement
Relieved by rest

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28
Q

What shapes can happen in osteoarthritis of the 1st Carpometacarpal joint?

What produces this shape?

A

Squaring

Subluxation of thumb in ulnar direction

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29
Q

What are the risk factors of OA?

A

Female
Age
Trauma to joint

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30
Q

What are Heberden’s Nodes?

A

Inflammation of synovial membrane at the Distal Interphalangeal joints leading to osteophytes forming here

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31
Q

What are Bouchard’s nodes?

A

Inflammation of synovial membrane of Proximal Interphalangeal Joints

32
Q

What increases the risk of developing Heberdens and Bouchard’s Nodes?

A

Female
Genetics

33
Q

What are the symptoms of Herberdens or Bouchard’s nodes?

A

Pain
Swelling
Loss of manual dexterity

34
Q

Where do patients commonly get Rheumatoid Arthritis?

A

Symmetrical polyarthropathy of small joints

35
Q

What are the common symptoms of Rheumatoid Arthritis?

A

Pain
Joint stiffness/pain that is relieved by increased movement
Joint swelling/erythema
Extra-articular features

36
Q

What are some extra articular features that Rheumatoid arthritis might present with?

A

Fatigue
Skin else where affected (nodes)

37
Q

What joints are often affected in the hand by Rheumatoid arthritis?

A

Proximal Interphalangeal Joint
Distal Interphalangeal Joint

38
Q

What characteristic features can be seen on an X-ray for Rheumatoid arthritis?

A

Loss of joint space
Erosions of bone
Soft tissue swelling
See through bones (osteopenia) near the joint space

LESS

39
Q

What are 2 types of deformity commonly seen in patients with Advanced Rheumatoid Arthritis?

A

Swan neck deformity
Boutonnière deformity

40
Q

What is Swan neck deformity?

A

Hyper extension of PIP (Proximal Interphalangeal Joint)
Flexion of DIP (Distal Interphalangeal joint)

41
Q

Why can Swan neck deformity occur with advanced RA?

A

Tissues on Palmar/Volar aspect of PIP become lax due to the synovitis
Causes imbalance in forces from extensors and flexors (flexors weaker so hyper extension of PIP)
Extensor digitorum inserting into distal phalanx elongated or ruptured so DIP flexed due to extensor deformity

42
Q

What causes hyperextension of PIP in Swan neck deformity?

A

Tissue on palmar aspect of PIPJ lax (adjacent synovitis)
Flexors weaker so extensor force out weighs it causing hyperextension

43
Q

What causes Flexion of DIPJ in swan neck deformity?

A

Rupture of elongation of insertion at distal phalanx of extensor digitorum leading to Flexion outweighing it

44
Q

What is Boutonnière deformity?

A

MCPJ and DIP hyperextended and PIPJ flexed

45
Q

What causes the shape seen in Boutonnière deformity?

A

Inflammation at PIPJ causes lengthening / destruction of central slip of Extensor digitorum
Causes the 2 lateral bands of extensor digitorum to slip down from the dorsal surface and insert on the palmar surface at the level of the PIPJ
These 2 bands now act as flexors at thee PIPJ and hyperextending DIPJ

46
Q

What is psoriasis?

A

Skin condition that causes red, flaky patches of skin covered with silvery scales

47
Q

Where does psoriasis commonly occur?

A

Elbows
Kness
Scalp
Lower back
(Can happen anywhere)

48
Q

How doe psoriatic arthropathy/arthritis develop?

A

Usually asymetrical oligoarthirits (1 joint at a time)

49
Q

How does psoriatic arthritis present?

A

Normal psoriasis signs (red flaky rash)

Dactylitis (finger swelling like sausages)
Onychodystrophy (Nail pitting)
Onchylosis (nail separating from nail bed)

50
Q

What is Dactylitis?

A

Sausage shaped swelling of fingers

51
Q

What is onchyodystrophy?

A

Nail pitting

52
Q

What is Onchylosis?

A

Lifting of nail away from the nail bed

53
Q

What is the term used to describe how psoriatic arthritis appears on an X-ray?

