16: Orthopaedic Problems of the Hand Flashcards
what is Dupuytren’s disease/contracture?
- a pathophysiological condition characterised by the progressive, fibrotic thickening of the palmar fascia that results in permanent flexion deformity of the affected fingers, predominantly the 4th and 5th digits.
Dupuytren’s contracture aetiology
- idiopathic: most prevalent cause
- diabetes
- excess alcohol consumption with chronic liver disease
- family history: autosomal dominant
- AIDS
- Peyronie’s disease
Dupuytren’s contracture most commonly affects what type of person?
- male > female
- prevalence increases with age
- almost exclusively in white races
Duputren’s disease treatment
- physio
- splint
- radiotherapy
- surgery: partial fasciectomy, dermo-fasciectomy, percutaneous needle fasciotomy
- collagenase injection
what is trigger finger?
- also known as stenosing tenosynovitis
- a condition where one or more fingers become stuck in a bent position due to the mechanical impingement of the A1 pulley, an annular ligament of the finger located at the metacarpal head.
- The finger may straighten with a snap, similar to a trigger being pulled and released.
who is most likely to get trigger finger?
- adults aged 40-60
- women > men
- repetitive strain of hand e.g. carpal tunnel
- RA
- diabetes
- gout
what are diagnosable signs of trigger finger?
- palpable lump in palm over A1 pulley
- feel the triggering around the A1 pulley
non-operative and operative treatment of trigger finger
non-operative: splintage, steroid injection
operative: percutaneous release, open surgery
what is De Quervain’s tenosynovitis?
An inflammatory condition characterised by the involvement of the tendons of extensor pollicis longus and extensor pollicis brevis, which are located at the base of the thumb.
De Quervain’s tenosynovitis signs and symptoms
- pain at the base of the thumb, which can extend to the forearm.
- pain exacerbation during thumb abduction, gripping, or ulnar movement of the wrist.
- tenderness of the anatomical snuffbox
- hand and thumb weakness
- occasionally, swelling and redness over the base of the thumb
who is most likely to get De Quervain’s syndrome?
- women > men
- 50-60s
- increase in post-partum and lactating females
- those who take part in activities with frequent thumb abduction and ulnar deviation e.g. office workers, musicians
what tests can be used to diagnose De Quervain’s tenosynovitis?
- Finkelstein’s test
- resisted thumb extension
De Quervain’s tenosynovitis management
- conservative: splinting of thumb and wrist, analgesics and activity modification.
- medical: intralesional corticosteroid injections
- surgical: decompression of the first dorsal compartment
what is a ganglion cyst?
- a non-cancerous tumour that arises from the synovial tissues, typically found in joints or tendons.
- cysts are filled with a thick, jelly-like fluid known as synovial fluid.
who gets ganglion cysts usually?
- females > males
- wide age distribution (peak 20-40 years)
- dorsal > volar aspect of hand
- may be associated with recurrent injury around the wrist
