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Flashcards in The Hand & Wrist Deck (29):

What is trigger finger?

What are the management options?

Trigger finger is a stenosing tenosynovitis at the A1 pulley (PIPJ)
Commonly the ring finger, associated with DM and RA
The stenosis limits the movement of FDS as FDP over one another, finger locks and clicks

Night splinting, NSAIDs, steroid injection
Surgical debridement and A1 pulley release


What is dupuytren contracture?

It is the shortening, thickening and fibrosis of the palmar fascia and the palmar aponeurosis due to the formation of nodules which can then extend to form fibrous cords.
It causes fixed flexion of the fourth and fifth digits, usually at the MCPJs which can progress to IPJs
The management is surgical release by needle fasciotomy


What is tenosynovitis?

Inflammation of the synovial sheath
Can be infective, non-infective, stenosing


Describe the blood flow to the hand by the ulnar artery

It enters the hand anterior to the flexor retinaculum between the pisiform and hook of hamate via the Guyon canal. It lies lateral to the ulnar nerve. It divides into two branches- the superficial palmar arch and the deep palmar arch, which give off anastomosing branches


Describe the blood flow to the hand by the radial artery

It curves dorsally around the scaphoid and trapezium and crosses the floor of the anatomical snuff box. It ends by anastomosing with the deep branch of the ulnar artery to form the deep palmar arch.


Why can an infection in the synovial sheath of the first and fifth digits spread to the forearm?

Because the synovial sheaths of the first and fifth digits are continuous with the common flexor sheath. - this can lead to a horseshoe abscess - most commonly Staph A
The synovial sheaths of the 2nd, 3rd, and 4th digits are individual and don't extend passed the MCPJs


What happens in ulnar claw?

Due to the nerve damage at the wrist, there is a clawing of the fourth and fifth digits. This is because the medial two lumbricals are paralysed. This means that there is hyperextension at the mcpj and flexion at the ipj


What happens in the ulnar paradox?

When the ulnar nerve is damaged at the elbow, the claw is less pronounced. This is because the medial half of flexor digitorum profundus is paralysed. This means that there is only hyperextension at the mcpj


In a fracture of the hamate, what nerve can be injured and why?

The ulnar nerve due to its close proximity to the hook of hamate


What happens in a boxer's fracture?

Neck of the fifth metacarpal
Clenched fist striking a hard object
Distal part of the fracture is displaced posteriorly, producing shortening of the affected finger


What happens in a Colle's fracture?

Extra-capsular fracture of distal radius with dorsal displacement
Wrist and hand displaced posteriorly
Dinner fork deformity


What happens on a Smith's fracture?

fracture of the distal radius, anterior displacement of the distal fragment (volar displacement)
A direct blow to the anterior forearm or falling onto flexed wrist
The characteristic appearance is a 'garden spade' deformity


What happens in the hand of benediction?

Due to the median nerve damage, the patient is unable to make a fist. This is because the lateral two lumbricals and lateral half of flexor digitorum profundus are paralysed. This means that the patient is unable to flex the second and third digits at the mcpj and ipj


What are the three thenar muscles of the hand?
What is their action?
How are they innervated?

Opponens pollicis - opposes the thumb
Abductor pollicis brevis - abducts the thumb
Flexor pollicis brevis - flexes the thumb
Median nerve


What are the three hypothenar muscle?
What is their action?
How are they innervated?

Opponens digiti minimi - opposes the fifth digit
Flexor digit minini brevis - flexes the fifth digit
Abductor digiti minimi - abducts the fifth digit
Ulnar nerve


How many lumbricals are there in the hand?
What actions do they do?
How are they innervated?

Flex the mcpj and extend the ipj
Lateral two - median nerve
Medial two - ulnar nerve


What are the two groups of interosseous muscles?
What is their innervation?

Dorsal (4) and palmar (3)
Ulnar nerve
PAD - palmar adduction
DAB - dorsal abduction


What are the management options in De Quervain's tenosynovitis?

Non-op: rest, NSAIDs, thumb spica, steroid injection
For severe symptoms, usually after 6 months of conservative Mx consider surgical release


What are the two other muscles in the hand?
How are the innervated?
What do they do?

Palmaris brevis - Tenses the ulnar side of the palm and hollows the palm during gripping action
Adductor pollicis - adducts the thumb
They are both innervated by the ulnar nerve


What is meant by De Quervain's tenosynovitis?

Stenosing tenosynovitis inflammation of the the first dorsal compartment (EPB and APL)
Common in the dominant hand
Finkelstein manoeuvre - thumb in fist, adduction, pain felt over styloid tip


Describe the fascia and connective tissues in the hand

Palmar aponeurosis - fasical thickening over muscle - continuous with PL
FDS splits in to for FDP passing through
Tendons surrounded by synovial sheath - lubricating fluid released so they slide over each other
Then surrounded by fibrous digital sheath which has pulleys at the joints


What are Kanavel signs on physical examination of infective tenosynovitis?

Involved digit flexed
Tendon sheath tenderness
Marked pain with passive extension


How do we measure radial length on an X-ray?
What is the normal value?

The radius is longer than the ulna at the DRUJ
Perpendicular line through the radial styloid
Perpendicular line through the distal articular surface of the ulnar head
AP view


How do we measure radial inclination?

AP view
Line from the radial styloid tip to the ulnar aspect of the distal radius
Other line perpendicular to the long axis of the radius
22 degrees


How do we measure volar tilt?

Lateral view
Line perpendicular to the long axis of the radius
Intersecting a line through the articular surface of the radius
Normal 11 degrees


What is a Barton's fracture?

Fracture dislocation of the radiocarpal joint with intra-articular fracture involving with volar or dorsal tip


What are the management options in wrist fractures?

Non-op: closed reduction and cast immobilisation
Indicated for extra-articular, less than 5mm radial shortening

Op:surgical fixation
Indicated for instability, displaced, infra-articular, more than 5mm radial shortening


What are the general complication of wrist fractures?

What are the complications of surgical fixation?

Median nerve damage - immediate carpal tunnel release
EPL rupture - most associated with non-displaced distal radius fractures

Malunion, stiffness, pin complications (infection etc)


Give four risk factors for Dupuytren's contracture

More common in those of Scandinavian descent, FHx