Regional Peri-Articular Pain - Hand/Wrist Flashcards by Tim Resch

What are the common presenting features of overusage/strain injuries?

Exact time/mechanism of injury identifiable
Pain non-progressive
Pain produced by one/few movements
Localised tenderness
Pain on active movement/stress testing

How well did you know this?

Not at all

Perfectly

What are the peri-articular syndromes affecting the wrist/hand?

De Quervain's Tenovaginitis
Median Nerve Compression
Cubital Tunnel Syndrome
Ganglion Cyst
Trigger Finger
Dupuytren's Contracture
Base of thumb OA

How well did you know this?

Not at all

Perfectly

What is De Quervain’s Tenovaginitis?

Painful inflammation of abductor pollicis longus & extensor pollicis brevis tendons in 1st dorsal compartment

How well did you know this?

Not at all

Perfectly

What causes De Quervain’s Tenovaginitis??

Unkown
Most common after unaccustomed intensive activity
-classically middle aged/post-partum women

How well did you know this?

Not at all

Perfectly

What is the 1st dorsal compartment?

Area just proximal to anatomical snuff box

How well did you know this?

Not at all

Perfectly

How does De Quervain’s Tenovaginitis present?

Acute pain over 1st dorsal compartment

worse when using thumb
tenderness/swelling

How well did you know this?

Not at all

Perfectly

What are the signs on examination of De Quervain’s Tenovaginitis ?

LOOK - normal/swelling over radial border
FEEL - normal/tender over radial border
MOVE - active thumb abduction/ulnar deviation affected
TEST - Finkelstein’s +ve

How well did you know this?

Not at all

Perfectly

What is Finkelstein’s test?

Thumbs across palm, ulnar deviation causes pain over the tunnel

How well did you know this?

Not at all

Perfectly

What is the key differential for De Quervain’s Tenovaginitis?

Base of thumb OA

How well did you know this?

Not at all

Perfectly

What is the conservative management of De Quervain’s Tenovaginitis?

Rest
Analgesia
Splintage w/ thumb immobilisation (3wks)

How well did you know this?

Not at all

Perfectly

What is the surgical management of De Quervain’s Tenovaginitis ?

Longitudinal compartment release

-required if recurrence

How well did you know this?

Not at all

Perfectly

What structures make up the carpal tunnel?

Carpal bones

Covered by flexor retinaculum

How well did you know this?

Not at all

Perfectly

What are the carpal bones?

Proximal row = Scaphoid, Lunate, Triquetrum, Pisiform
Distal row = Trapezium, Trapezoid, Capitate, Hamate
SOME LOVERS TRY POSITIONS THAT THEY CAN’T HANDLE

How well did you know this?

Not at all

Perfectly

What structures does the Carpal Tunnel contain?

Nine flexor tendons
   -4 flexor digitorum profundus
   -4 flexor digitorum superficialis
   -1 flexor pollicus longus
Median nerve

How well did you know this?

Not at all

Perfectly

What is Carpal Tunnel Syndrome?

Compression neuropathy of median nerve as it passes through the carpal tunnel
-technically median nerve compression until there is thenar eminence wasting

How well did you know this?

Not at all

Perfectly

What causes Carpal Tunnel Syndrome?

Idiopathic (95%)
Entrapment in other conditions
   -DM
   -RA
   -hypothyroidism
   -acromegaly
   -trauma (Colles' fracture)

How well did you know this?

Not at all

Perfectly

In which group is Carpal Tunnel Syndrome more common?

Women

-3x more common

How well did you know this?

Not at all

Perfectly

How does Carpal Tunnel Syndrome present?

Pain/paresthesia in hand, worst in morning
-due to wrist flexion when asleep
-may wake pt/sleep w/ hand over bed
Thenar muscle weakness
-noticed as clumsiness
Sensory loss in palm/radial 3 1/2 fingers
-often not noticed

How well did you know this?

Not at all

Perfectly

What are the signs on examination of Carpal Tunnel Syndrome?

LOOK - normal/thenar wasting
FEEL - reduced thenar bulk
MOVE - active thumb abduction/opposition affected
TEST - Tinel’s +ve, Phalen’s +ve, dec sensation

How well did you know this?

Not at all

Perfectly

What is Tinel’s test?

Tapping over carpal tunnel leads to paraesthesia

How well did you know this?

Not at all

Perfectly

What is Phalen’s test?

Flexion for 60s leads to pain

How well did you know this?

Not at all

Perfectly

What investigations may be appropriate in suspected carpal tunnel syndrome?

Nerve conduction studies

slowed at wrist
may be normal

How well did you know this?

Not at all

Perfectly

What is the conservative management of Carpal Tunnel Syndrome?

Rest
Night time splinting
NSAIDs/steroids

How well did you know this?

Not at all

Perfectly

What is the surgical management of Carpal Tunnel Syndrome?

Division of flexor retinaculum

-scar in palm

How well did you know this?

Not at all

Perfectly

What is Cubital Tunnel Syndrome?

Compression neuropathy of ulnar nerve at cubital tunnel of elbow

What is the Cubital Tunnel?

Area medial & posterior on elbow joint (in anatomical position)

What causes Cubital Tunnel Syndrome?

