Case Presentations: Wrist

Jenna Godfrey, MD

Hand Surgeon

Disclosure

I have nothing to disclose.

Patient 1

• 65yo female, RHD, former Architect

• c/o bilat hand numbness to thumb/IF/LF

• “Years”

• Was intermittent, now constant and distressing

• Worse at night – wakes her

• No prior pain management

• PMH: DM, chemo for endometrial CA with known neuropathy

Anatomy

What is a NCS?

2 Parts:

1. Nerve Conduction Velocity (NCV) measures speed and strength of nerveconduction

Determine if you have: demyelination

and axonal loss

2. Electromyography (EMG)

study individual muscle fibers

Looking for degeneration

Patient 2

• 16yo M

• Fall off bike

• Car pulled out in front of him

• Landed on outstretched hand

• Pain in wrist

• No deformity

Scaphoid tubercle tenderness

• 16yo F

• Tripped on dog at home and caught finger on couch falling down

• Hand pain and swelling, mostly dorsal

• Difficulty with making a fist

Patient 3

Don’t Let the XR Fool you…

Jahss Maneuver

• 64yo F

• Pain in “thumb”

• Can’t open doors, jars or hold garden sheers

• Denies numbness/tingling

• Taking ibuprofen for pain

Patient 4

On exam

• Shoulder sign

• Grind test

• Tenderness over TM joint

• Adduction contracture

Non-op Options

• Basilar thumb bracing

• CMC injections with steroid

• OT for thenar strength and custom splint

• REFERAL: when pt is ready for surgery with 3mo recovery!

Patient 5

• 72yo RHD Veteran

• c/o volar wrist pain

• 3 years with persistent volar mass

• Mildly painful with heavy lifting/activity

• Grows and shrinks in size

• 2 previous aspirations in clinic – returned each time

• PMH: Type 2 DM, cardiac pacemaker, HTN, s/p nephrectomy

Ganglions:

Dorsal Wrist Ganglion: From Scapholunate Ligament

Volar Wrist Ganglion: Volar Radialcarpal Ligaments or STT Joint

DRG: From SL Lig

Retinacular Cyst: From Flexor Tendon Sheath

Mucous Cyst: Arthritic Joint

Patient 5

• 31yo RHD female

• c/o “wrist pain”

• Mild swelling

• No trauma

• Points to radial side of wrist

• 6 wk old infant son at home

• PMH: negative

DeQuervain’s tenosynovitis

• Non op:• Thumb spica brace 3-4wks

• Steroid injection

• Wait until the infant is older

• Op:• Release compartment in office