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  /Title (6002-wrist-and-hand.pdf)
  /Creator (Cheatography)
  /Author (bee.f (bee.f))
  /Subject (6002 Wrist \& hand Cheat Sheet)
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{6002 Wrist \& hand Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{bee.f (bee.f)} via \textcolor{DarkBackground}{\uline{cheatography.com/180201/cs/43277/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}bee.f (bee.f) \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 3rd May, 2024.\\
   Updated 3rd May, 2024.\\
   Page {\thepage} of \pageref{LastPage}.
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Thumb OA*}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{GREEN}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
• {\bf{Intro:}} & - Degenerative condition of the thumb\{\{nl\}\}- Second most common site of degenerative disease in the hand after DIP \tn 
% Row Count 7 (+ 6)
% Row 2
\SetRowColor{LightBackground}
• {\bf{Aetiology (risk factors):}} & - \textgreater{}40 yrs\{\{nl\}\}- F\textgreater{}M (6:1)\{\{nl\}\}- {\bf{Risk factors:}} FHx, occupation w/ high load on hands, obesity, PMHx of joint injury, menopause \tn 
% Row Count 13 (+ 6)
% Row 3
\SetRowColor{white}
• {\bf{Pathophysiology:}} & - Correlation between basal joint laxity \& MCP OA \tn 
% Row Count 16 (+ 3)
% Row 4
\SetRowColor{LightBackground}
• {\bf{Clinical presentation:}} & - Px at the MC joint\{\{nl\}\}- {\bf{Aggravated:}} opening of a lid, turning door knob / car key \tn 
% Row Count 21 (+ 5)
% Row 5
\SetRowColor{white}
• {\bf{Physical examination:}} & - Resisted pinch\{\{nl\}\}- Palpation\{\{nl\}\}- Swelling\{\{nl\}\}- Crepitus \tn 
% Row Count 24 (+ 3)
% Row 6
\SetRowColor{LightBackground}
• {\bf{Management:}} & - NSAIDs\{\{nl\}\}- Activity modification\{\{nl\}\}- SMT / STW\{\{nl\}\}- Mobs\{\{nl\}\}- Support brace\{\{nl\}\}- Surgery \tn 
% Row Count 29 (+ 5)
% Row 7
\SetRowColor{white}
• {\bf{Ddx:}} & - Ganglion\{\{nl\}\}- Tendinopathy of flexor carpi radialis\{\{nl\}\}- Carpal fracture\{\{nl\}\}- UCL sprain\{\{nl\}\}- Quervain's tenosynovitis\{\{nl\}\}- Carpal tunnel syndrome\{\{nl\}\}- Trigger thumb\{\{nl\}\}- RA \tn 
% Row Count 38 (+ 9)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3563889/\#:\textasciitilde{}:text=Carpometacarpal\%20osteoarthritis\%20is\%20a\%20degenerative,of\%20the\%20distal\%20interphalangeal\%20joints."\}\}link text\{\{/popup\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Anterior interosseous n. syndrome}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{GREEN}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
• {\bf{Intro:}} & - Lesion of the motor branch of the median nerve\{\{nl\}\}- Forearm px \& weakness in index \& thumb pincer movement \tn 
% Row Count 6 (+ 5)
% Row 2
\SetRowColor{LightBackground}
• {\bf{Aetiology (risk factors):}} & - Very rare\{\{nl\}\}- Causes: spontaneous or traumatic\{\{nl\}\}- Pronator teres muscle most common\{\{nl\}\}- Associated w/ RA \& gout \tn 
% Row Count 12 (+ 6)
% Row 3
\SetRowColor{white}
• {\bf{Pathophysiology:}} & - Occurs due to 1° entrapment, direct trauma, or viral neuritis\{\{nl\}\}- Proximal lesions like {\emph{brachial plexus neuritis}} can cause similar syndromes\{\{nl\}\}- Suspicion for pts w/ motor loss after related Ssx like intense shoulder px or recent viral illness/exposure \tn 
% Row Count 24 (+ 12)
% Row 4
\SetRowColor{LightBackground}
• {\bf{Clinical presentation:}} & - No sensory deficits\{\{nl\}\}- No radiation\{\{nl\}\}- No numbness\{\{nl\}\}- {\bf{1° complaint:}} poorly localised px in forearm in cubital fossa \tn 
% Row Count 31 (+ 7)
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Anterior interosseous n. syndrome (cont)}}  \tn
% Row 5
\SetRowColor{LightBackground}
• {\bf{Physical examination:}} & - Pinch sign\{\{nl\}\}- Decreased strength of flexor policies longus \& flexor digitorum profundus \tn 
% Row Count 5 (+ 5)
% Row 6
\SetRowColor{white}
• {\bf{Management:}} & - Prognosis is usually good and doesn't need surgery\{\{nl\}\}- Rest\{\{nl\}\}- Observation\{\{nl\}\}- Splinting of the elbow at 90° of FX\{\{nl\}\}- Improves usually in 6-12 weeks\{\{nl\}\}- NSAIDs\{\{nl\}\}- SMT / STW\{\{nl\}\}- Surgery \tn 
% Row Count 15 (+ 10)
% Row 7
\SetRowColor{LightBackground}
• {\bf{Ddx:}} & - Stenosing tenosynovitis\{\{nl\}\}- Flexor tendon adherence or adhesion\{\{nl\}\}- Flexor tendon rupture\{\{nl\}\}- Brachial neuritis \tn 
% Row Count 21 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.ncbi.nlm.nih.gov/books/NBK525956/"\}\}link text\{\{/popup\}\}}  \tn 
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Carpal tunnel syndrome (CTS)*}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{GREEN}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
• {\bf{Intro:}} & - Entrapment neuropathy caused by compression the median nerve in the carpal tunnel \tn 
% Row Count 5 (+ 4)
% Row 2
\SetRowColor{LightBackground}
• {\bf{Aetiology (risk factors):}} & - Typically in 40 - 60 yrs\{\{nl\}\}- 1-5\% in general population\{\{nl\}\}- F\textgreater{}M (3:1)\{\{nl\}\}- {\bf{Risk factors:}} carpal tunnel modifications, fluid imbalance, neuropathic factors\{\{nl\}\}- Examples: carpal \seqsplit{dislocation/subluxation}, radius \#, arthritis, cysts/tumours, pregnancy/menopause, obesity/kidney \seqsplit{failure/hypothyroidism}, oral contraceptives/heart \seqsplit{failure/diabetes/alcoholism}, vitamin deficiency/toxicity \tn 
