Thumb OA*
GREEN |
• Intro: |
- Degenerative condition of the thumb
- Second most common site of degenerative disease in the hand after DIP |
• Aetiology (risk factors): |
- >40 yrs
- F>M (6:1)
- Risk factors: FHx, occupation w/ high load on hands, obesity, PMHx of joint injury, menopause |
• Pathophysiology: |
- Correlation between basal joint laxity & MCP OA |
• Clinical presentation: |
- Px at the MC joint
- Aggravated: opening of a lid, turning door knob / car key |
• Physical examination: |
- Resisted pinch
- Palpation
- Swelling
- Crepitus |
• Management: |
- NSAIDs
- Activity modification
- SMT / STW
- Mobs
- Support brace
- Surgery |
• Ddx: |
- Ganglion
- Tendinopathy of flexor carpi radialis
- Carpal fracture
- UCL sprain
- Quervain's tenosynovitis
- Carpal tunnel syndrome
- Trigger thumb
- RA |
Anterior interosseous n. syndrome
GREEN |
• Intro: |
- Lesion of the motor branch of the median nerve
- Forearm px & weakness in index & thumb pincer movement |
• Aetiology (risk factors): |
- Very rare
- Causes: spontaneous or traumatic
- Pronator teres muscle most common
- Associated w/ RA & gout |
• Pathophysiology: |
- Occurs due to 1° entrapment, direct trauma, or viral neuritis
- Proximal lesions like brachial plexus neuritis can cause similar syndromes
- Suspicion for pts w/ motor loss after related Ssx like intense shoulder px or recent viral illness/exposure |
• Clinical presentation: |
- No sensory deficits
- No radiation
- No numbness
- 1° complaint: poorly localised px in forearm in cubital fossa |
• Physical examination: |
- Pinch sign
- Decreased strength of flexor policies longus & flexor digitorum profundus |
• Management: |
- Prognosis is usually good and doesn't need surgery
- Rest
- Observation
- Splinting of the elbow at 90° of FX
- Improves usually in 6-12 weeks
- NSAIDs
- SMT / STW
- Surgery |
• Ddx: |
- Stenosing tenosynovitis
- Flexor tendon adherence or adhesion
- Flexor tendon rupture
- Brachial neuritis |
Carpal tunnel syndrome (CTS)*
GREEN |
• Intro: |
- Entrapment neuropathy caused by compression the median nerve in the carpal tunnel |
• Aetiology (risk factors): |
- Typically in 40 - 60 yrs
- 1-5% in general population
- F>M (3:1)
- Risk factors: carpal tunnel modifications, fluid imbalance, neuropathic factors
- Examples: carpal dislocation/subluxation, radius #, arthritis, cysts/tumours, pregnancy/menopause, obesity/kidney failure/hypothyroidism, oral contraceptives/heart failure/diabetes/alcoholism, vitamin deficiency/toxicity |
• Pathophysiology: |
- Caused by various factors
- Involves compression & traction affecting the median n.
- Compression leads to increased pressure, obstruction of venous outflow, localised edema, & impaired microcirculation of the median n.