Flexion of elbows for long periods Tight fascial bands Ulnar fracture Valgus deformities

How does Cubital Tunnel Syndrome present?

Pain near elbow joint -may radiate down ulnar forearm Paraesthesia/sensory loss over ulnar distribution Hand clumsiness/reduced pinch/grip strength Clawing of hand -if severe -due to wasting of hypothenar/interosseus muscles

What are the signs on examination of Cubital Tunnel Syndrome?

LOOK - guttering b/w metacarpals, hypothenar wasting FEEL - tenderness around cubital tunnel MOVE - elbow movements limited, unable to actively extend IPJs, or avtively abduct/adduct finger TEST - loss of sensation, reduced 1st dorsal interosseus power, Tinels +ve, elbow flexion +ve

What is the elbow flexion test?

Sustained elbow flexion, w/ forearm supinated & wrist extended will reproduce sx

What investigations may be appropriate in Cubital Tunnel Syndrome?

X-rays - pathogenic osteophyte | Nerve conduction studies - slowed at elbow

What is the conservative management of Cubital Tunnel Syndrome?

Night time splinting NSAIDs Activity modification

What is the surgical management of Cubital Tunnel Syndrome?

Simple cubital tunnel decompression | Anterior transposition of nerve

What is a ganglion cyst?

Soft tissue swelling filled w/ degenerative myxoid fluid stemming from underlying joint capsule, ligament or tendon sheath

How does a ganglion cyst present?

Lump in hand/wrist | Cosmetic concerns/associated pain

What are the causes of Ganglion cysts?

Idiopathic | Post trauma

In which group are ganglion cysts most common?

Women 20-40yrs

What are the signs on examination of ganglion cysts?

LOOK - swelling FEEL - hard/soft, not fixed to skin MOVE - obvious w/ joint movements/limit end range of movement TEST - transilluminate

What are the common sites of ganglion cyst formation?

Scapholunate joint (dorsum of wrist) Scaphotrapezial joint (volar aspect of wrist) Base of finger (seed ganglion) DIPJ (mucous cyst)

What is the conservative management of ganglion cysts?

Reassurance NSAIDs Aspiration +/- steroid injections

What is the surgical management of ganglion cysts?

Excision | -40% recurrence rate

What is Trigger Finger?

Idiopathic fibrosis of flexor tunnel leading to intratendinous nodule interrupting normal finer movement

How does Trigger Finger usually present?

``` Ring/middle finger affected Finger gets stuck in flexion -on further effort can snap into extension May be permanently locked -if severe ```

In which group is Trigger Finger most common?

Women >40yrs | RA & DM

What are the signs on examination of Trigger Finger?

LOOK - flexion at PIPJ/DIPJ FEEL - can feel triggering on flexion, nodule at base of finger MOVE - jerky/hesitant active flexion/extension, full extension limited TEST - n/a

What is the conservative management of Trigger Finger?

Activity modification NSAIDs Tendon sheath corticosteroid injection

What is the surgical management of Trigger Finger?

Release of A1 pulley Tenosynovectomy -in RA pts

What is Dupuytren's Contracture?

Progressive, painless thickening of palmar fascia, causing flexion deformities in fingers & functional difficulties

What are the risk factors for Dupuytren's Contracture?

``` Males Nordic Family hx Trauma DM Alcoholism Phenytoin Liver cirrhosis ```

How does Dupuytren's Contracture present?

Flexion deformities of fingers | Functional difficulties

What are the signs on examination of Dupuytren's Contracture?

LOOK - nodules/cords in palm/fingers w/ flexion of MCP/PIP (middle/ring) FEEL - thickened palmar fascia, Garrod's pads on dorsum of PIPJs MOVE - loss of active/passive extension TEST - n/a

What is the conservative management of Dupuytren's Contracture?

No treatment req if no functional impairment

What is the surgical management of Dupuytren's Contracture?

``` Needle aponeurotomy Enzymatic fasciotomy Fasciotomy Fasciectomy Dermofasciectomy ```

How does Base of Thumb OA present?

Pain on activities involving gripping/pinching | Swelling, deformity, tenderness at CMCJ

What are the signs on examination of Base of Thumb OA?

LOOK - shoulder sign +ve, base of thumb swelling, thenar wasting FEEL - pain/warmth, thenar wasting MOVE - global pain/stiffness of CMCJ movements (add, palmar/radial abd, opposition)

What is the conservative management of Base of Thumb OA?

As for any OA pt

What is the surgical management of Base of Thumb OA?

Denervation Trapeziectomy Basal thumb arthroplasty Joint fusion

What is the Shoulder Sign?

Radial prominence at base of thumb from dorsal subluxation | -sign of base of thumb OA

What is the Tuck sign?

Combined finger & wrist extension causes abnormal tenosynovium/dorsal skin to "tuck" under the extensor retinaculam of the wrist

What causes the Tuck Sign?

Inflamed synovial sheaths pressed up against flexor retinaculum -disappears on flexion

What is the Tuck Sign characteristic of?

Extensory Tynosinovitis

Regional Peri-Articular Pain - Hand/Wrist Flashcards

(61 cards)