% Row Count 23 (+ 18)
% Row 3
\SetRowColor{white}
• {\bf{Pathophysiology:}} & - Caused by various factors\{\{nl\}\}- Involves compression \& traction affecting the {\bf{median n.}}\{\{nl\}\}- Compression leads to increased pressure, obstruction of venous outflow, localised edema, \& impaired microcirculation of the median n.\{\{nl\}\}- Lesions on the myelin sheath \& axon cause inflammation \& loss of normal physiological functions of surrounding tissues\{\{nl\}\}- Worsening structural integrity of the nerve exacerbates the dysfunctional environment\{\{nl\}\}- Repeated traction \& wrist movements further injure the nerve\{\{nl\}\}- Inflammation of any of the 9 flexor tendons passing through the carpal tunnel can compress the median nerve\{\{nl\}\}- Sensory fibres are often affected before motor fibres, \& autonomic nerve fibres may also be affected \tn 
% Row Count 57 (+ 34)
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Carpal tunnel syndrome (CTS)* (cont)}}  \tn
% Row 4
\SetRowColor{LightBackground}
• {\bf{Clinical presentation:}} & - Numbness, tingling, \& px in the thumb, 2nd, \& radial portions of the 4th digits\{\{nl\}\}- Ssx worsen at night\{\{nl\}\}- Variability in Ssx distribution from wrist to shoulder\{\{nl\}\}- Initially intermittent, worsen w/ activities like driving, reading, painting\{\{nl\}\}- Nighttime exacerbation, relieved by shacking hand/wrist\{\{nl\}\}- Leads to permanent sensory loss, muscle weakness, \& clumsiness\{\{nl\}\}- Challenges in tasks like opening doorknobs \& buttoning clothes\{\{nl\}\}- Dominant hand usually affected first \tn 
% Row Count 23 (+ 23)
% Row 5
\SetRowColor{white}
• {\bf{Physical examination:}} & - Sensory loss or weakness in median n. distribution\{\{nl\}\}- Thenar eminence spared in sensory loss\{\{nl\}\}- Diminished thumb ABD \& opposition strength, thenar eminence atrophy\{\{nl\}\}- Tinel's sign\{\{nl\}\}- Carpal tunnel compression test\{\{nl\}\}- Phalen's test\{\{nl\}\}- Median n. tension test\{\{nl\}\}- Motor \& sensory testing \tn 
% Row Count 38 (+ 15)
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Carpal tunnel syndrome (CTS)* (cont)}}  \tn
% Row 6
\SetRowColor{LightBackground}
• {\bf{Management:}} & - 70-90\% of mild to moderate cases respond to conservative care\{\{nl\}\}- Some degree of recurrence, even after surgery\{\{nl\}\}- Pts w/ CTS 2° to diabetes or wrist \# have less favourable prognosis\{\{nl\}\}- SMT / STW\{\{nl\}\}- Nerve release\{\{nl\}\}- Support brace at night\{\{nl\}\}- Taping \tn 
% Row Count 13 (+ 13)
% Row 7
\SetRowColor{white}
• {\bf{Ddx:}} & - Brachial plexopathy\{\{nl\}\}- Cx myofascial px\{\{nl\}\}- Cx spondylosis\{\{nl\}\}- Compartment syndrome\{\{nl\}\}- Ischemic stroke\{\{nl\}\}- Mononeuritis multiplex\{\{nl\}\}- Multiple sclerosis\{\{nl\}\}- Median neuropathy in the forearm\{\{nl\}\}- Motor neuron disease\{\{nl\}\}- Diabetic neuropathy\{\{nl\}\}- Cx radiculopathy\{\{nl\}\}- Overuse injury\{\{nl\}\}- Traumatic brachial plexopathy\{\{nl\}\}- Neuropathies\{\{nl\}\}- Tendonitis\{\{nl\}\}- Tenosynovitis\{\{nl\}\}- TOS \tn 
% Row Count 33 (+ 20)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.ncbi.nlm.nih.gov/books/NBK448179/"\}\}link text\{\{/popup\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{DeQuervain's tenosynovitis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{GREEN}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
• {\bf{Intro:}} & - Involves tendon entrapment in the 1st dorsal compartment of the wrist \tn 
% Row Count 5 (+ 4)
% Row 2
\SetRowColor{LightBackground}
• {\bf{Aetiology (risk factors):}} & - F\textgreater{}M\{\{nl\}\}- Peak 40-50 yrs\{\{nl\}\}- Bilateral common in new mothers or child care providers\{\{nl\}\}- Spontaneous resolution often occurs once lifting of the child is less frequent\{\{nl\}\}- Pregnancy \& manual labour significant risk factor\{\{nl\}\}- Associated w/ repetitive wrist movements, particularly thumb radial ABD, EXT, \& radial deviation\{\{nl\}\}- Acute injury to the wrist, increased frictional forces, pathogenic causes, inflammatory ailments, \& anatomical variations \tn 
% Row Count 27 (+ 22)
% Row 3
\SetRowColor{white}
• {\bf{Pathophysiology:}} & - Risk of entrapment in acute trauma or repetitive motion\{\{nl\}\}- Thickening of tendon sheath in 1st compartment causes stenosing tenosynovitis\{\{nl\}\}- Fibrocartilage formation in response to increased stress over tendon sheaths, leading to thickening \tn 
% Row Count 39 (+ 12)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{DeQuervain's tenosynovitis (cont)}}  \tn
% Row 4
\SetRowColor{LightBackground}
• {\bf{Clinical presentation:}} & - Pts w/ radial-sided wrist px worsened by thumb \& wrist motion\{\{nl\}\}- Associated w/ difficulty opening a jar lid\{\{nl\}\}- Common in 3rd trimester pregnant women or breastfeeding mothers \tn 
% Row Count 9 (+ 9)
% Row 5
\SetRowColor{white}