- Lesions on the myelin sheath & axon cause inflammation & loss of normal physiological functions of surrounding tissues
- Worsening structural integrity of the nerve exacerbates the dysfunctional environment
- Repeated traction & wrist movements further injure the nerve
- Inflammation of any of the 9 flexor tendons passing through the carpal tunnel can compress the median nerve
- Sensory fibres are often affected before motor fibres, & autonomic nerve fibres may also be affected |
• Clinical presentation: |
- Numbness, tingling, & px in the thumb, 2nd, & radial portions of the 4th digits
- Ssx worsen at night
- Variability in Ssx distribution from wrist to shoulder
- Initially intermittent, worsen w/ activities like driving, reading, painting
- Nighttime exacerbation, relieved by shacking hand/wrist
- Leads to permanent sensory loss, muscle weakness, & clumsiness
- Challenges in tasks like opening doorknobs & buttoning clothes
- Dominant hand usually affected first |
• Physical examination: |
- Sensory loss or weakness in median n. distribution
- Thenar eminence spared in sensory loss
- Diminished thumb ABD & opposition strength, thenar eminence atrophy
- Tinel's sign
- Carpal tunnel compression test
- Phalen's test
- Median n. tension test
- Motor & sensory testing |
• Management: |
- 70-90% of mild to moderate cases respond to conservative care
- Some degree of recurrence, even after surgery
- Pts w/ CTS 2° to diabetes or wrist # have less favourable prognosis
- SMT / STW
- Nerve release
- Support brace at night
- Taping |
• Ddx: |
- Brachial plexopathy
- Cx myofascial px
- Cx spondylosis
- Compartment syndrome
- Ischemic stroke
- Mononeuritis multiplex
- Multiple sclerosis
- Median neuropathy in the forearm
- Motor neuron disease
- Diabetic neuropathy
- Cx radiculopathy
- Overuse injury
- Traumatic brachial plexopathy
- Neuropathies
- Tendonitis
- Tenosynovitis
- TOS |
DeQuervain's tenosynovitis
GREEN |
• Intro: |
- Involves tendon entrapment in the 1st dorsal compartment of the wrist |
• Aetiology (risk factors): |
- F>M
- Peak 40-50 yrs
- Bilateral common in new mothers or child care providers
- Spontaneous resolution often occurs once lifting of the child is less frequent
- Pregnancy & manual labour significant risk factor
- Associated w/ repetitive wrist movements, particularly thumb radial ABD, EXT, & radial deviation
- Acute injury to the wrist, increased frictional forces, pathogenic causes, inflammatory ailments, & anatomical variations |
• Pathophysiology: |
- Risk of entrapment in acute trauma or repetitive motion
- Thickening of tendon sheath in 1st compartment causes stenosing tenosynovitis
- Fibrocartilage formation in response to increased stress over tendon sheaths, leading to thickening |
• Clinical presentation: |
- Pts w/ radial-sided wrist px worsened by thumb & wrist motion
- Associated w/ difficulty opening a jar lid
- Common in 3rd trimester pregnant women or breastfeeding mothers |
• Physical examination: |
- Tenderness over radial styloid usually present
- Swelling over wrist typically seen proximal to radial styloid
- Finkelstein test
- Eichhoff test
- WHAT test |
• Management: |
- Prognosis is good w/ proper care |
• Ddx: |
- Thumb OA
- Scaphoid fracture
- Radial styloid fracture
- Sensory branch of radial nerve neuritis (Wartenberg's syndrome)
- Intersection syndrome
- Trigger thumb |
Diabetic neuropathy*
YELLOW |
• Intro: |
- Umbrella term for all non-inflammatory disorders of the peripheral nerve system/neuropathy that occur as a late complication of diabetes & include diabetic mononeuropathy, diabetic polyneuropathy & diabetic autonomic neuropathy |
• Aetiology (risk factors): |
- 50% of pts w/ DM
- Incidence higher in pts w/ DM2
- Risk factors: smoking alcohol, poor control/compliance regarding blood sugar, hypertension |
• Pathophysiology: |
- Exact cause unknown - metabolic, neurovascular, autoimmune causes
- Hyperglycaemia damage blood vessels → compromise oxygen & nutrients to nerves
- Risk factors contribute |
• Clinical presentation: |
- Burning, numbness, or tingling worsen at night
- Often presents as a "stocking-glove distribution" over several years
- Proprioceptive & sensory changes resulting in motor changes |
• Physical examination: |
- Trophic changes, motor Ssx, autonomic Ssx
- Px & cramps
- Foot problems, reoccurring amputations
- Radial n. test
- Kemps test
- Tinel's sign
- Dellon sign |
• Management: |
- Worse prognosis w/ bad control of DM
- TENS, low intensity laser therapy
- Radial n. floss
- STW
- Support brace
- Exercises |
• Ddx: |
- Alcohol-associated neuropathy
- Nutritional linked neuropathy
- Uremic neuropathy
- Vasculitic linked neuropathy
- Vitamin B-12 deficiency
- Toxic metal neuropathy |
