Wrist and hand 3 common condition Flashcards
(24 cards)
Carpal Tunnel Syndrome
Compression/entrapment of the MEDIAN nerve as it passes through the carpal tunnel
Compression occurs due to:
- Decreased tunnel size
Bony changes (RA, Fx, bony callus); Ganglion/cyst; dislocation - Increased size of the components running through carpal tunnel
RSI, systemic condition (diabetes, hypothyroidism, pregnancy), scar tissue from a cut flexor retinaculum) - Combination of the above (e.g. RA with edema)
Carpal tunnel MOI:
External
noxious pressure influence from an external source – eg. Shoulders and backpacks, watches, gloves, bracelets, splints)
Internal
hypertoned muscles, structural abnormalities, trauma, overuse (RSI), poor limb positioning (while sleeping), systemic condition
Contributing Factors
systemic condition, Vitamin B6 deficiency, inherited, females>males, work related
Carpal tunnel signs and symptoms
- Hallmark sign = Nocturnal neurological symptoms (numbness, tingling, pain, weakness)
- Unilateral - dominant hand
- Median nerve distribution
- Palmar Fascia can feel like it is tearing
- Pain is deep/achy at anterior forearm
- Possible weakness
- Self-relief = shaking, massaging, open-closing hand
- Atrophy of thenar muscles = clumsy movements, weakness w/ precision grips
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CTS Ddx compression site
So, if symptoms in palm and fingers
Possible pronator teres and carpal tunnel compressions
If symptoms in palm and not in fingers
Compression at pronator teres and not carpal tunnel
If symptoms in fingers and not in palms
Compression at carpal tunnel and not pronator teres
Carpal Tunnel Syndrome
special tests
- Phalen’s, or Flexion Ligamentous Stress Test
- Reverse Phalen’s, or Extension Ligamentous Stress Test
- Tinel’s
- Pronator Teres Syndrome Test (rule out)
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Dupuytren’s Contracture
Idiopathic contracture of the palmar fascia
Begins with shortening and fibrosis > proliferation of fibroblasts > nodular formation > contracture
Dupuytren’s Contracture
Tx Goals
Decrease SNS
Decrease pain, HT, TrP
Decrease fascial restriction
Decrease adhesions in palmar fascia (frictions, ice)
Maintain/increase ROM
Increase circulation/improve tissue health
Dupuytren’s Contracture
Tx Tissues
Forearm flexors
Palmar Fascia
Palmaris Longus, FCU
Carpals, metacarpals, PIPs, DIPs
Contrast hydro
DeQuervain’s Syndrome
Tenosynovitis of Abductor Pollicis Longus and Extensor Pollicis Brevis tendon sheaths
MOI = RSI, (Ulnar Deviation and Radial Deviation) forceful gripping
S&S = associated RSI symptoms over radial side of wrist/hand and thumb
DeQuervain’s Syndrome
Tx goals
Decrease SNS
Decrease pain, HT, TrP
Decrease fascial restriction
Decrease adhesions in tendon sheath (MFR, ice)
Maintain/increase ROM
Mobilise hypomobile joints
Stretch shortened muscles
DeQuervain’s Syndrome
Forearm extensors
Intrinsic hand muscles
Deep distal 4 (APL, EPB, EPL, EI)
Carpals
Forearm flexors
Rheumatoid Arthritis
- Autoimmune disorder causing chronic, destructive inflammation to multiple joints and connective tissue of the body
RA etiology
- Idiopathic (autoimmune)
- Gradual onset (@ age 25 - 50 years) or activation with injury to joint surfaces (trauma is not the cause)
- Synovial membrane of the joints thickens = Synovitis = boney changes = fibrosis = ankylosis
- Surrounding structures also affected i.e. - muscle imbalances, tendon ruptures, joint subluxation
Rheumatoid Arthritis
Signs and Symptoms:
- Symmetrical
- Affects small joints 1st
- Tendency to be systemic (all joints affected, pulmonary and renal systems as well)
- Deformities - Ulnar drift, Boutonniere, and Swan Neck deformities
Etiology
1st CMC OA
1st CMC OA is common in older adults.
It is of course a long-term degenerative process; it causes pain and relative instability of the 1st CMC (due to capsular laxity) which may predispose to UCL of the thumb injury.
Colles Fracture
- Transverse fracture of the radius proximal to the wrist
- Fragments of the radius displace dorsally
- Etiology: FOOSH, common in elderly
- Complications
- malunion (difficult to reduce), median nerve involvement, RSD, CTS
- S&S = ‘Dinner Fork’ deformity
Galeazzi Fracture
- Fracture of the radius + dislocation of the DRU joint
- MOI = FOOSH with rotation
- Complication = ulnar nerve lesion
Scaphoid Fracture
Most commonly fractured carpal bone; common in young adults
Most commonly misdiagnosed sprain
Wrist Pain – post trauma that doesn’t go away
Radiographs hard to read
Doesn’t show up on radiographs until weeks after incident
Poor blood supply to the scaphoid
Reflex Sympathetic Dystrophy:
Reflex sympathetic dystrophy syndrome (RSD) is a disorder that causes lasting pain, usually in an arm or leg, and it shows up after an injury, stroke, or even heart attack.
The severity of pain is typically worse than the original injury itself would suggest.
It most commonly follows a Colles’ fracture
It can occur in other injuries and is not specific to fracture
Lunate Dislocation
MOI = Palmar dislocation of the lunate from a FOOSH injury with wrist hyperextension > lunate compresses into carpal tunnel
S&S = swollen wrist with painful extension of fingers and wrist, possible median nerve symptoms
Medical intervention = strong traction with pressure over lunate; surgery
Complications: median nerve palsy, possible necrosis
Trigger Finger
Digital tenovaginitis/ tenosynovitis
- Results from thickening of the flexor tendon sheath or nodules developing along the affected tendon
- Causes “sticking” of the tendon when the affected finger(s) go from flexion to extension
Ulnar Collateral Ligament Sprain of the 1st MCP Joint
GAMEKEEPERS THUMB
UCL dysfunction of the thumb may be the result of acute trauma such as forceful abduction or radial deviation of the thumb away from the palm. It may also result from repetitive stress, or be secondary instability from chronic OA changes.
Skier’s Thumb/Gamekeepers Thumb
signs and symptoms
Signs and Symptoms:
Ulnar-sided MCP pain at digit 1
Difficulty and pain with gripping and pinching
Positive UCL of the thumb stress test
