Hand Flashcards
What forms the carpal tunnel in the wrist?
Carpal bones
Flexor retinaculum (a strong fibrous band that covers the carpal bones on the palmar side of the hand, near the wrist).
How many flexor tendons are around the carpal tunnel and what are they called?
9 flexor tendons
4x FDP (flexor digitorium profundus)
4x FDS (flexor digitorium superficialis)
1x FPL (flexor pollicis longus)
What nerve passes through the carpal tunnel?
Median Nerve
What are the causes of carpal tunnel syndrome?
Most cases of carpal tunnel are idiopathic; however, it can occur secondary to many conditions such as rheumatoid arthritis (decreases the joint space) as well as others such as pregnancy, hypothyroidism and diabetes (these result in a production in fluid retention).
Carpal tunnel syndrome is most likely seen in men. True/false.
False, it is mostly seen in women.
How does Carpal tunnel syndrome present?
Patients complain of paraesthesia (numbness and tingling) affecting the thumb and radial 2.5 fingers. It is described as being worse at night.
What area is wasting in the hand in carpal tunnel syndrome?
Wasting of the thenar eminence. It is a group of three small muscles present at the base of the thumb.
What tests can provoke symptoms of Carpal tunnel syndrome? Adequate for finding a positive result.
Tinel’s sign - percussion over the median nerve to sense tingling and determine nerve damage.
Phalen’s test - holding the wrist in hyper flexion, decreasing the CT (carpal tunnel) space.
Diagnosis is confirmed with nerve conduction studies.
Treatment of carpal tunnel syndrome?
Conservative: involves the use of a wrist splint at night (prevents flexion). This may be supplement by corticosteroid injections.
Surgery: carpal tunnel decompression via surgery can be carried out however there is an associated risk of median nerve damage.
What is Dupuytren’s contracture?
A proliferative connective tissue disorder in which palmar fascia undergoes hyperplasia, with normal fascial bands forming nodules and cords. Eventually progresses to contractures at the MCP and PIP joints.
What is the pathogenesis of Dupuytren’s contracture?
A result of myofibroblast cell proliferation and the production of abnormal collagen (type 3 formed rather than type 1).
Leading to thickening of palmar fascia
Who is most at risk of developing Dupuytrens’s contracture?
Males are most likely to be affected. It has a particularly high prevalence of Scandinavian descent. May develop in in those with alcohol cirrhosis, diabetics are more likely to develop this as well.
What is trigger finger?
It is a non-fixed flexion deformity. It is tendonitis of a flexor tendon to a digit; it is usually distal to a fascial pulley (A1 pulley) over the metacarpal neck. Movement of the affected finger produces a clicking sensation, caused by the nodule catching on and then passing under the pulley.
What is management of trigger finger?
Steroid injection to the tendon sheath to relieve symptoms. Surgery may be required in recurrent and persistent cases.
What effect does Rheumatoid arthritis have on the hand?
Can cause swelling of the joints in the hand, PIPJ and the metacarpophalangeal joints.