A

Pencil in a cup

Distal phalanx = Cup
Intermediate phalanx = Pencil

54
Q

What is carpal tunnel syndrome?

A

Swelling or narrowing of carpal tunnel which compresses the median nerve

55
Q

What are risk factors for carpal tunnel syndrome?

A

Obesity
Repetitive wrist work
Pregnancy
Rheumatoid arthritis
Hypothyroidism

56
Q

Where does the patient typically experience paraesthesia in carpal tunnel syndrome?

A

Radial/lateral 3.5 digits
Not the palm

57
Q

Why is sensation to the palm of the hand spared in carpal tunnel syndrome despite being supplied by the median nerve?

A

Supplied by palmar cutaneous branch of median nerve which branches before the medina enters the carpal tunnel
This branch doesn’t get compressed as it doesn’t pass through the carpal tunnel

58
Q

What branch of the median nerve supplies the Thenar muscles?

A

Recurrent branch

59
Q

Why can Thenar muscle weakness and wasting atrophy occur in long lasting carpal tunnel syndrome?

A

Median nerve compressed in carpal tunnel means the recurrent branch which comes from median after the carpal tunnel isn’t able to supply these muscles well (atrophy via Denervation))

60
Q

Why can a patient with carpal tunnel syndrome still flex and Adduction the thumb?

A

Flexor pollicis longus = anterior interosseis branch of median nerve from forearm

Flexor pollicis brevis = ulnar nerve

Adductor pollicis = ulnar nerev

61
Q

What is the term used to describe the muscles supplied by the median nerve and would be affectd in carpel tunnel syndrome?

A

Weakness of LOAF muscles

62
Q

How is carpal tunnel syndrome treated?

A

Splint at night in dorsiflexion

Corticosteroid injection

Surgical decompression

63
Q

What is Ulnar Tunnel Syndrome?

A

When ulnar nerve is compressed in the Guyons canal as it passes lateral to the pisiform and adove the surface of the flexor retinaculum

64
Q

What is the roof of the Guyons canal

A

Palmar carpal ligament

65
Q

Where will a patient complain of paraesthesia in Ulnar nerve compression?

A

Ring and little finger

66
Q

What muscles will be weakened in Guyons canal syndrome?

A

Palmar + Dorsal Interossei
Ulnar 2 lumbricals (little + ring finger)
Adductor pollicis

67
Q

What is Dupuytrens contracture?

A

Localised thickening and contraction of palmar aponeurosis leading to a Flexion deformity of adjacent fingers

FIXED FLEXION DEFORMITY

68
Q

What is meant by a fixed Flexion deformity?

A

Cannot be actively or passively extended (stuck in position)

69
Q

What leads to Dupuytrens contracture becoming a fixed Flexion deformity ?

A

Thickening /nodule forms in palm
Myofibroblasts of nodule contact leading to formation of tight bands called CORDS in the palmar fascia, this causes the skin and proximal fascia to be involved in the disease

70
Q

What are the most common fingers affected in Dupuytrens contracture?

A

Ring and little finger

71
Q

What are 4 risk factors of Dupuytrens Contracture?

A

Type 1 diabetes
Epilepsy meds
SMoking
HIV
Liver disease
Trauma to hand or fingers
Heart disease
Hypercholesterolaemia

72
Q

What commonly leads to a scaphoid fracture?

A

FOOSH causing hyperextension and impaction on scaphoid against radius

73
Q

Where is pain experience with a scaphoid fracture?

A

Anatomical snuffbox

74
Q

If you suspect a scaphoid fracture but you cant see it on an X-ray, what must be done?

A

Treat patient as if they have a fracture
(Put in plaster of Paris cast)

75
Q

Why must you treat the patient as if they have a fracture if you cant see a fracture line on the scaphoid if you suspect the fracture?

A

Fracture line may become more visible later on after some bone has been resorped

76
Q

How is Guyons canal syndrome treated?

A

Similar to carpal tunnel
Conservative management
Surgical decompression

MSK (36 decks)

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