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Orthopaedics > Hand and Wrist disorders > Flashcards

Hand and Wrist disorders Flashcards

1
Q

common presentatjions in hand and wrist disordrs 5

A

tingling finfers

sticking fingers

stuck fingers

radial sided wrist pain

lumps and bumps

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2
Q

differential diagnosis for tingling fingers 3

A

peripehral nerve entrapment
-carpal tunnel and cubital tunnel syndrome

central nerve entrapment

peripheral neuropathy

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3
Q

key features of peripheral nerve entrapment 3

A

pain/ paraesthesia in the distribution of the nerve

altered sensation in the distribution of the nerve

reduced muscle function supplied by the nerve

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4
Q

what forms the carpal tunnerl

A

bones of the carpus roofed by the transverse carpal ligament (flexor retinaculum)

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5
Q

what structuers pass through the carpal tunnel 4

A

median nerve

4xFDS(flexor digitorum superficiallis)

4xFDP (flexor digitorm profundus)

FPL- flexor pollicis longus

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6
Q

associtaed conditions with carpal tunnel syndrome 8

A

usually idopathic

DM

hypothyroidis

RA

acromegaly

wrist fractures

pregnnacy

use of heavy vibrating machinery

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7
Q

presentation of carpal tunnel syndrome 5

A

nocturnal waking with tingling in thumb, index and middle finger
-releived by shaking hand

altered/reduced sensation in median nerve distribution

difficulty manipulating small objects

clumsiness

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8
Q

clinical signs of carpal tunnel syndrome 6

A

reduced sensation in median nerve distribution

reduced sensation on raidal side compared with ulna side

reduced thumb abduction

thenar muscle wasting

+ve tinels sign

+ve phalens test

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9
Q

management of carpal tunnel syndrome 3

A

wrist splints- esp noctural

steroid injections- esp during pregnancy

carpal tunnel decompression surgery

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10
Q

describe carpal tunnel syndrome surgery 2

A

Local anaesthetic w tourniquet

diveide flexor retinaculum longitudinally

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11
Q

anatomy of cubital tunnel

A

formed by cubital tunnel retinaculum

-ulnar nerve travels between the 2 heads of FCU (flexor carpi ulnaris) under the CTR

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12
Q

where does cubital tunnel syndrome take place

A

compression of ulnar nerve in cubital tunnel behind medial epicondyle of elbow

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13
Q

presentation of cubital tunnel syndrome 2

A

noctural waking with tingling
-in ulnar nerve distribution
-pinky and half of ring finger

altered/reduced sensation

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14
Q

clinical signs of cubital tunnel syndrome 7

A

relative loss of senaation

reduced sensation of unla side compared with radial side

reduced finger abduction

claw posture- if severe

hypothenar wasting

interosseus wasting

+ve tinels sign at elbow

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15
Q

management of cubital tunnel syndrome 3

A

soft elbow spint- for noctural syx

NOT steroid injection-risk of injuring nerve

cubital tunnel decompresion surgery

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16
Q

differenital diagnossi for sitcking fingers 2

A

trigger finger

extensor tendon subluxation

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17
Q

what causes trigger finger

A

constirction and thickening of the A1 pulley

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18
Q

what can be foundin trigger finger disease

A

nodule on tendon

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19
Q

clinical presenation of trigger finger 2

A

finger sticks in felxion then clicks painfully as finger is extended

syx worse in am

*-increased risk w diabetes and more difficult to treat

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20
Q

management of trigger finger 3

A

non-operative
-splintage
-steroid injection

operative
-surgical release/widening of A1 pulley

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21
Q

another name for trigger finger

A

flexor tensynovitis

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22
Q

associated conditions with trigger finger 2

A

DM

RA

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23
Q

differentials for stuck fingers 2

A

dupuytrens dissae

radial nerve or posterio interosseus nerve palsy

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24
Q

who gets Dupuytren’s disease 4

A

2:1 M:F

AD w variable penetrace

caucasion

men>55 women>65

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25
Q

which fingers are affected by Dupuytren’s disease 2

A

commonly ring and little finger

26
Q

pathophys of Dupuytren’s disease

A

prolieratiion of myofibroblasts in palmar fascia producing pathological nodules and cords

27
Q

associated conditions with Dupuytren’s disease 5

A

diabetes

epilepsy

alcohol

anti-convulsatns

FHx

28
Q

clinical presenation of Dupuytren’s disease 1

A

fixed flexion deformities of MCP and PIP joints

difficulty with activities of daily living (ADLs)
-cant put hand in pocket
-poke themselves in eye when washing face

29
Q

management of Dupuytren’s disease 4

A

needle aponeurecomty

collagenase injfections

fasciecotmy

dermofasciectomy

30
Q

describe needle aponeurectomy in Dupuytren’s disease

A

under Local A

hypodermic needle used to cut cords

31
Q

describe collagenase injfection in Dupuytren’s disease

A

injection of enzyme into cords

-digests collagen and weakens cord
-allows cord to be snapped by firm extension of finger 24-72hrs later