Dupuytren's contracture
GREEN |
• Intro: |
- Genetic disorder
- 1° affects the palmar & digital fascia of the hand
- Leads to contracture deformities, particularly the 4th & 5th digit
- Predominantly in whites & often bilateral |
• Aetiology (risk factors): |
- Most common in Northern European/Scandinavian descent
- M>F (2:1), w/ more severe impact
- Younger age of onset associated w/ increased severity
- Multifactorial etiology
- Associated w/: diabetes, seizure disorders, smoking, alcoholism, HIV, vascular disease
- NOT associated w/ occupation or activities
- Ectopic manifestations: *Ledderhose disease (plantar fascia) 10-30%, Peyronie disease (dartos fascia of the penis) 2-8%, Garrod disease (dorsal knuckle pads) 40-50% |
• Pathophysiology: |
- Disease starts w/ painless nodules forming along lines of tension in the palm
- These nodules progress into cords that cause contracture deformities in hand tissues
- Progresses through proliferative, involution, & residual phases |
• Staging: |
- Starts as a palpable nodule in the palm
- Nodules enlarge into cords
- Early stage: palpable cords along the palm
- Progression: cords thicken & shorten, causing fixed FX contractures of fingers at MCP & PIP joints |
• Clinical presentation: |
- Loss of ROM of the hand
- Palpable cords in the palm extending into affected digits
- Pathogenic signs: nodules, cords, & finger contractures
- Rarely associated w/ px
- Affected digits: 4th digit most commonly affected, followed by the 5th digit, B cases may not exhibit symmetrical severity
- Px & tenderness: palpation of nodules usually painless unless ulnar n. is compressed, nodules may become tender in presence of tenosynovitis |
• Physical examination: |
- Hueston's tabletop test
- Observation: blanching of skin when finger EXT, pits & grooves may be present, knuckle pads over the PIP may be tender
- Decreased ROM
- If plantar fascia involved, indicates more severe disease (Ledderhose disease) |
• Management: |
- US, heat therapy, brace/splint, ROM exercise
- Needle aponeurotomy, corticosteroid injections
- Medications
- Surgery |
• Ddx: |
- Stenosing flexor tenosynovitis
- Callus
- Epitheliod sarcoma
- Ganglion
- Giant cell tumour
- Trigger finger
- Ulnar nerve palsy
- DJD of hand
- Post trauma
- Infection
- Volkmann's contracture
- Diabetic cheiroarthropathy |
Gamekeeper's / skier's thumb
YELLOW |
• Intro: |
- Partial or complete rupture of the ulnar collateral ligament
- It can either be acute or chronic injury
- Results from recurrent thumb hyperEXT, leading to degeneration & tears of the UCL |
• Aetiology (risk factors): |
- 86% of injuries to the base of the thumb
- 2nd most common ski-related injury, common in other sports using stick or ball
- Can occur due to mechanisms like falls or strikes that forcefully ABD the thumb |
• Pathophysiology: |
- UCL tear at the distal attachment of the proximal phalange → can lead to avulsion of the bone fragment
- Chronic: repetitive valgus stress
- Acute: hyperABD trauma |
• Clinical presentation: |
- Acute presentation post-injury or delayed presentation for chronic injuries
- Discomfort localised to 1st MCP joint area
- Swelling near or at the thumb base
- Hx of falls or trauma, causing extreme thumb ABD or hyperEXT
Ssx:
- Px, occasionally weakness
- Difficulty holding onto objects, especially w/ pincer grasp |
• Physical examination: |
- Decreased ROM
- Valgus stress test +ve (increased laxity in partial tears; lack of endpoint indicates complete tear w/ total instability) |
• Management: |
- Tend to heal well but long period of immobilisation
- Wait at least 6 weeks before returning to work or sport
- RICE
- Immobilisation
- If bony injury refer to A&E
- If significant laxity also refer for surgery |
• Ddx: |
- Tendinous injuries (e.g. ADD pollicis disruption)
- Thumb dislocation
- Bennett fractures
- Stener lesion
- RA
- OA |
Ganglion
GREEN |
• Intro: |
- Benign soft tissue tumours most commonly encountered in the wrist & hand, but may occur in any joint
- Majority asymptomatic, but can cause px, tenderness, weakness, & cosmetic concerns |
• Aetiology (risk factors): |
- F>M (3:1)
- Common in women 20-50 yrs
- 60-70% of hand & wrist soft-tissue masses
- Associated w/ gymnasts - likely due to repetitive trauma & stress on wrist joint |
• Pathophysiology: |
- Synovial cysts filled w/ connective tissue
- Can be filled w/ fluid from tendon sheath or joint
- 70% on the dorsal aspect, originating from the scapholunate ligament / articulation
- 20% on the viral aspect, originating from the radoiocarpal / scaphotrapezial joint
- 10% from various areas of the body
- Commonly found in women aged 40-70 w/ OA |
• Clinical presentation: |
- Majority are asymptomatic
- Ssx may inc. px, tenderness, or weakness exacerbated by wrist motion
