Hand problems.
What is this painless mass that developed on the back of this patients hand/wrist?
It is a cystic structure with a stalik like base that derives from tendon sheaths or joints. People still do not really know why they form. They may spontaneously resolve or require aspiration. Occasionally if they recur after aspiration, surgery may be required. Historically people struck it with a heavy book---and the heaviest around was the Bible. Dont do it---but it does give another meaning to "Bible bashers".
This is a scaphoid fracture in a young lady. Which of the following is untrue?
Males are in fact affected more often than females. Avascular necrosis of the proximal part of the bone is a problem with waist fractures (especially if displaced) because the dominant blood supply comes from distally with retrograde flow.
This person fell off his motorbike and has a very painful hand. What injury (s) are seen?
The dislocated moon shaped lunate can be seen tipped forward on the lateral view (the so called spilled cup sign). On the AP view the carpal bones are not well delineated from each other (crowded carpus) and the lunate now looks triangular (piece of pie or pizza sign).
This man smacked his bent thumb on the ground and now has a painful base of the thumb. What is this intra articular fracture known as?
A Bennett's fracture is a simple oblique fracture at the base of the first metacarpal that goes into the joint whilst a Rolando fracture is a comminuted fracture at the base of the first metacarpal that goes into the joint. Treatment of a Bennett fracture may be conservative or surgical depending mainly on the displacement of the fracture. Gamekeepers thumb is an ulnar collateral ligament injury at the metacarpophalangeal joint of the thumb.
What fracture did "The Queen" suffer in a riding accident in 1994?
The injury was not diagnosed for 24hrs and did not require surgery. For all you fashionistas note the matching glove, plaster, shoes and handbag.
This man had a motorbike accident and has a very painful hand. What do these 2 x-rays show?
The lunate is in the correct place but the carpus has gone backwards and dropped. On the way through the scaphoid gets fractured. Nasty injury.
This patient has pyogenic flexor tenosynovitis. Which of the following statements is incorrect?
Staph aureus is the most common organism. The 4 Kanavel signs are 1/ A sausage digit. 2/ Finger held in passive flexion. 3/ Pain to percussion/palpation of the flexor sheath. 4/ Pain with passive extension.
This man struck the end of his finger whilst playing cricket and now cannot extend his distal phalanx. What is this injury commonly called?
It is called a mallet finger because it looks a bit like a mallet. Either the extensor tendon is cut or it has come away with a bit of bone. Initial treatment is in a mallet finger splint which is often enough (4-6wks). Referral to a hand surgeon is pudent because occasionally surgery is required. Oh yes--- do an xray to see if a bit of distal phalanx bone has been pulled off.
This patient has a "Boxers fracture" of the 5th metacarpal. Which of the following statements is untrue?
No rotation is acceptable. Occasionally they are treated conservatively if there is minimal angulation, no rotation, and it is not an open fracture. However generally they go to OT so get an early orthopaedic opinion.
This is the "Terry Thomas" sign caused by injury to the scapholunate ligament. Terry Thomas was an English actor, now dead. What was his most famous film?
Terry Thomas was a very British, mainly comedy actor. "Those magnificent men in their flying machines" gets 80% on Rotten Tomatoes. Worth a watch with the kids on a rainy day.