Ganglion Cyst Overview

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Questions and Answers

What percentage of recurrence is observed after aspiration of a ganglion cyst?

50%

70%

90% (correct)

10%

What is the most common location for a ganglion cyst to occur?

On the dorsal aspect of the wrist (correct)

On the palmar aspect of the wrist

In the elbow joint

In the distal phalanx

Which of the following is a common symptom of carpal tunnel syndrome?

Numbness in the little finger

Pain in the elbow region

Awakening pain in the middle of the night (correct)

Swelling in the wrists

What is a common physical examination finding in carpal tunnel syndrome?

Positive Tinel's sign Signup and view all the answers

In the diagnosis of ulnar nerve entrapment, which sign is most indicative?

Froment's sign Signup and view all the answers

What is the primary management approach for carpal tunnel syndrome?

Rest and NSAIDs Signup and view all the answers

What is the primary provocative test used to diagnose de Quervain's tenosynovitis?

Finkelstein’s test Signup and view all the answers

Which condition is MOST appropriate for performing a nerve conduction velocity test?

Carpal Tunnel Syndrome (CTS) Signup and view all the answers

What is the main symptom of intersection syndrome?

Pain at the intersection of the first and second dorsal extensor compartments Signup and view all the answers

What is a characteristic hand deformity associated with median nerve injury?

Ape hand Signup and view all the answers

Which treatment method is considered as the first line for managing intersection syndrome?

Non-surgical methods like NSAIDs and rest Signup and view all the answers

What surgical procedure may be utilized if non-surgical management of intersection syndrome fails?

Release of the second dorsal extensor compartment Signup and view all the answers

Which condition is characterized by persistent wrist pain after repetitive activities like painting?

de Quervain’s tenosynovitis Signup and view all the answers

What is the purpose of differential local anaesthetic injections in diagnosing intersection syndrome?

To differentiate between conditions Signup and view all the answers

What is the expected outcome of conservative treatment for de Quervain's tenosynovitis?

Reduction of symptoms in 62% to 100% of cases Signup and view all the answers

What is a common characteristic of a ganglion cyst?

Fluid-filled cystic structure arising from the synovial sheath Signup and view all the answers

What is the primary stabilizer of the distal radioulnar joint?

TFCC Signup and view all the answers

What mechanism of injury is commonly associated with TFCC injuries?

Falling on an outstretched hand Signup and view all the answers

What is a common clinical feature of TFCC injuries in older adults?

Catching and locking sensation in the wrist Signup and view all the answers

Which imaging technique is considered the standard of care for assessing a TFCC injury?

MRI or MR arthrography Signup and view all the answers

In athletes, which injury is characterized by the inability to actively flex the DIP joint?

Jersey finger Signup and view all the answers

What is the typical treatment approach for Jersey finger injuries?

Early surgical repair Signup and view all the answers

What is another name for Mallet finger?

Baseball finger Signup and view all the answers

Which feature might indicate a central articular disc injury of the TFCC?

Wrist catching and locking Signup and view all the answers

What is the initial imaging technique recommended for identifying fractures of the hook of the hamate?

X-rays with PA and lateral views Signup and view all the answers

What is the recommended treatment duration for nondisplaced body fractures of the trapezium?

4 weeks with a short arm thumb spica cast Signup and view all the answers

Which muscle is most likely responsible for median nerve entrapment in the given case of paresthesias and weakness?

Pronator teres Signup and view all the answers

Which type of fracture occurs at the base of the thumb metacarpal due to axial loading?

Body fractures Signup and view all the answers

What is the typical symptom associated with a trapezial ridge fracture?

Tender point distal to the scaphoid tuberosity Signup and view all the answers

What does a fracture of the distal radius with dorsal angulation signify?

Colles’ fracture Signup and view all the answers

For a patient with a displaced body fracture of the trapezium, what is the advised course of action?

Surgical referral Signup and view all the answers

What type of fracture is characterized by tenderness of the dorsal wrist proximal to the thumb CMC joint?

Trapeziometacarpal fracture Signup and view all the answers

What is a classic sign of mallet finger?

Flexed DIP joint that cannot be actively extended Signup and view all the answers

Which imaging technique is best for identifying an avulsed fragment in mallet finger?

X-Ray Signup and view all the answers

What is the recommended conservative treatment for mallet finger?

Splinting the DIP in extension for 6–8 weeks Signup and view all the answers

What characterizes a Bennett's fracture?

Oblique fracture-subluxation at the base of the thumb metacarpal Signup and view all the answers

Which treatment option is typically recommended for displaced Bennett's fractures?

