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Orthopaedics > Hand and Wrist disorders > Flashcards

Hand and Wrist disorders Flashcards

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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
which fingers are affected by Dupuytren's disease 2
commonly ring and little finger
26
pathophys of Dupuytren's disease
prolieratiion of myofibroblasts in palmar fascia producing pathological nodules and cords
27
associated conditions with Dupuytren's disease 5
diabetes epilepsy alcohol anti-convulsatns FHx
28
clinical presenation of Dupuytren's disease 1
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
management of Dupuytren's disease 4
needle aponeurecomty collagenase injfections fasciecotmy dermofasciectomy
30
describe needle aponeurectomy in Dupuytren's disease
under Local A hypodermic needle used to cut cords
31
describe collagenase injfection in Dupuytren's disease
injection of enzyme into cords -digests collagen and weakens cord -allows cord to be snapped by firm extension of finger 24-72hrs later
32
describe fasciectomy and dermofasciectomy
fasiectomy -surgical excision of the cords dermofasciectomy -surgical excision of cords and overlying skin then application of a full thickness skin graft
33
most common lump in hand
ganglions
34
common sites of ganglions in the hand 4
dorsal wrist volar wrist finger felxor sheath DIP joint
35
treatment for ganglions 3
leave alone- may spontenously regress aspirate excise
36
who gets OA of hands
FHx F:M 3:1 presence increases risk of future hip and knee oOA
37
risk factors for OA hands 5
previous trauma of joint increases the risk of having OA in that joint obseity hypermobility of joint occupation osteoporosis -reduced risk of OA
38
features of hand OA
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
what joints are affected in hand OA
carpomatacarpal joints CMCs DIPs more than PIPs -in contract to RA where DIPs are spared
40
where are heberden nodes
at DIP joints
41
where are bouchard nodes
PIP joints
42
management options for OA in hands 2
conservative -weight loss -muscle strengthening analgesia -PCM -topical NSAIDs -oral NSAIds (add PPI )
43
surgical options for OA of hands 2
arhtrodesis -fusion of bones w interal metal fixation trapeziectomy-helps OA of thumb -removes trapezium and insert metal or plastic joint
44
common signs of rheumatoid hands 6
ulnar deviation of fingers Z thumb extensor tendon rupture boutonniere deformites swan neck deformites rheumatoid nodules
45
describe boutonniere deformites
flexed PIP hyperextened DIP
46
describe swan neck defromites
hyperextenion of PIP flexion of DIP (think PIPE=swan neck)
47
what needs to be assessed in amputations and partial amputations 3
level -finger-tip -finger-distal to FDS -hand,forearm, arm vascularity and time from injury bone, tendon and nerve injury
48
complete amputaion vs partial amputation of finger tip injuries
complete amputaion -generally not suitable for replantation partial amputation -presernve and suture back if viable -excise if non-viable
49
what is assessed in finger tip injuries 3
bone loss -viable bone detemines length of finger tip that can be preserved nail loss skin loss
50
aims of treatment for finger tip injuries 3
try preserve as much length as possible try preserve insertion of FDP preserve the nail then repair any nail bed injuries
51
treatment options for finger tip injuries 4
Increasing levels of severity: dressings trimming of bone and dressings terminalisation and primary closer local advancement or transposition flap
52
what determines replantation ability of finger amputations
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
assessment of hand lacerations 3
vascular assessment neurological assessment tendon assessment
54
vascular assessment in hand lacerations 2
cap refil pulses if vascualr compromise but potential for replantation or revasculasraisation then it becomes SURGICAL EMERGENCY
55
neurological assessment of hand lacerations 2
assess whhcih nerve most likely to be injured from location of laceration in finger lacerations differentiate between the raidal and ulna digital nerves
56
neurological assessment of hand lacerations 2
assess whhcih nerve most likely to be injured from location of laceration in finger lacerations differentiate between the raidal and ulna digital nerveste
57
tendon assessment of hand lacerations 2
estimate which tendons are likley to be injured from location of lacteration in finger lacerations differentiate between tenodns of FDS and FDP
58
treatment of hand lacerations in A&E 4
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
theatre treatment options for hand laceratsion
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
define fight bite
happens over metacarpo-phalangeal joint -knucle of fist connects with teeth
61
Mx of fight bite 4
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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