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Hand and Wrist Pathology - Coggle Diagram
Hand and Wrist Pathology
Carpal Tunnel Syndrome
Entrapment of the medial nerve
Symptoms
Pins and needles
Pains Numbness in fingers at
nighttime
Weakness of the hand
Tests
Phalen's test
Compress nerve
Pins and needles
Tinel's test
Tap fingers from distal to prox
Positive test - Elctric shock feeling
Reverse Phalen's tests
Durkan's Compression test
Nerve Conduction Test (NCS - EMG)
Normal : 3.7 ms delay
More than 4.5 ms delay - surgery
Conservative Treatment
Splinting in neutral position
Injection
Surgery
Post-OP
Pain and pins and needles at night gone
Anatomy
Median Nerve
Palmar branch
Recurrent Branch
Function
Sens
Carpal Bones
Some Lovers Try Positions That They Can't Handle
Scaphoid,
Lunate,
Triquetrum,
Pisiform,
Trapezoid
Trapezium
Capitate,
Hamate
Tendon Sheaths
Ganglion cysts
Mucin-filled synoval cysts
Cause
Mucoid degeneration
Synovial herniation
Trauma
Most common mass in the hand (60-70%)
Symptoms
Usually asympotomatic
Can cause compression of nerves and arteries
Transilluminates (transmits ligth through tissue)
Firm and well circumscribed
Ofetn fixed to deep tissue but not to overlying tissue
Allen's test
Differential Diagnosis
Lipoma
Hamartoma ex: hemangioma
Tenosynovitis
CMC boss
Radial arteyr aneurysm or arterio-venous malformation (volar)
Sarcoma
Conservative treatement
Splinting in neutral position
Aspiration +/- corticoid injetcion
Or Surgery
Careful of
Pulsation in mass
solid mass
Neurovascular symptoms
VEry adhrent to skin
Not well circumscribed
Ulceration
Inflammation around mass
Surgery
High rate of recurrence
Possible stiffness of wriist post-op
Radial artery damage
Trigger Finger
Stenosing tenosynovitis caused by inflammation of the flexor tendon sheath
Classification
Grade 1
Palm pain and tenderness in A1 pulley
Grade 2
Grade 3
Grade 4
Grade 5
Conservative Treatment
Splinting to rest tendon
Corticoid injection 1st line
Poor results in diabetics
Surgery
LA - DAy ward
Opn A1 pulley
Early mobolisation
Post-Op
Direct Mobilisation
Removal of stiches 10 days - 2 weeks
Recurrence very rare - good results
Dupuytren
Abnormal thicken of fascua of the palm and the fingers - digital flexion
