hand injuries Flashcards
- what is a distal radius fracture?
- what is the common mechanism of injury?
- what are the risk factors?
- intraarticular fracture of the distal radius
- fall onto outstretched hand
- osteoporosis
- what is a colles’ fracture?
- what is the common mechanism of injury?
- what is the management?
- extraarticular distal radius fracture with dorsal angulation
- fall on outstretched hand - wrist in flexed position
- reduce then splint then cast
how are ALL fractures managed?
- check neurovascular status - if compromised then higher urgency
- analgesia - pain med
- closed reduction with immobilisation
- closed reduction with percutaneous pinning
- open reduction
- internal fixation
- external fixation
- what is a smiths fracture?
- what is the common mechanism of injury?
- what are the risk factors?
- distal radius fracture with volar (palmar) angulation of distal fragment - 85% extra-articular
- falls onto dorsum of hand
- osteoporosis
what are the borders of the anatomical snuff box?
lateral border:
abductor pollicis longus
extensor pollicis brevis
medial border:
extensor pollicis longus
- what is a scaphoid fracture?
- what is the common mechanism of injury?
- how do patients with scaphoid fractures present?
- what are patients at increased risk of in scaphoid fractures?
- fracture of the scaphoid - most common type of carpal injury
- fall onto outstretched hands
- pain in anatomical snuff box which is worse upon moving wrist
- avascular necrosis due to retrograde blood supply
- what are the symptoms of osteoarthritis?
- how to patients with osteoarthritis of the hand present?
- what are the X-ray changes seen in osteoarthritis?
- pain, stiffness and swelling
- squaring of the wrist, bouchard nodes (osteophytes at PIPJ), heberden nodes (osteophytes at DIPJ)
- loss of joint space, osteophytes, subchondral scelrosis, subchondral cysts
- what is rheumatoid arthritis?
- what are the symotoms of rheumatoid arthritis?
- autoimmune condition which attacks synovium - symmetrical polyarthropathy typically of small joints
- pain, morning stiffness >1 hour, joint swelling, extra-articular features, bouchard’s nodes
how does rheumatoid arthritis present on an X-ray?
- joint space narrowing
- periarticular osteopenia
- juxta-articular bony erosions
- soft tissue swelling
what causes swan neck deformity?
DIPJ = flexed
PIPJ = hyperextended
what causes boutonnière’s deformity?
PIPJ = flexed
DIPJ = hyperextended
* inflammation of central slip of extensor digitorum longus
* lateral slips move to palmar surface of hand so it causes flexion of PIPJ
- what is psoriatic arthropathy?
- how do patients with psoriatic arthropathy present?
- what are x-ray characteristics present psoriatic arthritis
- 5-20% of patients with psoriasis affected - most commonly DIPJ’s
- dactylitis = swelling of fingers, onychodystrophy = nail pitting, onycholysis = nails seperate from nail bed
- distal phalanx has bony growths + intermediate phalanx has been worn down (pencil in a cup)
what is carpal tunnel syndrome?
swelling/narrowing of carpal tunnel which leads to compression of the median nerve
what are the symptoms of carpal tunnel syndrome?
- lack of sensation on distal phalanx of thumb and distal phalanx of fingers 1-3(1/2) - this is because digital cutaneous branch of median nerve is compressed (and the palmar cutaneous branch of median nerve isnt compressed)
- loss of sensation of the LOAF muscles
what are some causes of carpal tunnel syndrome?
diabetes
neoplasm
trauma
rheumatoid arthritis
pregnancy