- Aching of wrist, might radiate into arm |
• Physical examination: |
- Px on palpation
- Possible decreased ROM, grip strength
- Solar wrist ganglion cysts may lead to carpal tunnel s. or trigger finger due to compression of median n. or intrusion on flexor tendon sheath
- They can also cause ulnar n. neuropraxia & compression of radial artery, resulting in ischemia |
• Management: |
- Asymptomatic pts may regress spontaneously
- Surgery is an option for persistent Ssx
- Recurrence is the most common complication of surgery |
• Ddx: |
- Aneurysmal bone cyst
- Chondroblastoma
- Chondromyxoid fibroma
- Enchondroma
- Giant cell tumour
- Non-ossifying fibroma
- Osteoid osteoma
- Osteoblastoma
- Simple bone cyst |
Guyon's canal syndrome*
GREEN |
• Intro: |
- Relatively rare peripheral ulnar neuropathy
- Involves injury to the distal portion of the ulnar n. as it travels through a narrow anatomic corridor at the wrist |
• Aetiology (risk factors): |
- Distal ulnar n. injury can occur from various causes inc. compression, inflammation, trauma, or vascular issues
Etiologies include:
- Ganglion cyst
- Fracture or displacement of the hook of hamate
- Tumours (e.g. lipoma)
- Repetitive trauma (e.g. cyclist's handlebars)
- Aberrant muscle or excess fat tissue within the canal
- Ulnar artery thrombosis or aneurysm (e.g. HHS) |
• Pathophysiology: |
- Compression, inflammation, trauma or vascular insufficiency
- Most commonly due to ganglion cyst or repetitive trauma
- 4 borders of Guyana canal: volar carpal ligament, transverse carpal ligament, hamatum, pisiform
- Inside: ulnar nerve + artery
- Mixed sensory, motor nerve |
• Clinical presentation: |
- Hx of repetitive trauma / direct trauma
- Ssx/Sx can be motor, sensory, or mixed
- Motor complaints: weakness/paralysis of intrinsic muscles, weakening grip, clawing of 4th/5th digits
- Hypothenar atrophy in advanced cases
Differentiation between Guyon canal vs. cubical tunnel compression:
- Sparing of dorsal ulnar dermatome indicates Guyon canal involvement |
• Physical examination: |
- Tinel sign +ve
- Paper gripping test shows weakness of ADD pollicis muscle
- Froment sign: thumb IP joint hyperFX due to ADD inability
- Wartneberg sign: 5th digit over-ABD at rest
- Allen test: arterial supply evaluation |
• Management: |
- Ssx duration: acute, subacute, chronic
- Conservative vs. operative: depends on duration, severity of Ssx & etiology
- Splinting: avoidance of aggravating factors (1-12 weeks)
- US & nerve grinding exercises |
• Ddx: |
- Alcoholic neuroapthy
- ALS
- Brachial plexus abnormalities
- Cx radiculopathy
- Epicondylitis
- Pancoast tumour
- TOS |
Intersection syndrome
GREEN |
• Intro: |
- Inflammatory tenosynovitis at the intersection of the 1st dorsal compartment (APL, EPB) & 2nd dorsal compartment (ECRL, ECRB) of the wrist
- Often caused by overuse |
• Aetiology (risk factors): |
- F=M
- Associated w/: rowing, canoeing, skiing, racquet sports, & horseback riding
- Results from repetitive EXT & FX |
• Pathophysiology: |
- Repetitive EXT-FX causes friction injury at the crossover junction of 1st dorsal compartment (APL, EPB) & 2nd dorsal compartment (ECRB/ECRL) tendons
- Leads to inflammatory response & tenosynovitis |
• Clinical presentation: |
- Px or tenderness over dorsal aspect of wrist proximal to radial styloid |
• Physical examination: |
- Swelling, palpable crepitus w/ wrist or thumb EXT
- Pronation more uncomfortable than supination
- Swelling around Lister's tubercle
- Intersection syndrome test +ve
- Cozen's test +ve
- Resisted thumb EXT +ve
- Finkelstein's test +ve |
• Management: |
- RICE
- Splinting
- Steroid injections
- NSAIDs |
• Ddx: |
- DeQuervain tenosynovitis
- Muscle strain
- Wartenberg's syndrome
- EPL tendinitis |
Kienbock's disease
GREEN |
• Intro: |
- Avascular necrosis of the lunate
- Known as lunatomalacia |
• Aetiology (risk factors): |
- 20-40 yrs
- M>F
- Multifactorial etiology |
• Pathophysiology: |
- Shortened ulna when compared to the radius, increased mechanical stress, repetitive microtrauma
- Low number of supporting blood vessels
- Bigger size of lunate
- Increased radial inclination angle
- Venous plexus abnormalities leading to an obstructed venous drainage
- Repetitive compression of the wrist |
• Clinical presentation: |
- Unilateral px over dorsal aspect of the wrist
- Limited ROM
- Weakness
- Exacerbated: EXT & axial loading
- Ssx: mild to debilitating
- Rarely B
- Trauma is often absent |
• Physical examination: |
- Swelling, tenderness
- Synovitis
- Loss of grip strength |
• Management: |
- Reduction of compressive load
- Maintenance, improvement of ROM
- Stretching
- Massage to increase blood circulation |
• Ddx: |
- Ulnar impaction s.
