Hand and Wrist Conditions: Diagnosis and Treatment

• The notes below discuss the diagnosis and treatment of various hand and wrist conditions

Question 1

• A 42-year-old skier is tender in the anatomical snuffbox and on bimanual palpation after a fall
• X-rays with scaphoid views show no fracture
• Discharge with reassurance is the most appropriate course of action

Question 2

• A 42-year-old lady with systemic lupus erythematosus presents with a 5-day history of a painful purple lesion on her index finger
• Presents with a tender red lesion on the index finger
• Osler's nodes is the likely diagnosis

Question 3

• A 13-year-old boy falls onto an outstretched hand and is brought to the emergency department
• He re-presents a week later with pain in his hand after initial clinical clearance
• Fracture of the scaphoid is the most likely underlying injury

Question 4

• A 17-year-old boy has a soft fluctuant swelling on the dorsal aspect of his left hand, most obvious when making a fist
• A ganglion is the most likely nature of the lesion

Question 5

• A 62-year-old man presents with a hard swelling adjacent to the distal interphalangeal joint of his right index finger, with lateral deviation of the fingertip
• There is no sensory disturbance and the swelling is not tender
• Osteoarthritis is the pathological process likely underlying the diagnosis

Question 6

• A 52-year-old male presents with discomfort in the fingers of his left hand
• The ring and little fingers of his left hand are flexed and unable to extend completely, but he can make a fist
• Palpation reveals thickened nodules on the medial half of the palm
• Dupuytren's contracture is the most likely diagnosis

Question 7

• A 63-year-old lady presents with a three-month history of pins and needles in the fingers of her right hand, particularly at night
• Examination reveals loss of sensation over the palmar aspect of the lateral three fingers and wasting of the thenar eminence
• Carpal tunnel syndrome is the underlying diagnosis

Question 8

• A 25-year-old man is diagnosed with an undisplaced fracture of the proximal pole of the scaphoid
• Best course of action is immobilization in a futura splint for 5 weeks

Question 9

• A 62-year-old lady presents with a non-tender lump overlying the distal interphalangeal joint of the index finger, which is hard and causes deviation of the fingertip
• Heberden's nodes is the likely nature of the lesion

Question 10

• A 43-year-old man falls landing on his left hand and had anatomical snuffbox tenderness initially, but X-rays did not show a scaphoid fracture
• He has been immobilized in a futura splint for two weeks and is now asymptomatic
• Discharge with reassurance is the most appropriate course of action