- HAND and WRIST PAIN
- Ulnar Side
- Extensor carpi ulnaris tendinopathy and subluxation (Chronic as well)
- Triangular fibrocartilage complex injury (Chronic as well)
- Ulnar styloid impaction syndrome
- Radial Side
- Scaphoid fracture
- Trapezium fracture
- de Quervain’s tenosynovitis
- Carpometacarpal osteoarthritis
- Volar Side
- Hook of the hamate fracture
- Pisiform fracture
- Carpal tunnel syndrome
- Sensory:
- Motor: "LOAF: Lumbricals 1 and 2; OAF make the thenar eminence: Opponens Pollicis, Abductor Pollicis Brevis, Flexor Pollicis Brevis (FPB also has ulnar innervation)
- Median Nerve Innervation (Palmar View)
- Ulnar neuropathy (Guyon’s canal syndrome)
- Dorsal Side
Clinical Case Discussion - 1. 26 y/o AAF with Type 1 DM with neuropathy, and nephropathy presents in the IM clinic for R hand pain of 3 yr duration. Previous work up by PCP including Xray did not reveal the cause of the pain. Pain has been constant and does affect the quality of her life. Physical Examination shows tenderness in 2nd MCP of right hand. is positive for Finkelstein's test. Diagnosis of DeQuervain's tenosenovitis was made. How should this patient be managed.
- a. No need to do any thing as chronic problem, and has not really got worsened.
- b. Wrist splint including Velcro thumb spica and NSAIDs.
- c. Steroid injection
- d. Evaluation for surgical release
- Answer cues:
- Observation alone is never enough when patient has symptoms.
- Conservative treatment is preferred especially early in the disease process.
- If not better, we need to do Steroids Injection.
- If still not better after 1-2 steroid injection, consider surgical release.
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