- Lunate intraosseous ganglion
- Bone contusion
- Arthritis
- Osteoid osteoma
- Enostosis/bone island |
Rheumatoid arthritis*
YELLOW |
• Intro: |
- Common autoimmune disorder of the joints
- Characterised by inflammatory arthritis as well as extra-articular involvement
- Can levelly impair physical function & quality of life
- Typically B & symmetrical
- MCPs & PIPs most commonly affected |
• Aetiology (risk factors): |
- F>M
- 30-50 yrs (can occur at any age)
- Northern Europe & North America
- Multifactorial nature involving genetic (caucasians, FHx) & environmental factors
- Risk factors: females, smoking (strongest), microbiota, Western diet, stress, infections |
• Pathophysiology: |
- Exact cause unknown
- Multifactorial
- Hypothesis: results from the interaction between genetic predisposition & environment → autoimmune response |
• Clinical presentation: |
- Morning stiffness >1h (gelling phenomenon)
- Involvement of small hand joints affecting ADLs (e.g. opening jars, wringing washcloths)
- Decreased strength may cause issues (e.g. dropping objects)
- Pts struggle w/ ADLs (e.g. showering, combing hair, dressing, or using handgrips to unlock doors)
- Constitutional Ssx: fatigue & malaise are common
- Weight loss & low-grade fevers can accompany onset or flares of RA
- FHx of inflammatory joint disease or autoimmune collagen vascular disease is present in up to 50% of cases
Typical Ssx:
- Joint px
- Joint swelling, notably in the MCPs
- Decreased strength
- Limited ROM
- Stiffness in affected joints, particularly after long periods or rest or sleep |
• Physical examination: |
Synovitis:
- Key clinical finding in RA: palpable synovial hypertrophy
- Joints appear swollen, fusiform/spindle-shaped PIPs
- Decreased ROM
- Grip strength may be reduced
- RA synovitis feels "doughy"
- Erythema & warmth may or may not be present
Tenosynovitis:
- Flexor tendon frequently involved, leading to swelling & thickening
- Triggering & locking of fingers possible
- Poor prognosis if flexor tenosynovitis present
- Extensor tendons of wrist commonly involved
- Tenosynovial effusions can compress median n., causing CTS
Hand & wrist deformities:
- Boutonniere deformity
- Swan-neck deformity
- Subluxation of MCPs
- Ulnar drift/deviation
- Hitchhiker thumb/Z deformity
- Piano key sign/floating ulnar styloid
- Subluxation of wrist
- Vaughan-Jackson deformity
Subcutaneous nodules:
- Seen in seropositive RA (-ve HLA-B27), especially on pressure areas
- Firm, contender, not freely mobile
- Poor prognostic marker if present early in disease |
• Management: |
- Imaging: x-ray, MRI, MSK US
- Labs: RF, ACPAs, ANA, ANCAs
- Presence of RF, anti-CCP indicate RA being seropositive (seronegative RA also occurs)
- Not associated w/ HLA-B27
- Medical treatment
- Improvement of general fitness
- Manual therapy (thermo-therapy, TENS, rest during flare-ups)
- Surgery is rarely needed
- Cx adjustment contraindicated due to Atlanta-axial subluxation |
• Ddx: |
- Infections
- OA
- Seronegative spondyloarthroapthies
- Crystalline arthropathies
- Other autoimmune connective tissue diseases
- Others |
Scapholunate dissociation
YELLOW |
• Intro: |
- Rotatory subluxation of the scaphoid
- Most frequent pattern of carpal instability & is classified as an acute or chronic & static or dynamic instability
- Disruption of the ligamentous complex holding the scaphoid & lunate together
- Refers to abnormal orientation of the scaphoid relative to the lunate |
• Aetiology (risk factors): |
- Typically after FOOSH, ulnar-deviated hand
- Atraumatic: infection, inflammatory arthritis, neurological disorders, & certain congenital malformations
- These conditions disrupt the 1° & 2° ligamentous stabilisers of the scapholunate joint |