• {\bf{Physical examination:}} & - Tenderness over radial styloid usually present\{\{nl\}\}- Swelling over wrist typically seen proximal to radial styloid\{\{nl\}\}- Finkelstein test\{\{nl\}\}- Eichhoff test\{\{nl\}\}- WHAT test \tn 
% Row Count 18 (+ 9)
% Row 6
\SetRowColor{LightBackground}
• {\bf{Management:}} & - Prognosis is good w/ proper care \tn 
% Row Count 20 (+ 2)
% Row 7
\SetRowColor{white}
• {\bf{Ddx:}} & - Thumb OA\{\{nl\}\}- Scaphoid fracture\{\{nl\}\}- Radial styloid fracture\{\{nl\}\}- Sensory branch of radial nerve neuritis (Wartenberg's syndrome)\{\{nl\}\}- Intersection syndrome\{\{nl\}\}- Trigger thumb \tn 
% Row Count 29 (+ 9)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.ncbi.nlm.nih.gov/books/NBK442005/"\}\}link text\{\{/popup\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Diabetic neuropathy*}}  \tn
% Row 0
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\mymulticolumn{2}{x{17.67cm}}{{\bf{YELLOW}}} \tn 
% Row Count 1 (+ 1)
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• {\bf{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 \tn 
% Row Count 12 (+ 11)
% Row 2
\SetRowColor{LightBackground}
• {\bf{Aetiology (risk factors):}} & - 50\% of pts w/ DM\{\{nl\}\}- Incidence higher in pts w/ DM2\{\{nl\}\}- {\bf{Risk factors:}} smoking alcohol, poor control/compliance regarding blood sugar, hypertension \tn 
% Row Count 20 (+ 8)
% Row 3
\SetRowColor{white}
• {\bf{Pathophysiology:}} & - Exact cause unknown - metabolic, neurovascular, autoimmune causes\{\{nl\}\}- Hyperglycaemia damage blood vessels → compromise oxygen \& nutrients to nerves\{\{nl\}\}- Risk factors contribute \tn 
% Row Count 29 (+ 9)
% Row 4
\SetRowColor{LightBackground}
• {\bf{Clinical presentation:}} & - Burning, numbness, or tingling worsen at night\{\{nl\}\}- Often presents as a "stocking-glove distribution" over several years\{\{nl\}\}- Proprioceptive \& sensory changes resulting in motor changes \tn 
% Row Count 38 (+ 9)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Diabetic neuropathy* (cont)}}  \tn
% Row 5
\SetRowColor{LightBackground}
• {\bf{Physical examination:}} & - Trophic changes, motor Ssx, autonomic Ssx\{\{nl\}\}- Px \& cramps\{\{nl\}\}- Foot problems, reoccurring amputations\{\{nl\}\}- Radial n. test\{\{nl\}\}- Kemps test\{\{nl\}\}- Tinel's sign\{\{nl\}\}- Dellon sign \tn 
% Row Count 9 (+ 9)
% Row 6
\SetRowColor{white}
• {\bf{Management:}} & - Worse prognosis w/ bad control of DM\{\{nl\}\}- TENS, low intensity laser therapy\{\{nl\}\}- Radial n. floss\{\{nl\}\}- STW\{\{nl\}\}- Support brace\{\{nl\}\}- Exercises \tn 
% Row Count 16 (+ 7)
% Row 7
\SetRowColor{LightBackground}
• {\bf{Ddx:}} & - Alcohol-associated neuropathy\{\{nl\}\}- Nutritional linked neuropathy\{\{nl\}\}- Uremic neuropathy\{\{nl\}\}- Vasculitic linked neuropathy\{\{nl\}\}- Vitamin B-12 deficiency\{\{nl\}\}- Toxic metal neuropathy \tn 
% Row Count 25 (+ 9)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.ncbi.nlm.nih.gov/books/NBK442009/"\}\}link text\{\{/popup\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Dupuytren's contracture}}  \tn
% Row 0
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\mymulticolumn{2}{x{17.67cm}}{{\bf{GREEN}}} \tn 
% Row Count 1 (+ 1)
% Row 1
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• {\bf{Intro:}} & - Genetic disorder\{\{nl\}\}- 1° affects the palmar \& digital fascia of the hand\{\{nl\}\}- Leads to contracture deformities, particularly the 4th \& 5th digit\{\{nl\}\}- Predominantly in whites \& often bilateral \tn 
% Row Count 11 (+ 10)
% Row 2
\SetRowColor{LightBackground}
• {\bf{Aetiology (risk factors):}} & - Most common in Northern European/Scandinavian descent\{\{nl\}\}- M\textgreater{}F (2:1), w/ more severe impact\{\{nl\}\}- Younger age of onset associated w/ increased severity\{\{nl\}\}- Multifactorial etiology\{\{nl\}\}- {\bf{Associated w/:}} diabetes, seizure disorders, smoking, alcoholism, HIV, vascular disease\{\{nl\}\}- {\bf{NOT}} associated w/ occupation or activities\{\{nl\}\}- Ectopic manifestations: {\emph{*Ledderhose disease}} (plantar fascia) 10-30\%, {\emph{Peyronie disease}} (dartos fascia of the penis) 2-8\%, {\emph{Garrod disease}} (dorsal knuckle pads) 40-50\% \tn 
% Row Count 35 (+ 24)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Dupuytren's contracture (cont)}}  \tn
% Row 3
\SetRowColor{LightBackground}
• {\bf{Pathophysiology:}} & - Disease starts w/ painless nodules forming along lines of tension in the palm\{\{nl\}\}- These nodules progress into cords that cause contracture deformities in hand tissues\{\{nl\}\}- Progresses through proliferative, involution, \& residual phases \tn 
% Row Count 11 (+ 11)
% Row 4
\SetRowColor{white}
• {\bf{Staging:}} & - Starts as a palpable nodule in the palm\{\{nl\}\}- Nodules enlarge into cords\{\{nl\}\}- Early stage: palpable cords along the palm\{\{nl\}\}- Progression: cords thicken \& shorten, causing fixed FX contractures of fingers at MCP \& PIP joints \tn 
% Row Count 22 (+ 11)
% Row 5
\SetRowColor{LightBackground}
• {\bf{Clinical presentation:}} & - Loss of ROM of the hand\{\{nl\}\}- Palpable cords in the palm extending into affected digits\{\{nl\}\}- Pathogenic signs: nodules, cords, \& finger contractures\{\{nl\}\}- Rarely associated w/ px\{\{nl\}\}- Affected digits: 4th digit most commonly affected, followed by the 5th digit, B cases may not exhibit symmetrical severity\{\{nl\}\}- Px \& tenderness: palpation of nodules usually painless unless ulnar n. is compressed, nodules may become tender in presence of tenosynovitis \tn 