Closed reduction and orthopedic referral Signup and view all the answers

Which condition may result from a rupture of the central slip in the finger?

Boutonniere deformity Signup and view all the answers

Which of the following is a complication associated with Bennett's fracture?

Subluxation of an avulsed metacarpal fragment Signup and view all the answers

What is one of the main clinical features of a Bennett's fracture?

Tenderness and swelling at the base of the digit Signup and view all the answers

Study Notes

De Quervain’s Tenosynovitis

Characterized by pain in the first dorsal compartment, exacerbated by repetitive forceful gripping and ulnar deviation of the thumb.
Finkelstein’s test is pathognomonic for diagnosis.
Conservative treatment options include rest, modalities, thumb spica splinting, NSAIDs, and corticosteroid injections.
Surgical intervention may be necessary if conservative treatments fail.

Intersection Syndrome

Involves irritation of tendons in the second dorsal compartment, usually from repetitive wrist use.
Symptoms include pain at the intersection of the first and second dorsal extensor compartments, with crepitus often present.
Diagnosis made through history and clinical examination, differential diagnosis may include local anesthetic injections.
Initial treatment is conservative: NSAIDs, rest, activity modification, and wrist splinting.

Ganglion Cyst

A synovial fluid-filled cyst often located on the wrist's dorsal or volar aspect.
Typically appears as a small, smooth mass; pain may occur with movement or pressure.
Imaging if required may include plain X-rays.
Treatment options include immobilization, aspiration (high recurrence), or surgical removal.

Nerve Conduction Velocity Test

Most appropriate for diagnosing conditions such as Carpal Tunnel Syndrome (CTS), reflecting median nerve issues.
Other conditions like CVA, myotonia, and DMD may require different testing approaches.

Carpal Tunnel Syndrome (CTS)

Caused by compression of the median nerve and results in pain, numbness, or tingling in the palmar aspect of the thumb, index, and middle fingers.
Symptoms often worsen at night and may be temporarily relieved by shaking the hands.
Clinical tests include Phalen’s maneuver and Tinel’s sign; diagnosis may be supported by EMG and NCV studies.
Management options include rest, NSAIDs, gabapentin, steroid injections, and splinting.

Ulnar Nerve Entrapment

Characterized by numbness in the ulnar distribution, particularly the little finger, due to compressive trauma.
Positive Froment’s sign indicates weakness in grip strength, while Tinel’s sign may also be present.
Management includes splinting, NSAIDs, activity modification, and surgical options if necessary.

Fractures of the Hook of Hamate

Common in racquet sports; symptoms include localized pain in the wrist while gripping.
Imaging includes X-rays to diagnose fractures; treatment for non-displaced fractures involves casting, while displaced may require surgical intervention.

Trapezium Fractures

Isolated fractures are rare, typically occur from axial loads to the base of the thumb metacarpal.
Clinical features include tenderness proximal to the thumb CMC joint; imaging and treatment vary based on fracture type.
Nondisplaced fractures treated with a short arm thumb spica cast; surgical referral required for displaced fractures.

TFCC Injury

Risks include positive ulnar variance, particularly in young athletes or older adults due to degenerative changes.
Symptoms often include wrist catching, locking, and tenderness between the FCU and ECU tendons.
Imaging may include ulnar variance X-rays and wrist arthrography; surgical options depend on the type of tear.

Flexor Digitorum Injuries (Jersey Finger)

Caused by trauma or spontaneous injury; typically results from fingers getting caught in clothing during play.
Unable to actively flex the DIP joint; treatment necessitates orthopedic referral for early surgical repair.

Mallet Finger

Results from sudden passive flexion, leading to flexed DIP joint that cannot actively extend.
Associated with tenderness and may show an avulsed fragment on X-ray.
Treatment involves splinting for 6-8 weeks; surgical intervention necessary for poor healing in severe cases.

Fractures of the Base of the First Metacarpal (Bennett’s and Rolando’s Fracture)

Bennett’s fracture involves oblique fracture-subluxation at the thumb metacarpal's base; Rolando’s fracture may present as T, Y, or comminuted configurations.
Clinical features include tenderness and swelling following direct trauma; imaging is crucial for diagnosis.
Conservative management for non-displaced fractures; orthopedic referral for displaced fractures.

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Description

This quiz focuses on the clinical features and imaging guidelines for ganglion cysts. Explore the common presentations, including the typical locations on the wrist and treatment options available. Test your understanding of this common wrist condition and its management strategies.