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MS of the Hand.

Clinical Medicine II

Name the four main joints of the hand CMC: carpometacarpal joint of thumb, MP joint: metacarpophalangeal, PIP proximal interphalangeal, DIP: Distal interphalangeal joint
What side is the flexor side? Extensor side? Flex: volar-stronger Extensor: dorsal side
Thenar and hypothenar muscles Thenar: thumb, hypothenar: along lateral pinky finger
Name the three bones that connect in the wrist joint radius, scaphoid and lunate
Nerve innervation of Thenar, Hypothenar, Lumbricals, Interosseous T: median, H: ulnar, L: 1,2median, 3,4Ulnar, I: ulnar
Origination of the flexor muscles of the forearm, Extensor? Supination? medial epicondyle of humerous, lateral epicondyle, lateral
Infection of the cuticle paronychia
Causes of paronychia poor hygiene, biting nails, hang nails,
Typical pathogens of paronychia staph, strep, MRSA for resistant paronychia
Bacterial superinfection with fungal onychomycosis usually indicates what with paronychia pseudomonas infections, often w/ green discharge
Tx paronychia oral abx, I&D marsupialization if large abscess
Packing an abscess to heal inside out marsupialization
Infections “locked in” bw fibrous septae of distal phalanx felon
Tx of a felon Refer to ortho, very nerve sensitive, near bone don’t mess!
Cause of a felon puncture, foreign body wound harvests infx
What must we be aware of with human “fight bites” Extensor tendon injury at MCP joint
Tx of infected human bites I&D, XRay for foreign bodies, leave open, marsupilization if needed
Common organisms in animal bites pasteurella Multocida: GI track dogs/cats
What is a common side effect/sign w/ animal bites rapid onset lymphangitis
Ascending lymphangitis Check what? cellulitis in finger/infx that ascends thru lymph sys up arm. Check epicondular nodes
Two most common areas for ganglion cysts Scaphoid-lunate joint on dorsum, Volar ganglion
Tx of ganglion cysts? Why? Usually leave alone, surgery if problematic, connects to joint, infx can cause arthritis
How can tell bw tumor and cyst? Cyst changes w/ activity (^w/activity) and tumor usually slow growing
Cysts commonly found in pt’s with arthritis on dorsum of hand Digital mucous cyst, still connected to joints
Issue with palmer fascia that causes palmer deformity Dupuytren’s Contracture
Diagnosis of Dupuytren’s Contracture H & P, R/O tendon by making a fist
Where is Dupuytren’s seen most commonly Ring finger in pt’s w/diabetes, epilepsy and alcoholism
Cause of Dupuytren’s Genetic: Autosomal-Dominant
Tx of Dupuytren’s Conservative, surgery if can’t flatten hand, more problematic usually cuz tethered to skin->necrosis
What does the ulnar nerve supply in the hand 5th and lateral ½ of 4th digit palmer, lateral ½ of dorsum
What does median n. supply in the hand medial ½ 4th digit, 3,2,1st of palmer, tips of medial ½ 4th, 3,2,1st dorsal
What does the radial n. supply in the hand lateral 1st digit, dorsal 1st,2nd, medial 1/2 3rd digit
Cubital Tunnel Syndrome “Truck driver’s elbow” chronic compression of the ulnar N. of elbow, Ganglion may grow and compress it
End result sxs of Cubital Tunnel syndrome atrophy/weakness of intrinsic hand muscles (small and ring finger ulnar side of hand)
Ulnar N. compression signs Froment’s sign, Pope’s blessing: lateee sign
Froment’s sign Sign of cubital tunnel syndrome, can’t grab paper, or with 1st and 2nd digit
Tx of Cubital Tunnel Syndrome leave until weakness, cut elbow fascia, let ulnar n. be free in Soft tissue
Cause of Carpal Tunnel Syndrome Hypertrophy of flexor tendons, dec. room for median N.->median N. sxs,congenital: some ppl’s tunnel is smaller than others
Most workers that develop Carpal Tunnel? assembly line work, not data entry ppl
CTS tests Tinel’s Test, Phalen’sTest, CTS nerve compression test
Holding two hands dorsum to dorsum for 60-90s phalen’s test: pinching median nerve causes sxs
Tapping on the median n. under the Transverse carpal ligament causes a shock in median n. fingers “Tinel’s test”
Saturday Night palsy Radial n. palsy from prolong compression of nerve, lose radial n. hand fxs: may take weeks to return
