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wrist and hand conditions Flashcards

1
Q

what is a tenosynovitis?

A

an inflammation of the fluid filled synovium within the tendon sheet

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2
Q

what age group and profession is most at risk to develop DeQuervain’s tenosynovitis?

A

female 30-40
hairdressers

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3
Q

what is the DeQuervain’s tenosynovitis?

A

a tenosynovitis of the abductor pollicis longus and the extensor pollicis brevis
usually due to overuse and repetitive strain of the hand (hairdresser, gardener)

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4
Q

what are s&s of DeQuervain’s tenosynovitis?

A

pain at the base of thumb
worse with movement
TTP over abductor pollicis longus and extensory pollicis brevis
palpable tendon crepitus

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5
Q

which special test is positive in DeQuervain’s tenosynovitis?

A

finkelstein

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6
Q

what is the management for DeQuervain’s tenosynovitis?

A

rest and splinting
NSAIDS
manual therapy
surgery

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7
Q

what ligament is injured in the dorsal wrist syndrome?

A

the scapholunate ligament

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8
Q

what are s&s in dorsal wrist syndrome?

A

pain over dorsal wrist
pain on passive wrist extension

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9
Q

which tests are positive in dorsal wrist syndrome?

A

finger extension test
scapholunate instability test

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10
Q

what is Dupuytren’s contracture?

A

fibrous proliferation of the palmar fascia of the hand

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11
Q

which fingers are most commonly affected with Dupuytren’s contracture?

A

4th and 5th digit

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12
Q

what are s&s for Dupuytren’s contracture?

A

flexion deformity of MCP and PIP joints
inability to straighten fingers

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13
Q

which conditions is Dupuytren’s contracture often associated with?

A

alcoholism
diabetes
epilepsy

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14
Q

what is the management for Dupuytren’s contracture?

A

Surgery

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15
Q

which ligament is ruptured in a gamekeepers/skiers thumb?

A

the ulnar collateral ligament of the thumb

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16
Q

what are s&s for a gamekeepers/skiers thumb?

A

laxity to abduct the 1st metacarpal
tenderness on thumb palpation
pain and/or inflammation of ulnar aspect of metacarpal phalangeal joint
weakness to make pinch sign

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17
Q

which test is positive in a gamekeepers/skiers thumb?

A

ulnar collateral ligament test

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18
Q

what is the adviced management for a gamekeepers/skiers thumb?

A

4-6 weeks in a thumb spica cast
if highly unstable refer for surgery

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19
Q

what is a ganglion?

A

a fluid-filled swelling developing near a joint or tendon (synovial fluid leaks out and forms a cyst)

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20
Q

what are the s&s of a ganglion in the wrist/hand?

A

cystic lump on dorsum of hand (feels hard)
mildly tender
mostly harmless (can resolve from itself in one year)

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21
Q

what is the intersection syndrome?

A

inflammation of the crossover between:
abductor pollicis longus
extensor pollicis brevis
extensor carpi radialis longus
extensor carpi radialis brevis

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22
Q

what is the cause of intersection syndrome?

A

repetitive wrist extension

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23
Q

what are s&s of intersection syndrome?

A

swelling and point tenderness (6-8cm proximal to radial styloid process)
crepitus on wrist extension
worse on resisted thumb extension

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24
Q

which tests are positive in intersection syndrome?

A

intersection syndrome test
finkelstein (association with DeQuervain’s)

25
Q

what is Kienbock’s disease?

A

avascular necrosis of the lunate

26
Q

in which population is Kienbock’s disease most common?

A

people between 18-40 yrs, manual labourers (most of them have light wrist trauma)

27
Q

what are s&s of Kienbock’s disease?

A

wrist swelling and tenderness
reduced flexion and extension
normal pronation and supination
reduced grip strength
on x-ray: increased density, lucent areas, articular collapse, decrease lunate size

28
Q

what is the treatment for Kienbock’s disease?

A

surgery

29
Q

which tendon is rupture in a Mallet finger?