% Row Count 43 (+ 21)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Dupuytren's contracture (cont)}}  \tn
% Row 6
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• {\bf{Physical examination:}} & - Hueston's tabletop test\{\{nl\}\}- Observation: blanching of skin when finger EXT, pits \& grooves may be present, knuckle pads over the PIP may be tender\{\{nl\}\}- Decreased ROM\{\{nl\}\}- If plantar fascia involved, indicates more severe disease {\emph{(Ledderhose disease)}} \tn 
% Row Count 12 (+ 12)
% Row 7
\SetRowColor{white}
• {\bf{Management:}} & - US, heat therapy, brace/splint, ROM exercise\{\{nl\}\}- Needle aponeurotomy, corticosteroid injections\{\{nl\}\}- Medications\{\{nl\}\}- Surgery \tn 
% Row Count 19 (+ 7)
% Row 8
\SetRowColor{LightBackground}
• {\bf{Ddx:}} & - Stenosing flexor tenosynovitis\{\{nl\}\}- Callus\{\{nl\}\}- Epitheliod sarcoma\{\{nl\}\}- Ganglion\{\{nl\}\}- Giant cell tumour\{\{nl\}\}- Trigger finger\{\{nl\}\}- Ulnar nerve palsy\{\{nl\}\}- DJD of hand\{\{nl\}\}- Post trauma\{\{nl\}\}- Infection\{\{nl\}\}- Volkmann's contracture\{\{nl\}\}- Diabetic cheiroarthropathy \tn 
% Row Count 32 (+ 13)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.ncbi.nlm.nih.gov/books/NBK526074/"\}\}link text\{\{/popup\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Gamekeeper's / skier's thumb}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{YELLOW}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
• {\bf{Intro:}} & - Partial or complete rupture of the ulnar collateral ligament\{\{nl\}\}- It can either be acute or chronic injury\{\{nl\}\}- Results from recurrent thumb hyperEXT, leading to degeneration \& tears of the UCL \tn 
% Row Count 11 (+ 10)
% Row 2
\SetRowColor{LightBackground}
• {\bf{Aetiology (risk factors):}} & - 86\% of injuries to the base of the thumb\{\{nl\}\}- 2nd most common ski-related injury, common in other sports using stick or ball\{\{nl\}\}- Can occur due to mechanisms like falls or strikes that forcefully ABD the thumb \tn 
% Row Count 21 (+ 10)
% Row 3
\SetRowColor{white}
• {\bf{Pathophysiology:}} & - UCL tear at the distal attachment of the proximal phalange → can lead to avulsion of the bone fragment\{\{nl\}\}- {\bf{Chronic:}} repetitive valgus stress\{\{nl\}\}- {\bf{Acute:}} hyperABD trauma \tn 
% Row Count 30 (+ 9)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Gamekeeper's / skier's thumb (cont)}}  \tn
% Row 4
\SetRowColor{LightBackground}
• {\bf{Clinical presentation:}} & - Acute presentation post-injury or delayed presentation for chronic injuries\{\{nl\}\}- Discomfort localised to 1st MCP joint area\{\{nl\}\}- Swelling near or at the thumb base\{\{nl\}\}- Hx of falls or trauma, causing extreme thumb ABD or hyperEXT\{\{nl\}\}{\bf{Ssx:}}\{\{nl\}\}- Px, occasionally weakness\{\{nl\}\}- Difficulty holding onto objects, especially w/ pincer grasp \tn 
% Row Count 16 (+ 16)
% Row 5
\SetRowColor{white}
• {\bf{Physical examination:}} & - Decreased ROM\{\{nl\}\}- Valgus stress test +ve (increased laxity in partial tears; lack of endpoint indicates complete tear w/ total instability) \tn 
% Row Count 23 (+ 7)
% Row 6
\SetRowColor{LightBackground}
• {\bf{Management:}} & - Tend to heal well but long period of immobilisation\{\{nl\}\}- Wait at least 6 weeks before returning to work or sport\{\{nl\}\}- RICE\{\{nl\}\}- Immobilisation\{\{nl\}\}- If bony injury refer to A\&E\{\{nl\}\}- If significant laxity also refer for surgery \tn 
% Row Count 34 (+ 11)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Gamekeeper's / skier's thumb (cont)}}  \tn
% Row 7
\SetRowColor{LightBackground}
• {\bf{Ddx:}} & - Tendinous injuries (e.g. ADD pollicis disruption)\{\{nl\}\}- Thumb dislocation\{\{nl\}\}- Bennett fractures\{\{nl\}\}- Stener lesion\{\{nl\}\}- RA\{\{nl\}\}- OA \tn 
% Row Count 7 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.ncbi.nlm.nih.gov/books/NBK482383/"\}\}link text\{\{/popup\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Ganglion}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{GREEN}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
• {\bf{Intro:}} & - Benign soft tissue tumours most commonly encountered in the wrist \& hand, but may occur in any joint\{\{nl\}\}- Majority asymptomatic, but can cause px, tenderness, weakness, \& cosmetic concerns \tn 
% Row Count 10 (+ 9)
% Row 2
\SetRowColor{LightBackground}
• {\bf{Aetiology (risk factors):}} & - F\textgreater{}M (3:1)\{\{nl\}\}- Common in women 20-50 yrs\{\{nl\}\}- 60-70\% of hand \& wrist soft-tissue masses\{\{nl\}\}- Associated w/ gymnasts - likely due to repetitive trauma \& stress on wrist joint \tn 
% Row Count 19 (+ 9)
% Row 3
\SetRowColor{white}
• {\bf{Pathophysiology:}} & - Synovial cysts filled w/ connective tissue\{\{nl\}\}- Can be filled w/ fluid from tendon sheath or joint\{\{nl\}\}- 70\% on the dorsal aspect, originating from the scapholunate ligament / articulation\{\{nl\}\}- 20\% on the viral aspect, originating from the radoiocarpal / scaphotrapezial joint\{\{nl\}\}- 10\% from various areas of the body\{\{nl\}\}- Commonly found in women aged 40-70 w/ OA \tn 