• Pathophysiology: |
- Axial loading in hyperEXT shifts scaphoid proximal pole dorsally
- High-speed trauma like motorcycle accidents may cause bony avulsions leading to scapholunate dissociation
- Isolated scapholunate ligament rupture alters wrist biomechanics & kinematics
- Gradual attenuation of scapholunate joint 2° stabilisers follows ligament rupture
- Failure of 2° stabilisers leads to apparent radiographic evidence |
• Complications: |
- Degenerative changes
- Rotational alterations in the scapholunate joint |
• Clinical presentation: |
- Can be isolated or associated w/ distal radius or carpal bone #
- Persistent wrist px after FOOSH
- Decreased grip strength
- Popping or clicking during activities loading the wrist
- Exacerbated px w/ wrist EXT & radial deviation
- Limited ROM due to px
- Chronic cases: wrist ROM normal until degenerative changes occur
Presentation varies w/ Watson staging:
Stage 1: predynamic
Stage 2: dynamic
Stage 3: static
Stage 4: osteoarthrotic |
• Physical examination: |
- Tenderness to palpation dorsally over the scapholunate joint
- Localised swelling in acute cases
- Watson shift test: +ve w/ palpable clunk & presence of dorsal wrist px |
• Management: |
- Injury acute if it has occurred within 6 weeks
- Conservative care (non-displaced & chronic asymptomatic): immobilisation & NSAIDs
- Surgery normally required to prevent long-term complications |
• Ddx: |
- Scaphoid fracture
- Kienbock disease
- Ganglion cyst
- Flexor carpi radialis tendinopathy
- Extensor carpi radialis brevis/longus tendinopathy
- CIND-DISI |
Trigger finger / stenosing tenosynovitis
GREEN |
• Intro: |
- Tenosynovitis in the flexor sheaths of the fingers & thumb
- Result of overuse
- Causes significant functional impairment |
• Aetiology (risk factors): |
- 1st peak: young age <8yrs, F=M (mostly thumb)
- 2nd peak: 40-50yrs F>M (dominant hand)
- Multifactorial etiology
- Trauma cause hypertrophy & narrowing of tendon & sheath, leading to catching & locking
- Adult comorbid diseases associated: diabetes, amyloidosis, CTS, gout, thyroid disease, RA
- In children: seems developmental, w/ size mismatch between flexor tendon & sheath, often idiopathic but associated w/ conditions like Hurler s., juvenile RA |
• Pathophysiology: |
- Microtrauma leads to inflammation & injury of the flexor tendon-sheath complex
- A1 pulley experiences greatest force & commonly affected
- Inflammation over time causes tendon sticking within its sheath, perceived as locking by the pt
- Flexor tendon apparatus is stronger than the extensor tendon apparatus
- Pts can FX fingers w/o difficulty but experience locking during EXT due to inflammation causing tendon catching in the flexor sheath |
• Clinical presentation: |
- Discomfort or functional limitations in the affected digit
- Thumb, ring finger most common sites (dominant hand)
- Swelling or a nodule may be present
- Complaints of a painful click in the digit
- Locking of finger during EXT or inability to move it from fixed FX position
- Ssx may develop gradually or be acute |
• Physical examination: |
- Tender nodule (due to inflammation) at the distal palmar crease
- Affected digit may be FX or locked on observation
- Moving may cause px &/or swelling |
• Management: |
- Good prognosis w/ treatment, sometimes spontaneous resolution
- Conservative: splinting (6-10 weeks) & steroid injections
- Surgery (if conservative care fails or trigger thumb during infancy) |
• Ddx: |
- Abnormal sesamoid
- Acromegaly
- Ganglion cyst
- Infection within the tendon sheaths
- Presence of loose body in MCP joint
- Subluxation of extensor digitorum communis |
|
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