Hand and wrist problems

Question 1

What is carpal tunnel syndrome

Answer 1

compression of the median nerve in the carpal tunnel

Question 2

What covers the palmer aspect. of the median nerve

Answer 2

transverse carpal ligament

Question 3

What are the symptoms of carpal tunnel syndrome?

Answer 3

1. pain + pins and needles in thumb, index and middle finger
2. Pt shakes hand for relief (esp @ night)
3. Sx occur mainly at night in early disease

Question 4

What can be found on examination in carpal tunnel syndrome?

Answer 4

1. weak thumb abduction
2. wasting of THENAR eminence
3. +ve tingles sign - tapping on carpal tunnel produces sx
4. Phalen’s sign, flexion of wrists for 60s produces sx

Question 5

How is carpal tunnel diagnosed?

Answer 5

1. clinically

2. electrophysiology: motor and sensory, prolongation of action potential

Question 6

What are the causes of carpal tunnel?

Answer 6

• idiopathic
• pregnancy
• f>m
• RA
• Oedema
• Lunate fracture

Question 7

What is the management of carpal tunnel

Answer 7

1. surgical decompression

2. Splinting and bracing

Question 8

What are the risk factors for dupuytrens

Answer 8

• age
• m>F
• FHx

Question 9

What happens in dupuytrens contracture

Answer 9

fixed flexion contracture of the hand caused by underlying contract rues of the underlying Palmar aponeurosis (becomes hyperplastic)

Question 10

What digits are spared in dupuytrens?

Answer 10

index finger and thumb

Question 11

Is dupuytrens painful?

Answer 11

no

Question 12

Is dupuytrens slow or fast progressing?

Answer 12

slow

Question 13

what is the treatment of dupuytrens contracture?

Answer 13

fasciectomy

Question 14

What is the risk of treatment of dupuytrens?

Answer 14

neurovascular damage to digital nerves and arteries

Question 15

what is a ganglion

Answer 15

fluid filled bump associated w joint or tendon sheath

Question 16

How are ganglions treated?

Answer 16

usually asymptomatic so can be left alone

if troublesome may be excised or steroid injection if inflamed

Question 17

What is trigger finger?

Answer 17

disparity between size of tendons and the pulleys through which they pass
tendon becomes stuck and can’t pass smoothly through pulley
finger becomes locked in flexed position

Question 18

What are sx of trigger finger

Answer 18

finger locked in flexed position
pain at distal palm near A1 pulley
finger clicking

Question 19

What are the associations of trigger finger?

Answer 19

mostly idiopathic
f>m
RA, DM

Question 20

What fingers are trigger finger more common in?

Answer 20

thumb
middle
ring finger

Question 21

What is the management of trigger finger

Answer 21

steroid injection

splint

Question 22

What nerve roots make up the radial nerve

Answer 22

C5-T1

Question 23

Go over the sensory distribution of the radial, ulnar and median nerve

Answer 23

ok hehe

Question 24

What are the motor functions of the radial nerve?

Answer 24

extend arm at elbow
wrist extension
finger extension
supinate forearm

Question 25

What are the motor functions of the ulnar nerve

Answer 25

flex + adduct hand at wrist flex ring and little fingers at DIP abduction at fingers

Question 26

what are the motor functions of the median nerve

Answer 26

pronation of forearm | flexion of wrist + digits of hand

Question 27

What nerve roots make up the ulnar nerve

Answer 27

C8 + T1

Question 28

What nerve roots make up the median nerve?

Answer 28

C6-T1

Question 29

How do u test each of the peripheral nerves of the arm in the hand examination?

Answer 29

radial - wrist dorsiflexion, resist pushing down ulnar - cross middle and index finger median - break finger and thumb apart

Question 30

What is a pulled elbow?

Answer 30

Subluxation of radial head

Question 31

What age group does pulled elbow usually occur? Why?

Answer 31

<6yrs | distal attachment of annular ligament covering radial head is weaker in children

Question 32

What are the sx of pulled elbow

Answer 32

elbow pain | limited supination and extension

Question 33

What is the rx of pulled elbow?

Answer 33

analgesia | supinate elbow whilst flexed at to 90 degrees

Question 34

What is tennis elbow

Answer 34

lateral epicondylitis

Question 35

What causes tennis elbow?

Answer 35

repetitive strain injury resulting from tendon overuse and failed healing of the tendon. In addition, the extensor carpi radialis brevis muscle plays a key role

Question 36

What age group are usually affected by tennis elbow?

Answer 36

45-55

Question 37

What are the features of tennis elbow

Answer 37

1. pain and tenderness localised to lateral condyle (prominent part of bone of humerus) 2. pain worse on wrist extension against resistance w elbow extended or supination fo forearm w elbow extended

Question 38

What is the treatment of tennis elbow

Answer 38

- avoid muscle overload - simple analgesia - steroid inj - physio

Question 39

How long do episodes of tennis elbow last?

Answer 39

6m - 2yrs

Question 40

What is golfers elbow?

Answer 40

medial epicondylitis

Question 41

What are the clinical features of golfers elbow?

Answer 41

1. pain and tenderness localised to medial epicondyle 2. pain is aggravated by wrist flexion and pronation 3. numbness/tingling in 4th + 5th finger (ulnar nerve)

Question 42

What is cubital tunnel syndrome?

Answer 42

compression of the ulnar nerve

Question 43

What are the initial and late sx of cubital tunnel syndrome? when are sx aggravated?

Answer 43

initially - intermittent tingling in 4th and 5th finger later - numbness in 4th and 5th fingers w/ associated weakness aggravated by resting elbow on firm surface for long periods

Question 44

What is radial tunnel syndrome?

Answer 44

compression of posterior interosseous branch of radial nerve

Question 45

What are the features of radial tunnel syndrome?

Answer 45

sx similar to lateral epicondylitis pain is 4-5cm distal to lateral epicondyle sx may worsen w extending elbow and pronating forearm