% Row Count 36 (+ 17)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Ganglion (cont)}}  \tn
% Row 4
\SetRowColor{LightBackground}
• {\bf{Clinical presentation:}} & - Majority are asymptomatic\{\{nl\}\}- Ssx may inc. px, tenderness, or weakness exacerbated by wrist motion\{\{nl\}\}- Aching of wrist, might radiate into arm \tn 
% Row Count 7 (+ 7)
% Row 5
\SetRowColor{white}
• {\bf{Physical examination:}} & - Px on palpation\{\{nl\}\}- Possible decreased ROM, grip strength\{\{nl\}\}- Solar wrist ganglion cysts may lead to carpal tunnel s. or trigger finger due to compression of {\bf{median n.}} or intrusion on flexor tendon sheath\{\{nl\}\}- They can also cause {\bf{ulnar n.}} neuropraxia \& compression of {\bf{radial artery}}, resulting in ischemia \tn 
% Row Count 22 (+ 15)
% Row 6
\SetRowColor{LightBackground}
• {\bf{Management:}} & - Asymptomatic pts may regress spontaneously\{\{nl\}\}- Surgery is an option for persistent Ssx\{\{nl\}\}- Recurrence is the most common complication of surgery \tn 
% Row Count 29 (+ 7)
% Row 7
\SetRowColor{white}
• {\bf{Ddx:}} & - Aneurysmal bone cyst\{\{nl\}\}- Chondroblastoma\{\{nl\}\}- Chondromyxoid fibroma\{\{nl\}\}- Enchondroma\{\{nl\}\}- Giant cell tumour\{\{nl\}\}- Non-ossifying fibroma\{\{nl\}\}- Osteoid osteoma\{\{nl\}\}- Osteoblastoma\{\{nl\}\}- Simple bone cyst \tn 
% Row Count 39 (+ 10)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.ncbi.nlm.nih.gov/books/NBK470168/"\}\}link text\{\{/popup\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Guyon's canal syndrome*}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{GREEN}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
• {\bf{Intro:}} & - Relatively rare peripheral ulnar neuropathy\{\{nl\}\}- Involves injury to the distal portion of the ulnar n. as it travels through a narrow anatomic corridor at the wrist \tn 
% Row Count 9 (+ 8)
% Row 2
\SetRowColor{LightBackground}
• {\bf{Aetiology (risk factors):}} & - Distal ulnar n. injury can occur from various causes inc. compression, inflammation, trauma, or vascular issues\{\{nl\}\}{\bf{Etiologies include:}}\{\{nl\}\}- Ganglion cyst\{\{nl\}\}- Fracture or displacement of the hook of hamate\{\{nl\}\}- Tumours (e.g. lipoma)\{\{nl\}\}- Repetitive trauma (e.g. cyclist's handlebars)\{\{nl\}\}- Aberrant muscle or excess fat tissue within the canal\{\{nl\}\}- Ulnar artery thrombosis or aneurysm (e.g. HHS) \tn 
% Row Count 28 (+ 19)
% Row 3
\SetRowColor{white}
• {\bf{Pathophysiology:}} & - Compression, inflammation, trauma or vascular insufficiency\{\{nl\}\}- Most commonly due to ganglion cyst or repetitive trauma\{\{nl\}\}- {\bf{4 borders of Guyana canal:}} volar carpal ligament, transverse carpal ligament, hamatum, pisiform\{\{nl\}\}- {\bf{Inside:}} ulnar nerve + artery\{\{nl\}\}- Mixed sensory, motor nerve \tn 
% Row Count 42 (+ 14)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Guyon's canal syndrome* (cont)}}  \tn
% Row 4
\SetRowColor{LightBackground}
• {\bf{Clinical presentation:}} & - Hx of repetitive trauma / direct trauma\{\{nl\}\}- Ssx/Sx can be motor, sensory, or mixed\{\{nl\}\}- {\bf{Motor complaints:}} weakness/paralysis of intrinsic muscles, weakening grip, clawing of 4th/5th digits\{\{nl\}\}- Hypothenar atrophy in advanced cases\{\{nl\}\}{\bf{Differentiation between Guyon canal vs. cubical tunnel compression:}}\{\{nl\}\}- Sparing of dorsal ulnar dermatome indicates {\emph{Guyon canal}} involvement \tn 
% Row Count 19 (+ 19)
% Row 5
\SetRowColor{white}
• {\bf{Physical examination:}} & - Tinel sign +ve\{\{nl\}\}- Paper gripping test shows weakness of ADD pollicis muscle\{\{nl\}\}- Froment sign: thumb IP joint hyperFX due to ADD inability\{\{nl\}\}- Wartneberg sign: 5th digit over-ABD at rest\{\{nl\}\}- Allen test: arterial supply evaluation \tn 
% Row Count 31 (+ 12)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Guyon's canal syndrome* (cont)}}  \tn
% Row 6
\SetRowColor{LightBackground}
• {\bf{Management:}} & - Ssx duration: acute, subacute, chronic\{\{nl\}\}- Conservative vs. operative: depends on duration, severity of Ssx \& etiology\{\{nl\}\}- Splinting: avoidance of aggravating factors (1-12 weeks)\{\{nl\}\}- US \& nerve grinding exercises \tn 
% Row Count 11 (+ 11)
% Row 7
\SetRowColor{white}
• {\bf{Ddx:}} & - Alcoholic neuroapthy\{\{nl\}\}- ALS\{\{nl\}\}- Brachial plexus abnormalities\{\{nl\}\}- Cx radiculopathy\{\{nl\}\}- Epicondylitis\{\{nl\}\}- Pancoast tumour\{\{nl\}\}- TOS \tn 
% Row Count 18 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.ncbi.nlm.nih.gov/books/NBK431063/"\}\}link text\{\{/popup\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Intersection syndrome}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{GREEN}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
• {\bf{Intro:}} & - Inflammatory tenosynovitis at the intersection of the 1st dorsal compartment (APL, EPB) \& 2nd dorsal compartment (ECRL, ECRB) of the wrist\{\{nl\}\}- Often caused by overuse \tn 
% Row Count 9 (+ 8)
% Row 2
\SetRowColor{LightBackground}