A

the extensor tendon at the base of the distal phalax

30
Q

what is the most common site for a Mallet finger?

A

4th and 5th digit

31
Q

what are the most common causes of Mallet finger?

A

blow on fingertip (sports injury)
RA

32
Q

what are s&s for mallet finger?

A

finger held in flexion
active and resisted extension are impossible
passive movement is normal
can be inflamed (red hot swollen) when acute
chronic: no pain

33
Q

what is the imaging of choice for a mallet finger?

A

x-ray: may show avulsed fragment of bone

34
Q

what is the management for a mallet finger?

A

splint finger
ice
4-6 weeks to heal

35
Q

what are the s&s of OA of the 1st carpo-metacarpal joint?

A

constant aching pain around base of thumb
crepitus with movement
decreased ROM (difficulty holding a mug or turning a doorknob)

36
Q

which joints are most commonly affected in RA of the hands?

A

MCP
PIP
carpals
ulnar styloid process
radiocarpal joint

37
Q

what are the s&s of RA in the hands?

A

symmetrical and bilateral symptoms
fusiform swelling
stiffness (takes a long time to ease of with movement)
redness & warmth
fatigue & weightloss

38
Q

what are the x-ray findings of RA in the hands?

A

uniform loss of joint space
marginal (rat bite) erosion
subchondral cyst at the distal radius
ulnar styloid erosion
widened scapho-lunate joint space

39
Q

what characterises boutonniere deformity?

A

PIP flexion and DIP extension

40
Q

what characterises a swan neck deformity?

A

PIP extension and DIP flexion

41
Q

what what is a scapholunate dissociation?

A

abnormal orientation of the scaphoid relative to the lunate due to injury of the stabilising scapholunate ligament (more severe than dorsal wrist syndrome)

42
Q

what is the injury mechanism of a scapholunate dissociation?

A

fall onto dorsiflexed hand

43
Q

what are s&s of scapholunate dissociation?

A

tenderness around dorsal wrist and hand
pain in anatomical snuffbox
limited grip strength and ROM

44
Q

which test is positive in scapholunate dissociation?

A

the scapholunate instability (watson) test

45
Q

what is the management for scapholunate dissociation?

A

surgery

46
Q

which tendons in the wrist and hand are commonly affected by tendinopathies?

A

extensor carpi radialis longus
extensor carpi radialis brevis
flexor carpi radialis
extensor carpi ulnaris
flexor carpi ulnaris

47
Q

how to test for a tendinopathy?

A

check resisted ROM, if painful it might indicate a tendinopathy

48
Q

where is the triangular fibrocartilage situated?

A

between the ulnar head, the lunate and the triquetrium

49
Q

what causes a tear in the triangular fibrocartilage?

A

sudden, forcible supination or pronation of the forearm (racquet sports)

50
Q

what are s&s of a triangular fibrocartilage tear?

A

pain over distal end of ulna
pain and clicking
weakness and instability of the wrist
painful resisted extension and ulnar deviation
reduced grip strengths

51
Q

which tests are positive in triangular fibrocartilage tear?

A

press test
triangular cartilage load test

52
Q

what is the imaging of choice for a cartilage tear?

A

ultrasound
MRI

53
Q

what is the treatment for a fibrocartilage tear?

A

conservative
NSAIDS
rest

54
Q

what is trigger finger?

A

inflammation and constriction of the retinacular sheat, the irritation causes nodules to form on the tendon

55
Q

which fingers are commonly affect in trigger finger?

A

ring and little finger

56
Q

what are s&s of trigger finger?

A

pain over nodules
pain, stiffness and a sensation of locking and catching when trying to straighten finger
pain over base of affected fingers

57
Q

which other condition does a trigger finger commonly associate with?

A

carpal tunnel syndrome

58
Q

what is the most common population for trigger finger?

A

diabetic
female
>60 years

59
Q

what is the treatment of choice for trigger finger?

A

immobilisation
NSAIDS
taping

conditions (29 decks)

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