Paronychia affects the nail folds and is often bacterial, while a felon is a deep abscess in the fingertip pulp, causing intense pain. Both require early recognition and drainage to prevent complications like osteomyelitis, septic arthritis, or fingertip sensory loss.
Fractures are three-dimensional injuries best described using the PLACES framework: Pattern, Location, Alignment, Closed/open status, Examination findings, and Special investigations. At least two orthogonal X-rays are required to assess fracture type, displacement, joint involvement, and severity.
The upper limb is divided by fascia into compartments with specific muscles, nerves, and vessels. The arm has anterior (flexor) and posterior (extensor) groups & the forearm has volar, dorsal, and lateral compartments. Rising pressure causes compartment syndrome requiring urgent fasciotomy.
Ulnar nerve tendon transfers restore key hand functions such as grip strength, key pinch, and correct clawing after ulnar nerve palsy. By transferring muscles like the extensor carpi radialis brevis (ECRB) or flexor digitorum superficialis (FDS), tendon transfers improve hand movement and strength.
Radial nerve tendon transfers restore wrist, finger, and thumb extension when direct nerve repair isn't possible. Using tendons like Pronator Teres or Flexor Carpi Ulnaris, the procedure requires supple joints and healthy tissue. Success rates are high, with 80-90% achieving good outcomes.
Compartment syndrome of the hand is a rare surgical emergency where rising intracompartmental pressure (often after trauma) causes ischemic pain out of proportion, especially on passive stretch. It’s diagnosed clinically; urgent fasciotomy within 6 h is crucial to preserve tissue and function.
Extensor tendon injuries affect hand and finger extension and are classified by anatomical zones. They result from lacerations, rupture, or attrition, with Zone I injuries (mallet finger) being most common. Assessment includes Elson’s test and imaging. Management varies by zone and injury severity.
Upper limb cellulitis is a bacterial infection of the skin and subcutaneous tissue, causing erythema, warmth, and swelling. Diagnosis is clinical and involves imaging. Treatment includes cephalexin for mild cases, IV antibiotics for severe infections, and drainage for abscesses.
Finger replantation restores function, sensation, and aesthetics following the traumatic or surgical loss of a digit. Success depends on injury type, ischemia time, and microsurgical repair. Complications like venous insufficiency and arterial thrombosis require early management.
Trigger finger, or stenosing tenosynovitis, occurs when the flexor tendon is trapped at the A1 pulley, leading to pain during finger movement. Common risk factors include manual labor, older age, and diabetes. Treatment options range from splinting and corticosteroids to surgical A1 pulley release.
Soft tissue sarcomas are rare, malignant tumors of mesenchymal origin. They are classified into over 70 subtypes, with risk factors including environmental exposures and genetic predispositions. Management involves surgery, radiotherapy, and sometimes chemotherapy, tailored to the sarcoma type.
Median nerve tendon transfers restore thumb opposition, flexion of the index and middle fingers, and thumb flexion. The procedure involves relocating functional tendons to compensate for lost function due to nerve injury.
Thoracic outlet syndrome (TOS) is the compression of neurovascular structures at the brachial plexus. It commonly presents with neurogenic symptoms, such as pain and tingling. Management involves physiotherapy, pain control, and surgery for severe cases.
Macrodactyly involves disproportionate digit overgrowth, often due to lipofibromatosis of the nerve and PiK3CA mutations. Diagnosed via X-rays, MRI, and genetic tests, it's treated surgically to debulk and stop growth. Surgical management focuses on nerve issues to reduce recurrence.
Congenital Brachial Plexus Palsy: Upper limb movement loss at birth, often from birthing traction. Early surgical exploration recommended if no biceps function after 3 months.
Giant Cell Tumours are neoplastic lesions on tendon sheaths, often in hands. Diagnosed via physical exam and imaging, often treated with surgical excision. Recurrence is common.
Dupuytren's disease causes progressive hand contractures from fibrous nodules in the palm. Common in older Northern European men, it's linked to genetics and manual labor. Diagnosis is clinical, with treatments including collagenase injections, needle aponeurotomy, or surgery.
Poland syndrome is a congenital condition involving unilateral chest wall deformity and hand anomalies. It can be managed surgically for functional and aesthetic improvement.
Ulnar Tunnel Syndrome involves compression of the ulnar nerve at the wrist. It manifests as motor and sensory issues, varying based on the compression site. Diagnosis primarily uses X-rays, while management ranges from non-surgical interventions to surgical decompression.
Anterior Interosseous Nerve Syndrome (AINS) affects the median nerve's motor branch, leading to muscle paralysis without sensory loss. Diagnosis involves physical exams, EMG, and imaging. Initial treatment is conservative, followed by surgery if symptoms persist.
Pronator Syndrome involves compression of the median nerve in the forearm, often affecting middle-aged women. It typically presents with forearm pain and a positive Tinel sign. Management starts conservatively with rest and splinting, progressing to surgery if symptoms persist.
Thumb MCPJ UCL injuries range is typically diagnosed with stress tests and imaging. Conservative treatment for partial tears to surgical repair for complete tears and avulsions.