When do you refer someone to a surgeon with sat. night palsy? 4-6 wks doesn’t resolve
Tendinitis of Thumb extensor compartment DeQuervain’s Tenosynovitis
Causes of DeQuervain’s over use of thumb ab/adduction, ^ulnar/radial deviation, RA
Tx DeQuervain’s Corticosteroid injections, decrease inflammation and irritation
Diagnostic teset of DeQuervain’s Finkelstein’s Maneuver: thumb in fist, ulnar deviation causes pain in abductor thumb compartment
Forced flexion of the DIP joint whilte it is in extension Mallet Finger: caused by jamming that finger
Tx of mallet finger strict splinting in full extension of DIP 8-10wks
Potential complication of mallet finger swan neck deformity: flexed DIP, hyperextended PIP
Two types of mallet finger osseous and non-osseous: ligiment tear: takes longer to heal
Traumatic rupture of the central extensor tendon in PIP joint Boutonniere finger: hyperextension DIP, flexion PIP
Tx of Boutonniere finger, complication tx: 8-10 wk full PIP extension, stiffness often remains Refer to hand surgeon
Flexor tendon controlling the DIP, PIP joints DIP: Flexor digitorum profundum, PIP: Flexor digitorum superficialis
Swelling of flexor tendon unit in fingers, causes “stuck” flexor position Trigger Finger: often passively reduced
Cause of trigger finger, tx Routinely griping in flexing fashion, hypertrophy of synovial tissue,will slide back and forth tx: corticosteroid injections, or surgical release of the “pulley”
Acute traumatic rupture of the FDP tendon from DIP joint, MC? Jersey finger, MC is ring finger of dominant hand, longest finger
Test for jersey finger make a fist, the DIP won’t be able to bend on command
Tx for jersey finger surgical repair within a week
FOOSH injury, don’t miss what? fall on outstretched hand, don’t miss lunate dislocation into carpal tunnel,must fix d/t loss of median n. fxn
Fracture of the distal head of radius in the forearm with dorsal (posterior) displacement of the wrist and hand. Colles’ fracture-FOOSH
Fracture of distal head of radius w/ volar deviation-toward palm smith’s fracture, landing hand in flexed position
Fracture of distal radium down the center of head w/ either dorsal or volar deviations Dorsal Barton’s for Volar Barton’s fractures
Buckleing of either the radius or ulna, happens in who? Torus fracture, kids only
Hand fracture need to be careful off with FOOSH fall scaphoid fracture, in anatomical snuff box, radial a. there
How do we check for a scaphoid fracture palpation in anatomical snuff box, compare to unaffected side
No fracture seen on plain film, pain in wrist 2wks later, next step advanced imaging looking for scaphoid fracture
The UCL is torn at (or in some cases even avulsed from) its insertion site into the proximal phalanx of the thumb gamekeeper’s thumb
Stener lesion osseous fracture at proximal phalanx d/t UCL tear-gamekeeper’s thumb
Test for gamekeeper’s thumb bend thumb laterally, no solid endpoint
Intra-articular thumb fracture in first CMC joint usually w/ dislocation of CMC joint Bennet’s fracture-avulsion: surgical mngmt
Type of fracture causes high risk of malrotation of the digits metacarpal spiral fractures
Transverse fracture of the distal 5th metacarpal boxer’s fracture: commonly open
Tx for proximal phalanx fracture long ulnar gutter splint
Distal phalangeal fracture characteristic “tuft”: very thing, usually smashed, septae are there, extremely painful, mights lose sensation for months
What is common w/ a PIP dislocation middle phalanx fracture, numb w/lidocain and reduce
Chronic inflammation of synovial fluid, swelling Rheumatoid arthritis: autoimmune
Joints affected by RA, dx? MCP, PIP joints, fingers spared dx: ESR, CRP, FANA, and Rheumatoid factor all elevated
ANA ananuclear antibodies, FANA same thing
Swelling and cartilage loss of the PIP and DIP joints in the hand osteoarthritis
Causes of osteoarthritis old age, cartilage loss, osteophyte formation at edges of articular surfaces (bone spur) inflammation
Visible enlargements and lumps of PIP joints Bouchard’s nodes
Visible enlargements and lumps of DIP joints Heberden’s nodes
Created by: streetsmarts
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