TOP TEN HAND MALADIES

1
TOP TEN HAND MALADIES

• 1. Carpal tunnel
• 2. Cubital tunnel
• 3. Ganglions
• 4. Trigger finger
• 5. Lateral epicondylitis

• 6.deQuervains
• 7. Mallet finger
• 8. Nailbed injury
• 9. Gamekeepers thumb
• 10. Dupuytrens contracture

2
10. Dupuytrens Contracture

• Sxs hard palmer nodule or band
• Cause Genetic, ? Traumatic
• Tests Physical exam, Family hx
• Rx Surgery, ? Collagenase

3
9. Gamekeepers Thumb

• Sxs Pain on radial MP stress
• Cause Rupture ulnar collateral ligament
• Tests Exam, local anesthesia, x-ray
• Rx Splint if incomplete, repair if gt 30 degrees
  deviation

4
8. Nailbed Injuries

• Treatment All lacerations repaired with
  absorbable sutures. All subungual hematomas
  explored if gt 50 of nailbed. Smaller hematomas
  drained with ophthalmic cautery

5
7. MALLET FINGER

• Sxs finger droops at DIP joint
• Cause rupture extensor tendon or avulsion
  fracture distal phalanx
• Tests X-ray
• Rx 8 weeks extension splint if tendon ORIF if
  gt 30 joint surface avulsed

6
6. deQuervains Syndrome

• Sxs Pain swelling radial wrist worse with
  thumb extension.
• Cause stenosing tenosynovitis EPB APL leading
  to radial neuritis
• Tests Finkelsteins test
• Rx Thumb spica splint, NSAID, steroid injection,
  rest, surgery

7
5. Lateral Epicondylitis

• Sxs Pain and tenderness lateral elbow
• Cause Tendonitis extensor origin leading to
  radial neuritis
• Tests Resisted extension wrist or long finger
• Rx NSAID, elbow band, rest, steroid injection,
  surgery

8
4. Trigger Finger

• Sxs Painful locking of finger or thumb in
  flexion often present on wakening
• Cause Stenosing tenosynovitis flexor tendons
  repetitive motion or pressure
• Tests Palpation of tendon nodule
• Rx Extension splint, rest, NSAID, steroid
  injection, surgery

9
3. Ganglions

• Sxs Firm, round, aching mass radial palmer
  wrist, mid-dorsal wrist, palmer finger base
• Cause unknown
• Tests Physical exam, sonogram if unsure
• Rx splint, drain with steroid injection, surgery

10
2. Cubital Tunnel Syndrome

• Sxs Aching medial elbow, numbness ring small
  finger, decreased strength
• Cause Compression of ulnar nerve at elbow,
  trauma, constant stretch
• Tests Elbow flexion test, FDP 5 strength, spread
  fingers, EMG\NCV
• RxSoft elbow splint, restrict elbow flexion,
  surgery-No Steroid Injections

11
1. Carpal Tunnel Syndrome

• Sxs Aching palmer wrist and mid-palm, numbness
  thumb, index, long and ring fingers, clumsiness,
  decreased grip, painful nocturnal paresthesias
• Cause flexor tenosynovial edema and hypertrophy
  causing ischemic pressure on median nerve

12
1. Carpal Tunnel Syndrome

• Tests Tinels sign, Phalens test, pronator
  teres and carpal tunnel compression tests, thumb
  opposition, EMG/NCV
• Rx wrist splint, NSAID, rest, steroid injection
  by expert, surgery physical therapy is seldom
  useful

13
Causation

• Temporality
• Biologic plausibility
• Dose response
• Consistent literature support
• Could I do this job?

14
Occupational Risk Factors

• Highly repetitive motion 30 sec. work cycle
  2,000 manipulations per hour
• Joint position wrist, elbow, shoulder
• Amount of force applied
• Palmar compression
• Direct trauma, tool design
• Low frequency vibration

15
Predisposing Risk Factors

• Age, previous jobs
• Sex
• Metabolic risk factors Obesity, diabetes,
  hypothyroidism, rheumatoid or osteoarthritis,
  peripheral edema, pregnancy

16
Hand Exam

• Inspection position, color, atrophy, swelling,
  skin quality
• Palpation Tenderness, swelling, tumor,
  crepitation, stiffness, abnormal mobility
• Provocative tests

17
Upper Extremity Exam-Elbow

• Medial epicondyle palpate, Tinels sign
• Bicipital tendon- palpate under tension
• Lateral epicondyle- palpate, resisted wrist and
  long finger extension
• Extensor muscles-radial tunnel
• Flexor muscles- pronator teres compression

18
Wrist Exam

• Flexion, extension, radial/ulnar deviation
• 1st extensor compartment palpation, Finkelsteins
  test, thumb CMC compression
• Tinels sign, carpal tunnel compression test
• Allens test for circulation
• Palpation for tenderness or swelling of 3 flexor
  and 6 extensor compartments

19
Hand Exam

• FDS/FDP function
• Median/ulnar intrinsic muscle strength
• Joint stiffness, tenderness, or swelling
• Grip strength/pinch strength-Jamar Dynometer
• Sensation sharp/dull, static/moving 2 point,
  Semmes-Wienstein monofilaments