32
Q

describe fasciectomy and dermofasciectomy

A

fasiectomy
-surgical excision of the cords

dermofasciectomy
-surgical excision of cords and overlying skin then application of a full thickness skin graft

33
Q

most common lump in hand

A

ganglions

34
Q

common sites of ganglions in the hand 4

A

dorsal wrist

volar wrist

finger felxor sheath

DIP joint

35
Q

treatment for ganglions 3

A

leave alone- may spontenously regress

aspirate

excise

36
Q

who gets OA of hands

A

FHx

F:M 3:1

presence increases risk of future hip and knee oOA

37
Q

risk factors for OA hands 5

A

previous trauma of joint increases the risk of having OA in that joint

obseity

hypermobility of joint

occupation

osteoporosis
-reduced risk of OA

38
Q

features of hand OA

A

usually bilateral

episodic joint pain

stiffness
-worse after long periods of inactivity
-only lasts few minutes compared to RA

painless nodes
-heberdens
-bouchards
-due to osteophyte formation

squaring of thumbs

39
Q

what joints are affected in hand OA

A

carpomatacarpal joints CMCs

DIPs more than PIPs
-in contract to RA where DIPs are spared

40
Q

where are heberden nodes

A

at DIP joints

41
Q

where are bouchard nodes

A

PIP joints

42
Q

management options for OA in hands 2

A

conservative
-weight loss
-muscle strengthening

analgesia
-PCM
-topical NSAIDs
-oral NSAIds (add PPI )

43
Q

surgical options for OA of hands 2

A

arhtrodesis -fusion of bones w interal metal fixation

trapeziectomy-helps OA of thumb
-removes trapezium and insert metal or plastic joint

44
Q

common signs of rheumatoid hands 6

A

ulnar deviation of fingers

Z thumb

extensor tendon rupture

boutonniere deformites

swan neck deformites

rheumatoid nodules

45
Q

describe boutonniere deformites

A

flexed PIP

hyperextened DIP

46
Q

describe swan neck defromites

A

hyperextenion of PIP

flexion of DIP

(think PIPE=swan neck)

47
Q

what needs to be assessed in amputations and partial amputations 3

A

level
-finger-tip
-finger-distal to FDS
-hand,forearm, arm

vascularity and time from injury

bone, tendon and nerve injury

48
Q

complete amputaion vs partial amputation of finger tip injuries

A

complete amputaion
-generally not suitable for replantation

partial amputation
-presernve and suture back if viable
-excise if non-viable

49
Q

what is assessed in finger tip injuries 3

A

bone loss
-viable bone detemines length of finger tip that can be preserved

nail loss

skin loss

50
Q

aims of treatment for finger tip injuries 3

A

try preserve as much length as possible

try preserve insertion of FDP

preserve the nail then repair any nail bed injuries

51
Q

treatment options for finger tip injuries 4

A

Increasing levels of severity:

dressings

trimming of bone and dressings

terminalisation and primary closer

local advancement or transposition flap

52
Q

what determines replantation ability of finger amputations

A

if distal to FDS and proximal to DIP
-idela for replant as PIP is undamaged and likely to be flexible

if proximal to FDS
-just terminalise over replantation as PIP is likely to be very stiff

53
Q

assessment of hand lacerations 3

A

vascular assessment

neurological assessment

tendon assessment

54
Q

vascular assessment in hand lacerations 2

A

cap refil

pulses

if vascualr compromise but potential for replantation or revasculasraisation then it becomes SURGICAL EMERGENCY

55
Q

neurological assessment of hand lacerations 2

A

assess whhcih nerve most likely to be injured from location of laceration

in finger lacerations differentiate between the raidal and ulna digital nerves

56
Q

neurological assessment of hand lacerations 2

A

assess whhcih nerve most likely to be injured from location of laceration

in finger lacerations differentiate between the raidal and ulna digital nerveste

57
Q

tendon assessment of hand lacerations 2

A

estimate which tendons are likley to be injured from location of lacteration

in finger lacerations differentiate between tenodns of FDS and FDP

58
Q

treatment of hand lacerations in A&E 4

A

Local anaesthic and irrigation
DO NOT USE LA UNTIL NEURO ASSESSMENT BEEN MADE

tetanus/ IV ABx

dressing and back slab

low threshold for surgical exploration
-any suspicion of tendon or nerve injury
-refer to ortho/plastics

59
Q

theatre treatment options for hand laceratsion

A

tenodn repair
-balace between mobilisation adn immobilisation
-too little mobilisatio-> adhesions and stiffnes
-to aggressive mobilisatio-> rupture of repair

nerve repair
-slow recovery 1mm/day

60
Q

define fight bite

A

happens over metacarpo-phalangeal joint
-knucle of fist connects with teeth

61
Q

Mx of fight bite 4

A

x-ray for tooth

high risk of penetration of MCPJ

low threshold for surgical irrigation

consider tetanus, debridement

-often ABx if skin has been broken

Orthopaedics (15 decks)

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