Hand Flashcards
(12 cards)
What is trigger finger?
Stenosing tenosynovitis caused by inflammation of the flexor tendon sheath
What are the signs and symptoms of trigger finger?
Symptoms
- Finger clicking
- Pain at distal palm near A1 pulley
- Finger becoming “locked’ in flexed position
Signs:
- Tenderness to palpation over A1 pulley
- Palpable bump may be present
What are the risk factors for trigger finger?
- Diabetes
- RA
- Amyloidosis
How do you classify the severity of trigger finger?
Green classification
Grade 1: Palm pain and tenderness at A1 pulley
Grade 2: Catching of digit
Grade 3: locking of digit, passively correctable
Grade 4: Fixed, locked digit
What is the management of trigger finger?
Conservative:
- Night splinting, activity modifications
- Pain management: NSAIDs, Steroid injections
Surgical:
- Surgical debridement and release of the A1 pulley
What is the pathophysiology of trigger finger
- Caused by entrapment of the flexor tendons at the level of the A1 pulley (middle of the metacarpal)
What is de quervain’s tenosynovitis?
Stenosing tenosynovial inflammation of the 1st dorsal compartment which includes the abductor pollicis longus and the extensor pollicis brevis.
What is the clinical presentation of de quervain’s tenosynovitis?
Symptoms:
- Gradual onset
- Radial sided wrist pain
- Exacerbated by gripping and raising objects
Physical Exam
- Tenderness over 1st dorsal compartment at level of radial styloid
- Pain with resisted radial deviation
- Provocative test:
- Finkelstein maneuver (grasp thumb, quickly abduct hand ulnarward, pain over styloid tip painful.
What are the risk factors of de quervain’s tenosynovitis?
-
Demographic
- Women
- 30 years old
-
Exposure
- Overuse (golfers, racquet sports )
- Post-Traumatic
- Postpartum
What is the management of de quervain’s tenosynovitis?
Conservative:
- Rest, activity modification
- Immobilization: Thumb Spica splint
- Medical: NSAIDS, steroid injection
Surgical:
- Surgical release of 1st dorsal compartment
What are some possible complications of surgical management of de quervain’s tenosynovitis?
- Sensory branch of radial nerve injury
- Failure to decompress with recurrence
- Complex regional pain syndrome
What is the pathophysiology of de quervain’s tenosynovitis?
- Thickening and swelling of extensor retinaculum causes increased tendon friction
