Chapter 35- Common Hand Conditons

Question 1

What conditions is carpal tunnel syndrome associated with?

Answer 1

• pregnancy
• RA
• hypothyroidism
• diabetes
• gout

Question 2

Typical history for carpal tunnel syndrome

Answer 2

• nocturnal waking with burning paraesthesia
• need to shake/ hang hands out
• recovers after 20 minutes
• sometimes exacerbated by driving and prolonged holding of objects in hand

Question 3

Findings on examination in carpal tunnel syndrome?

Answer 3

• abnormal light touch and pinprick sensibility in median nerve distribution
• weakness/ wasting of thenar muscles, especially APB
• Tinel test
• Phalens test

Question 4

Differential diagnosis of carpal tunnel syndrome

Answer 4

Cervical spine pathology

Question 5

Conservative treatment of carpal tunnel syndrome syndrome

Answer 5

• night splints and injection into carpal tunnel with steroid

Question 6

Surgical management of carpal tunnel syndrome

Answer 6

Carpal tunnel release - decompression of transverse carpal ligament

Question 7

What is the cause of de quervains tendonitis

Answer 7

Thickening and tightening of the compartment through which APL and EPB run

Question 8

Examination findings in de quervains tendonitis

Answer 8

• Local tenderness and swelling over radial styloid may be present
• Finksteins test is always positive

Question 9

Treatment of de quervains tendonitis

Answer 9

Direct infiltration with cortisone injection, if this fails then simple surgical release under local Anaesthetic is recommended

Question 10

What is the cause of trigger fingers

Answer 10

Localized tenosynovitis of superficial and deep flexor tendons adjacent to the A1 pulley at a metacarpal head. inflammation causes nodular enlargement of tendon distal to pulley

Question 11

Findings on examination of a trigger finger

Answer 11

• Digit may be locked in flexion, extension or may be arrested in middle range
• palpation may reveal tender nodule over metacarpal head
• Painful clicking as the inflamed tendon passes through constricted sheath as finger is flexed and extended

Question 12

Treatment of trigger digits

Answer 12

• Local injection of steroid

- 10 percent may require surgical release of A1 pulley

Question 13

Typical history of a ganglion

Answer 13

• painless swelling on dorsum and palmar aspect of wrist, varying in size
• May follow traumatic event or may arise without apparent cause
• Pain on loaded wrist in extended position

Question 14

Findings on examination of a gangion

Answer 14

• Firm smooth mass (feels like extra bone)
• Can be tender to palpatin
• Usually fixed to deep structures (not mobile)
• Usually not fluctulant
• Transilluminates

Question 15

Treatment of a ganglion

Answer 15

• Worth attempting aspiration with a 16 G needle

- Surgery indicated for symptomatic ganglions

Question 16

Typical history of osteoarthritis of the thumb

Answer 16

• Pain base of thumb
• Difficulty opening jars/ taps/ door handles
• Weakness of pinch grip

Question 17

Examination findings for osteoarthritis of the thumb

Answer 17

• Subluxation and ostephyte formation causes prominence of thumb base- Squaring of the hand
• Crank and grind test painful
• Can get Z thumb deformity

Question 18

Treatment of osteoarthritis of the thumb

Answer 18

• Splints
• Cortisone injection into joint
• Excision of trapezium