• {\bf{Aetiology (risk factors):}} & - F=M\{\{nl\}\}- {\bf{Associated w/:}} rowing, canoeing, skiing, racquet sports, \& horseback riding\{\{nl\}\}- Results from repetitive EXT \& FX \tn 
% Row Count 15 (+ 6)
% Row 3
\SetRowColor{white}
• {\bf{Pathophysiology:}} & - Repetitive EXT-FX causes friction injury at the crossover junction of 1st dorsal compartment (APL, EPB) \& 2nd dorsal compartment (ECRB/ECRL) tendons\{\{nl\}\}- Leads to inflammatory response \& tenosynovitis \tn 
% Row Count 25 (+ 10)
% Row 4
\SetRowColor{LightBackground}
• {\bf{Clinical presentation:}} & - Px or tenderness over dorsal aspect of wrist proximal to radial styloid \tn 
% Row Count 29 (+ 4)
% Row 5
\SetRowColor{white}
• {\bf{Physical examination:}} & - Swelling, palpable crepitus w/ wrist or thumb EXT\{\{nl\}\}- Pronation more uncomfortable than supination\{\{nl\}\}- Swelling around Lister's tubercle\{\{nl\}\}- Intersection syndrome test +ve\{\{nl\}\}- Cozen's test +ve\{\{nl\}\}- Resisted thumb EXT +ve\{\{nl\}\}- Finkelstein's test +ve \tn 
% Row Count 42 (+ 13)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Intersection syndrome (cont)}}  \tn
% Row 6
\SetRowColor{LightBackground}
• {\bf{Management:}} & - RICE\{\{nl\}\}- Splinting\{\{nl\}\}- Steroid injections\{\{nl\}\}- NSAIDs \tn 
% Row Count 3 (+ 3)
% Row 7
\SetRowColor{white}
• {\bf{Ddx:}} & - DeQuervain tenosynovitis\{\{nl\}\}- Muscle strain\{\{nl\}\}- Wartenberg's syndrome\{\{nl\}\}- EPL tendinitis \tn 
% Row Count 8 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.ncbi.nlm.nih.gov/books/NBK430899/"\}\}link text\{\{/popup\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Kienbock's disease}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{GREEN}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
• {\bf{Intro:}} & - Avascular necrosis of the lunate\{\{nl\}\}- Known as {\emph{lunatomalacia}} \tn 
% Row Count 4 (+ 3)
% Row 2
\SetRowColor{LightBackground}
• {\bf{Aetiology (risk factors):}} & - 20-40 yrs\{\{nl\}\}- M\textgreater{}F\{\{nl\}\}- Multifactorial etiology \tn 
% Row Count 7 (+ 3)
% Row 3
\SetRowColor{white}
• {\bf{Pathophysiology:}} & - Shortened ulna when compared to the radius, increased mechanical stress, repetitive microtrauma\{\{nl\}\}- Low number of supporting blood vessels\{\{nl\}\}- Bigger size of lunate\{\{nl\}\}- Increased radial inclination angle\{\{nl\}\}- Venous plexus abnormalities leading to an obstructed venous drainage\{\{nl\}\}- Repetitive compression of the wrist \tn 
% Row Count 23 (+ 16)
% Row 4
\SetRowColor{LightBackground}
• {\bf{Clinical presentation:}} & - Unilateral px over dorsal aspect of the wrist\{\{nl\}\}- Limited ROM\{\{nl\}\}- Weakness\{\{nl\}\}- Exacerbated: EXT \& axial loading\{\{nl\}\}- Ssx: mild to debilitating\{\{nl\}\}- Rarely B\{\{nl\}\}- Trauma is often absent \tn 
% Row Count 33 (+ 10)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Kienbock's disease (cont)}}  \tn
% Row 5
\SetRowColor{LightBackground}
• {\bf{Physical examination:}} & - Swelling, tenderness\{\{nl\}\}- Synovitis\{\{nl\}\}- Loss of grip strength \tn 
% Row Count 4 (+ 4)
% Row 6
\SetRowColor{white}
• {\bf{Management:}} & - Reduction of compressive load\{\{nl\}\}- Maintenance, improvement of ROM\{\{nl\}\}- Stretching\{\{nl\}\}- Massage to increase blood circulation \tn 
% Row Count 11 (+ 7)
% Row 7
\SetRowColor{LightBackground}
• {\bf{Ddx:}} & - Ulnar impaction s.\{\{nl\}\}- Lunate intraosseous ganglion\{\{nl\}\}- Bone contusion\{\{nl\}\}- Arthritis\{\{nl\}\}- Osteoid osteoma\{\{nl\}\}- Enostosis/bone island \tn 
% Row Count 18 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.ncbi.nlm.nih.gov/books/NBK536991/"\}\}link text\{\{/popup\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Rheumatoid arthritis*}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{YELLOW}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
• {\bf{Intro:}} & - Common autoimmune disorder of the joints\{\{nl\}\}- Characterised by inflammatory arthritis as well as extra-articular involvement\{\{nl\}\}- Can levelly impair physical function \& quality of life\{\{nl\}\}- Typically B \& symmetrical\{\{nl\}\}- MCPs \& PIPs most commonly affected \tn 
% Row Count 14 (+ 13)
% Row 2
\SetRowColor{LightBackground}
• {\bf{Aetiology (risk factors):}} & - F\textgreater{}M\{\{nl\}\}- 30-50 yrs (can occur at any age)\{\{nl\}\}- Northern Europe \& North America\{\{nl\}\}- Multifactorial nature involving genetic (caucasians, FHx) \& environmental factors\{\{nl\}\}- {\bf{Risk factors:}} females, smoking (strongest), microbiota, Western diet, stress, infections \tn 
% Row Count 27 (+ 13)
% Row 3
\SetRowColor{white}
• {\bf{Pathophysiology:}} & - Exact cause unknown\{\{nl\}\}- Multifactorial\{\{nl\}\}- {\bf{Hypothesis:}} results from the interaction between genetic predisposition \& environment → autoimmune response \tn 
% Row Count 35 (+ 8)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Rheumatoid arthritis* (cont)}}  \tn
% Row 4
\SetRowColor{LightBackground}
