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1. 1 st part: Fatima Mirza Hammad 2 nd part: Naeema Abdulla Ali DOWNLOAD THIS SLIDE For more slides click here

18. Lateral band Central slip Distal phalanx

24. - the PIP joint is hyper extended . - DIP joint is flexed .

25. volar plate becomes weakened and stretched by RA , direct truma! PIP joint becomes loose and begins to easily bend back into hyperextension extensor tendon gets out of balance allows the DIP joint to get pulled downward into flexion swan neck deformity occurs

26. - Symptoms : - swelling and pain due to inflammation from injury or disease (RA) - Signs : Swan-neck !! - the PIP joint is hyper extended . - DIP joint is flexed. - Diagnosis : - clinical diagnosis - X-ray is done to evaluate the joints (RA) and look for fractures. .

30. Infections in the hand are dictated by fascial boundaries within the hand, so they can be classified as follows: 1.Under nail fold (paronychia). 2.Pulp space infections (whitlow). 3.Other subcutaneous infections. 4.Infections of the tendon sheaths (Tenosynovitis). 5.Infections of the deep fascial spaces.

31. Infection of the perionychium (also called eponychium), which is the epidermis bordering the nail. It results in swelling, erythema, and pain at the base of the fingernail and later pus.

32. Acute paronychia is usually the result of localized trauma to the skin surrounding the nail plate. Infection begins with a break in the skin of the nail fold and spreads to the subungual (underneath a fingernail or a toenail) space causing severe pain. The responsible organisms in acute paronychia are usually Staphylococcus aureus and Streptococcus pyogenes. other: Pseudomonas ,Candida ,Gram -ve bacilli.

33. Early cases may be treated with soaks and antibiotics with the hand elevated . If there is no rapid improvement and pus is seen or suspected, The cuticle (the dead skin at the base of a fingernail or toenail ) should be raised and the pus evacuated . In some cases, the proximal half of the nail is removed. This procedure can be done under general or regional anesthesia, but remember that local anesthetics must never be used in the presence of infection because it helps spread the infection.

34. ♣ Infection of the distal pulp or phalanx pad of the fingertip. ♣ It is usually caused by inoculation of bacteria into the fingertip through a penetrating trauma. ♣ The most commonly affected digits are the thumb and index finger.

37. ♠ . It is a small laceration or puncture wound occurs over the middle of a finger , especially near a joint on the palmar side , an infection of the flexor tendon can occur. ♠ . These can often cause severe stiffness , even destruction and rupture of the tendon . ♠ . These present acutely with: ♣ . stiffness of the finger in a slightly bent posture ♣ . diffuse swelling and redness of the finger ♣ . tenderness on the palmar side of the finger, and severe aggravation of pain with attempts to straighten the finger.

38. ♣ . The flexor tendons of the hand are enclosed in distinct synovial sheaths. ♣ . The flexor tendon sheaths of the index , middle , and ring fingers extend from the distal phalanges to the distal palmar crease. ♣ . The sheath encompassing the fifth finger extends from its distal phalanx to the mid-palm , where it expands across the palm to form the ulnar bursa. ♣ . The thumb flexor sheath begins at the terminal phalanx and extends to the volar (palmar) wrist crease , where it communicates with the radial bursa.

41. ♠ . It is dangerous and must be recognized early to prevent: ♣ . tendon necrosis ♣ . adhesion formation ♣ . spread of infection to the deep fascial spaces. ♠ . The synovial sheaths are poorly vascularized , but are rich in nutritious synovial fluid . This combination provides an ideal environment for bacterial growth . ♠ . Once inoculated, infection spreads rapidly through the sheath.

42. Appreciable pain along the tendon sheath with passive extension of the digit is often the first clinical sign of this hand infection.

43. In the early stage: may respond to non-operative treatment that includes : ♠ . Splinting ♠ . elevation ♠ . intravenous antibiotics. Rings should be removed from the affected finger and other fingers of the hand as soon as possible. - If there is no improvement within 12 to 24 hours , surgical intervention is warranted.

44. Early surgical treatment should be considered if the patient is immunocompromised or has diabetes. Surgical treatment involves proximal and distal tendon exposure, and careful insertion of a catheter or feeding tube into the tendon sheath with copious intra-operative irrigation. Postoperatively, the catheter may be left in place for 24 hours to allow for further low-flow irrigation.

50. Its 8 times more common in women than men (age 40-50 years). ♠ Pain: # waken in the early morning hours With: ♣ burning pain ♣ tingling ♣ numbness May be relieved by: ♣ Hanging the arm over the side of the bed. ♣ shaking the arm # Little pain during the day # may develop in the arm and the shoulder # there also could be swelling in the hand, increases at night

52. Tinel sign : Tap over median nerve at wrist crease >>> electric or tingling sensation Examination: Thumb abduction Abductor pollicis brevis

53. Examination: Phalen maneuver : Holding the wrist fully palmarflexed for 1 min> Paresthesia. << positive Wrist compression test ( Durkan's test): pressure over the median nerve proximal to the wrist, appearance of symptoms within 30 seconds = positive Durkan test is more sensitive than tinel’s sign and phalen maneuver

55. ♣ Splinters - Prevent wrist flexion and pain appearance during sleep. - Preferable during pregnancy. ♣ Open surgical division of the transverse carpal ligament (flexor retinaculum) ♣ Corticosteroid injection into the carpal canal. ♣ Arthroscopic carpal tunnel release.

60. ♣ . Splint that includes wrist and thumb. (24 hours a day for 4 to 6 weeks to immobilize the affected area. ) ♣ . Avoid any activities that aggravate the condition. ♣ . Anti-inflammatory medication (such as naproxen or ibuprofen). ♣ . If symptoms continue, inject the area with cortisone to decrease pain and swelling. ♣ . Resistant cases, need surgery