WRIST AND HAND

SIGN AND
DISEASE DESCRIPTION PATHOPHYSIOLOGY MANAGEMENT
SYMPTOMS
Carpal Tunnel - Common form of any - occurs when the tunnel, where the In the distribution of Nonsurgical:
Syndrome focal mononeuropathy. nerve passes through becomes narrowed median nerve (palmar -Bracing or splinting oh hand
or when tissues surrounding the flexor aspect of thumb, index, and wrist at night
Causes: Heredity, tendons swell, putting pressure on the middle and radial - NSAIDS
Repetitive hand use, MEDIAN NERVE. These tissues are aspect of fouth finger) -Activity changing/
Hand and wrist position, called the synovium - which normally -Pain modifying activity with
Pregnancy, DM, lubricates the tendons making it easier to -Paresthesias (Pins and limited hand movement
Rhematoid arthritis, move. Needles) -Nerve gliding exercise
Thyroid Imbalance -Numbness - Steroid injection
When the synovium swells, it takes up - Tingling sensation -weight loss; avoid caffeine,
space in the carapal tunnel and crowds - Hand weakness nicotine, alocohol
the nerve. the pressure building up Surgical:
causes pain, numbness, tingling and (+) Phalen sign - Open carpal tunnel release
weakness in the hand.
De Quervain's De Quevain Tendons of the abductor pollicis longus -pain along the radial - splinting on hand at night;
Disease tenosynovitis is an and the extensor pollicis brevisare aspect of the wrist that Rest
entrapment tendinitis of tightly secured against the radial styloid radiate to the thumb or - Anti-inflammatory
the tendons contained by the overlying extensor retinaculum. extended forearm. medication 10-14 days
within the first dorsal any thickening of the tendons from acute -painful ROM of -Activity changing/
compartment at the or repetitive trauma restrains gliding of thumb, local tenderness modifying activity with
wrist; repetitive use of the tendons through the sheath. over the radial styloid limited hand movement;
thumb or wrist (+)Finkelstein test stretching and flexing
-Most cases UNKNOWN cause exercise
- Steroid injection

Trigger Stenosing tenosynovitis, -Trigger fingers occur when the A1 - Swelling Common treatment:
Finger/thumb also known as the pulleys (hold the tendon close) of the -Catching feeling - Night splints; Rest
"Trigger finger" hand become too thick, from friction and -- flexed, finger lock - Anti-inflammatory
sometimes called the catching between tendon sheaths, so the -Sharp pain upon medication
"trigger thumb" tendon cannot glide easily through it. extension of finger - Steroid injection
-from repetitive use Causes: then relieved after a - Limiting hand activity
develop in the flexor - Rheumatoid arthritis, Gout and DM painful “snap” as the
sheaths of the fingers -Repeated and strong gripping tendon clears the
and thumb. -Most cases UNKNOWN obstruction.
Gamekeeper Insufficiency of ulnar It occurs as a result of a valgus force - thumb instability, Night splints
Thumb/Ulnar collateral ligament of the placed onto the abducted MCP joint, abducted thumb - Anti-inflammatory
nerve syndrome metacarpophalangeal leading to ruptured ulnar collateral - pain on the thumb medication;Steroid injection
(MCP) joint of the ligament (UCL) injury and chronic -tenderness - Limiting hand activity
thumb. attritional injury. Surgery is recommended with
weakness of pincer function
Radial nerve Radial tunnel syndrome - Radial nerve impingement over the - dull aching pain at the Night splints, Ice compress
syndrome is a set of symptoms that traversing tunne between the muscles top of the forearm, to - Anti-inflammatory
include fatigue or a dull, and under the fascial bandsl, with the outside of the medication;Steroid injection
aching pain at the top of repetitive use of hand gripping, bending elbow, or the back of - Limiting hand activity;
the forearm with use of wrist can irritate the nerve; twisting of the hand Stretching and flexibility
arm or wrist - pain with extended exercise
hands = Wrist drop Surgery: to relieve tension
over the tunnel.
HIP
Congenital Hip Developmental DDH, the socket (acetabulum) is the head of the femur is Newborn, : Pavlik harness for
Dislocation Dislocation (Dysplasia) shallow, meaning that the ball of the completely out of the 1-2mos (help tighten
of the Hip, is a thighbone (femur) cannot firmly fit into socket.Leg length ligament)
hereditary congenital the socket;Cause: Family history of difference; uneven skin 1-6mos: same with newborn 6
anomaly. DDH (parents or siblings); folds, less mobility or weeks
F>M Oligohydraminos (low levels of flexibility on one side; 6mos-2yrs: closed reduction,
amniotic fluid) limping, toe walking or spica casting; open sugery
walding, duck like gait can also be done