• {\bf{Clinical presentation:}} & - Morning stiffness \textgreater{}1h (gelling phenomenon)\{\{nl\}\}- Involvement of small hand joints affecting ADLs (e.g. opening jars, wringing washcloths)\{\{nl\}\}- Decreased strength may cause issues (e.g. dropping objects)\{\{nl\}\}- Pts struggle w/ ADLs (e.g. showering, combing hair, dressing, or using handgrips to unlock doors)\{\{nl\}\}- {\bf{Constitutional Ssx:}} fatigue \& malaise are common\{\{nl\}\}- Weight loss \& low-grade fevers can accompany onset or flares of RA\{\{nl\}\}- FHx of inflammatory joint disease or autoimmune collagen vascular disease is present in up to 50\% of cases\{\{nl\}\}{\bf{Typical Ssx:}}\{\{nl\}\}- Joint px\{\{nl\}\}- Joint swelling, notably in the MCPs\{\{nl\}\}- Decreased strength\{\{nl\}\}- Limited ROM\{\{nl\}\}- Stiffness in affected joints, particularly after long periods or rest or sleep \tn 
% Row Count 36 (+ 36)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Rheumatoid arthritis* (cont)}}  \tn
% Row 5
\SetRowColor{LightBackground}
• {\bf{Physical examination:}} & {\bf{Synovitis:}}\{\{nl\}\}- Key clinical finding in RA: palpable synovial hypertrophy\{\{nl\}\}- Joints appear swollen, \seqsplit{fusiform/spindle-shaped} PIPs\{\{nl\}\}- Decreased ROM\{\{nl\}\}- Grip strength may be reduced\{\{nl\}\}- RA synovitis feels "doughy"\{\{nl\}\}- Erythema \& warmth may or may not be present\{\{nl\}\}{\bf{Tenosynovitis:}}\{\{nl\}\}- Flexor tendon frequently involved, leading to swelling \& thickening\{\{nl\}\}- Triggering \& locking of fingers possible\{\{nl\}\}- Poor prognosis if flexor tenosynovitis present\{\{nl\}\}- Extensor tendons of wrist commonly involved\{\{nl\}\}- Tenosynovial effusions can compress {\bf{median n.}}, causing {\bf{CTS}}\{\{nl\}\}{\bf{Hand \& wrist deformities:}}\{\{nl\}\}- Boutonniere deformity\{\{nl\}\}- Swan-neck deformity\{\{nl\}\}- Subluxation of MCPs\{\{nl\}\}- Ulnar drift/deviation\{\{nl\}\}- Hitchhiker thumb/Z deformity\{\{nl\}\}- Piano key sign/floating ulnar styloid\{\{nl\}\}- Subluxation of wrist\{\{nl\}\}- Vaughan-Jackson deformity\{\{nl\}\}{\bf{Subcutaneous nodules:}}\{\{nl\}\}- Seen in seropositive RA (-ve HLA-B27), especially on pressure areas\{\{nl\}\}- Firm, contender, not freely mobile\{\{nl\}\}- Poor prognostic marker if present early in disease \tn 
% Row Count 51 (+ 51)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Rheumatoid arthritis* (cont)}}  \tn
% Row 6
\SetRowColor{LightBackground}
• {\bf{Management:}} & - {\bf{Imaging:}} x-ray, MRI, MSK US\{\{nl\}\}- {\bf{Labs:}} RF, ACPAs, ANA, ANCAs\{\{nl\}\}- Presence of RF, anti-CCP indicate RA being seropositive (seronegative RA also occurs)\{\{nl\}\}- Not associated w/ HLA-B27\{\{nl\}\}- Medical treatment\{\{nl\}\}- Improvement of general fitness\{\{nl\}\}- Manual therapy (thermo-therapy, TENS, rest during flare-ups)\{\{nl\}\}- Surgery is rarely needed\{\{nl\}\}- Cx adjustment {\bf{contraindicated}} due to Atlanta-axial subluxation \tn 
% Row Count 20 (+ 20)
% Row 7
\SetRowColor{white}
• {\bf{Ddx:}} & - Infections\{\{nl\}\}- OA\{\{nl\}\}- Seronegative spondyloarthroapthies\{\{nl\}\}- Crystalline arthropathies\{\{nl\}\}- Other autoimmune connective tissue diseases\{\{nl\}\}- Others \tn 
% Row Count 28 (+ 8)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.ncbi.nlm.nih.gov/books/NBK560890/"\}\}link text\{\{/popup\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Scapholunate dissociation}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{YELLOW}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
• {\bf{Intro:}} & - Rotatory subluxation of the scaphoid\{\{nl\}\}- Most frequent pattern of carpal instability \& is classified as an acute or chronic \& static or dynamic instability\{\{nl\}\}- Disruption of the ligamentous complex holding the scaphoid \& lunate together\{\{nl\}\}- Refers to abnormal orientation of the scaphoid relative to the lunate \tn 
% Row Count 16 (+ 15)
% Row 2
\SetRowColor{LightBackground}
• {\bf{Aetiology (risk factors):}} & - Typically after FOOSH, ulnar-deviated hand\{\{nl\}\}- Atraumatic: infection, inflammatory arthritis, neurological disorders, \& certain congenital malformations\{\{nl\}\}- These conditions disrupt the 1° \& 2° ligamentous stabilisers of the scapholunate joint \tn 
% Row Count 28 (+ 12)
% Row 3
\SetRowColor{white}
• {\bf{Pathophysiology:}} & - Axial loading in hyperEXT shifts scaphoid proximal pole dorsally\{\{nl\}\}- High-speed trauma like motorcycle accidents may cause bony avulsions leading to scapholunate dissociation\{\{nl\}\}- Isolated scapholunate ligament rupture alters wrist biomechanics \& kinematics\{\{nl\}\}- Gradual attenuation of scapholunate joint 2° stabilisers follows ligament rupture\{\{nl\}\}- Failure of 2° stabilisers leads to apparent radiographic evidence \tn 
% Row Count 48 (+ 20)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Scapholunate dissociation (cont)}}  \tn
% Row 4
\SetRowColor{LightBackground}
• {\bf{Complications:}} & - Degenerative changes\{\{nl\}\}- Rotational alterations in the scapholunate joint \tn 
% Row Count 4 (+ 4)
% Row 5
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• {\bf{Clinical presentation:}} & - Can be isolated or associated w/ distal radius or carpal bone \#\{\{nl\}\}- Persistent wrist px after FOOSH\{\{nl\}\}- Decreased grip strength\{\{nl\}\}- Popping or clicking during activities loading the wrist\{\{nl\}\}- Exacerbated px w/ wrist EXT \& radial deviation\{\{nl\}\}- Limited ROM due to px\{\{nl\}\}- {\bf{Chronic cases:}} wrist ROM normal until degenerative changes occur\{\{nl\}\}Presentation varies w/ {\bf{Watson staging:}}\{\{nl\}\}{\bf{Stage 1:}} predynamic\{\{nl\}\}{\bf{Stage 2:}} dynamic\{\{nl\}\}{\bf{Stage 3:}} static\{\{nl\}\}{\bf{Stage 4:}} osteoarthrotic \tn 