Seymour fractures are open, displaced distal phalangeal fractures in children, often caused by crushing injuries and associated with nail bed damage. Treatment includes irrigation, debridement, reduction, fixation, and antibiotics.
Ring avulsion injuries range from lacerations to amputation, typically caused by a ring catching on an object. Proper assessment and treatment depend on the severity, involving everything from suturing to amputation.
Polydactyly is the radial, ulnar, or central duplication of digits. This article details the classification, treatment, and aetiology of this congenital condition.
Upper Limb development occurs during weeks 4-8 of gestation. This article details the mechanisms of development and critical milestones.
Septic arthritis of the hand arises from direct inoculation, local infection spread, or hematogenous routes, often due to Staphylococcus aureus. Diagnosis involves clinical signs, imaging, and lab tests, with treatment requiring surgical debridement and antibiotics.
Flexor Tenosynovitis is a surgical emergency needing admission, elevation, IV antibiotics, and usually surgical washout within 24 hours.
Camptodactyly is the progressive flexion deformity of the PIPJ. This article details the aetiology, features, classification, and management of this congenital hand condition.
Syndactyly is the fusion of soft tissue and bone of the finger. This article details the aetiology, diagnosis, and treatment of syndactyly.
Necrotising fasciitis is a severe infection causing tissue death. Symptoms include severe pain and rapid tissue destruction, requiring immediate medical and surgical intervention to prevent high mortality.
Thumb hypoplasia is congenital undergrowth of the thumb. This article details its diagnosis, classification, and treatment.
The scaphoid bone, as the largest carpal bone in the proximal carpal row, is crucial in the wrist's mechanical integrity. This article explores scaphoid bone's anatomy, mechanics, and significance.
Ganglion cysts are common soft tissue tumors in the hand, often linked to joint capsules or tendons. Their diagnosis is primarily clinical. Treatment options are observation, aspiration, injection & surgical excision.
Cubital Tunnel Syndrome is a compression neuropathy of the ulnar nerve at the level of the elbow. This article reviews the current literature in relation to anatomy, clinical diagnosis, and treatment options of Cubital Tunnel Syndrome.
"Intrinsic Plus" is a condition caused by tight interossei and lumbricals, leading to MCPJ hyperflexion and PIPJ hyperextension, managed through therapies or surgical procedures like intrinsic release to alleviate symptoms and restore hand function.
Understanding thumb osteoarthritis: Covering anatomy, pathophysiology, diagnosis, classification, and treatments including surgery and non-operative methods for improved joint function.
Flexor Tendon Injury Repair is a common surgical operation in hand surgery. This article discusses diagnosis, surgical options, and post-operative recovery.
Posterior Interosseous Nerve (PIN) Palsy is a syndrome characterised by a reduction in extensor movements of the fingers. It most commonly due to a compression at the radial tunnel. This article explores the causes, signs and symptoms, and management of this entrapment.
This assesses your clinical expertise, decision-making, and management skills through an oral "viva" structure, using real-world scenarios representative of clinical practice and exams.
This assesses your clinical expertise, decision-making, and management skills through an oral "viva" structure, using real-world scenarios representative of both practice and exams.
This assesses your clinical expertise, decision-making, and management skills through an oral "viva" structure, using real-world scenarios representative of both practice and exams
Cleft hand is a central longitudinal congenital deficiency. This article details the aetiology, features, classification and treatment.
Brachial Plexus anatomy is a complex topic that can be difficult to learn. This article details the key anatomical points, provides mnemonics and detailed illustrations.
The quadriga phenomenon is a clinical diagnosis characterized by reduced flexion of non-injured fingers most commonly due to an injured FDP. This article explores the pathophysiology, causes and treatment options.
There are 5 Flexor and 9 Extensor Zones of the Hand. They are used to describe the location of a tendon injury, guide post-operative therapy and predict prognosis.
Radial nerve palsy affects wrist, finger, and thumb extension. Diagnosis involves motor/sensory tests, NCS, and imaging. Treatment includes splinting, physiotherapy, nerve repair, or tendon transfers.
Carpal Tunnel Syndrome is the most common upper extremity compression neuropathy. This article reviews the current literature in relation to anatomy, clinical diagnosis, and treatment options of Carpal Tunnel Syndrome.
Swan-neck and Boutonnière deformities are caused by an imbalance in mechanics at the proximal interphalangeal joint (PIPJ). This article explains their aetiology, features, biomechanics and treatment.
Soft Tissue Reconstruction in lower limb trauma is a complex area to understand theoretical principles and practical nuances. This article provides a decision algorithm as a guide.
A Bennett Fracture is an oblique, intra-articular fracture at the volar-ulnar base of the thumb metacarpal. This article details the anatomy, diagnosis and treatment of Bennett's Fracture.
There are different techniques described for volar hand surgery. This article describes, illustrates, and compares Bruner, Mild-lateral, and other incisions.
Compartment syndrome of the hand is an uncommon but acute surgical issue. With reference to 41 peer-reviewed publications, this article discusses the definition, pathophysiology, diagnosis and treatment of compartment syndrome.
Radial Tunnel Syndrome is a common entrapment neuropathy of the posterior interosseous nerve. This reviews anatomy, diagnosis and treatment.
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