Ganglion Cyst Overview

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.