KNEE
SIGN AND
DISEASE DESCRIPTION PATHOPHYSIOLOGY MANAGEMENT
SYMPTOMS
Terrible Triad of Also known as the It occurs with blow to the lateral side of - Extreme pain in the Rest, Ice, Immobilize with
O'Donoghue unhappy triad; is a extended knee or excessive lateral knee and upon knee cast or braces, elevate
severe injury which twisting of the flexed knee that disrupts movement; Rapid, foot.
involves three major the TCL and concomitantly tears and or extreme swelling; A For ACL, MCL, may or may
ligaments, ACL, MCL, destroy the medial meniscus from joint popping or tearing not do surgery
Medial Meniscus capsule. sound at the time of For MML, surgery is
Ligament Common among foot ball players and injury;.; Bruising recommended. If sporty,
other sports. usually appears within surgery may be indicated for
2-3 days.; An unstable all type of ligament tear.
feeling knee.
Housemaid's Also known as Caused by inflammation of a small - skin over the bursa is Supportive treatment
knee prepatellar bursitis. fluid-filled sac or bursa in front of the thickened or calloused Rest, ice, immobilize.
kneecap with prolonged periods of time -swelling (non-tender, NSAID
Male > female kneeling. With ff mechanisms: not warm) Treat underlying cause.
- sudden, one-off, injury to the knee With full ROM
- Recurrent minor injury knee 14-day course of antibiotic
-Infection (clindamycin)
- Inflammatory diseases: Gout,
rheumatoid
Popliteal Bursitis also known as Baker’s Caused by inflammation of the fluid- -golf ball swelling Supportive treatment
cyst; is a golf ball sized filled sac or bursa behind the knee, or behind the knee; Pain Rest, ice, immobilize.
swelling that develops at out-pouching of a portion of the bursa on the popletial area Compression bandage
the back of the knee which resembles a cyst formation. May upon extension and NSAID; corticosteroid
be normal in some. flexion of the knee; injection
Treat underlying cause.
Patellar - More common in Occurs from a twisting injury to the - pain - Rest, Ice, Immobilize,
Dislocation women extended knee. The patella is displaced - swelling Elevate.
laterally over the lateral condyle of the -deformity of the knee -Closed reduction by flexing
lower limb. the hip, hyper extending the
knee, sliding the patella back
into space.
Osteochondritis Is a rare disorder in Result from acute or chronic trauma. - unilateral, non- - Observational and activity
dissecans which a segment of Occurs when a small segment of bone weight bearing lateral changing
articular cartilage and begins to separate from its surrounding aspect of the femoral - children and teens heal on
subchondral bone region due to lack of blood supply. The condyle, pain and their own
become partially or small pieces of bone and the cartilage swelling. - Rest; avoiding vigorous
totally separated from begins to crack and loosen. affected: activity; splinting or cast of
the underlying bone. knee, ankle, and elbow affected limb
-most often children and - Unknown cause of the disruption of -Arthroscopy for retrieval of
adolescents. blood supply. loose bodies
Osgood Schlatter - Is apophysis of the Cause: repetitive stress imposed by the -Chronic intermittent -self-limiting; Rest, initially
Disease tibial tubercle resulting patellar tendon on its site of insertion pain and tenderness limit contact sports; however,
from the repeated normal results in a series of microavulsions of over the anterior aspect avoidance is not essential.
stresses or overuse. the ossification center and the of the knee and tibial - Stretching/flexibility
- M>F; age onset 10-15 underlying cartilage. tuberosity, aggravated exercise;
y/o; more commonly by running, kneeling, -NSAIDS
occur in running or squatting and climbing - Ice application to decrease
jumping athletes. stairs. swelling over the swelling
tibial tubercle.
 Shin Splints - medial tibial stress Develop after physical activity; -pain on the inner -Rest,
syndrome- inflammation associated with running. border of tibia or -Ice application to decrease
of muscles, tendons and Caused by repetitive trauma induced tenderness over medial swelling
bone tissue of tibia periostitis of the tibia. Sudden increase or posterior tibia. -Stretching/flexibility
-exercise-related in training particularly running on hard -swelling exercise; NSAIDS,
problem; refers to pain surface. -Supportive shoes
along the inner edge of >15 years old, runner, military recruits
the shinbone (tibia)

Ahmed Bryle I Indanan

SOM Level III

Sources: American Academic of Orthopedic Surgeon; Tintinalli’s Emergency Medicine 7th edition; Schwartz surgery 10th edition; Snell’s Clinical
Antomy by Region 8th Edition