% Row Count 28 (+ 24)
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• {\bf{Physical examination:}} & - Tenderness to palpation dorsally over the scapholunate joint\{\{nl\}\}- Localised swelling in acute cases\{\{nl\}\}- Watson shift test: +ve w/ palpable clunk \& presence of dorsal wrist px \tn 
% Row Count 37 (+ 9)
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Scapholunate dissociation (cont)}}  \tn
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• {\bf{Management:}} & - Injury acute if it has occurred within 6 weeks\{\{nl\}\}- Conservative care (non-displaced \& chronic asymptomatic): immobilisation \& NSAIDs\{\{nl\}\}- Surgery normally required to prevent long-term complications \tn 
% Row Count 10 (+ 10)
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• {\bf{Ddx:}} & - Scaphoid fracture\{\{nl\}\}- Kienbock disease\{\{nl\}\}- Ganglion cyst\{\{nl\}\}- Flexor carpi radialis tendinopathy\{\{nl\}\}- Extensor carpi radialis brevis/longus tendinopathy\{\{nl\}\}- CIND-DISI \tn 
% Row Count 19 (+ 9)
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\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.ncbi.nlm.nih.gov/books/NBK557729/"\}\}link text\{\{/popup\}\}}  \tn 
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\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Trigger finger / stenosing tenosynovitis}}  \tn
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\mymulticolumn{2}{x{17.67cm}}{{\bf{GREEN}}} \tn 
% Row Count 1 (+ 1)
% Row 1
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• {\bf{Intro:}} & - Tenosynovitis in the flexor sheaths of the fingers \& thumb\{\{nl\}\}- Result of overuse\{\{nl\}\}- Causes significant functional impairment \tn 
% Row Count 8 (+ 7)
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• {\bf{Aetiology (risk factors):}} & - 1st peak: young age \textless{}8yrs, F=M (mostly thumb)\{\{nl\}\}- 2nd peak: 40-50yrs F\textgreater{}M (dominant hand)\{\{nl\}\}- Multifactorial etiology\{\{nl\}\}- Trauma cause hypertrophy \& narrowing of tendon \& sheath, leading to catching \& locking\{\{nl\}\}- Adult comorbid diseases associated: diabetes, amyloidosis, CTS, gout, thyroid disease, RA\{\{nl\}\}- In children: seems developmental, w/ size mismatch between flexor tendon \& sheath, often idiopathic but associated w/ conditions like Hurler s., juvenile RA \tn 
% Row Count 30 (+ 22)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Trigger finger / stenosing tenosynovitis (cont)}}  \tn
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• {\bf{Pathophysiology:}} & - Microtrauma leads to inflammation \& injury of the flexor tendon-sheath complex\{\{nl\}\}- A1 pulley experiences greatest force \& commonly affected\{\{nl\}\}- Inflammation over time causes tendon sticking within its sheath, perceived as locking by the pt\{\{nl\}\}- Flexor tendon apparatus is stronger than the extensor tendon apparatus\{\{nl\}\}- Pts can FX fingers w/o difficulty but experience locking during EXT due to inflammation causing tendon catching in the flexor sheath \tn 
% Row Count 22 (+ 22)
% Row 4
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• {\bf{Clinical presentation:}} & - Discomfort or functional limitations in the affected digit\{\{nl\}\}- Thumb, ring finger most common sites (dominant hand)\{\{nl\}\}- Swelling or a nodule may be present\{\{nl\}\}- Complaints of a painful click in the digit\{\{nl\}\}- Locking of finger during EXT or inability to move it from fixed FX position\{\{nl\}\}- Ssx may develop gradually or be acute \tn 
% Row Count 38 (+ 16)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Trigger finger / stenosing tenosynovitis (cont)}}  \tn
% Row 5
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• {\bf{Physical examination:}} & - Tender nodule (due to inflammation) at the distal palmar crease\{\{nl\}\}- Affected digit may be FX or locked on observation\{\{nl\}\}- Moving may cause px \&/or swelling \tn 
% Row Count 8 (+ 8)
% Row 6
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• {\bf{Management:}} & - Good prognosis w/ treatment, sometimes spontaneous resolution\{\{nl\}\}- Conservative: splinting (6-10 weeks) \& steroid injections\{\{nl\}\}- Surgery (if conservative care fails or trigger thumb during infancy) \tn 
% Row Count 18 (+ 10)
% Row 7
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• {\bf{Ddx:}} & - Abnormal sesamoid\{\{nl\}\}- Acromegaly\{\{nl\}\}- Ganglion cyst\{\{nl\}\}- Infection within the tendon sheaths\{\{nl\}\}- Presence of loose body in MCP joint\{\{nl\}\}- Subluxation of extensor digitorum communis \tn 
% Row Count 27 (+ 9)
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\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.ncbi.nlm.nih.gov/books/NBK459310/"\}\}link text\{\{/popup\}\}}  \tn 
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\end{tabularx}
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\end{document}