4- common hand conditions Flashcards
what are mucous cysts? presentation? management?
they are outpouchings of synovial fluid, often early stage of arthritis
presents = can be painful & may deform nail or cause ridge. may fluctuate discharge
management = can be left alone or excised
what are ganglions? presentation? management?
outpouching of synovial cavity (filled with synovial fluid)
presents = big lump usually over wrist, painless, should fluctuate & trans illuminate
management = usually resolved with time, very hard to aspirate & get infection. try convince patient to live with as benign & will go away with time. can excise
what is trigger finger? presents? management?
tendons within flexor tendon sheath = swelling & inflammation
presents = pain over MCP joints, painful nodule area & often fails like it’s stuck
management = most resolve spontaneously but can also offer steroid injections or surgery
what is carpal tunnel syndrome? presentation? management
median nerve compressed in carpal tunnel
presents = worse at night, relieved by shaking, sensory problems in digits supplied by median nerve, palmar aspect spared
management = splintage at night, steroid injections, surgery
what’s in carpal tunnel?
the median nerve, the four tendons of the flexor digitorum profundus, the four tendons of the flexor digitorum superficialis, and the flexor pollicis longus (FPL) tendon
what are risk factors for carpal tunnel syndrome?
- diabetic
- hormonal fluctuations like pregnancy
- obesity
- hypothyrodism
- rheumatoid arthritis
what examinations & investigations can be done to diagnose carpal tunnel syndrome?
- examination of LOAF muscles by abduction test
- phalen’s = forced flexion of both wrists for 1 min
- Tinel’s test = tap over carpal tunnel and they feel like electric shocks
investigations can be test where measure speed & amplitude of signals in median nerve or questionnaire
what is De Quervain’s tenosynovitis? presentation? management?
inflammation & swelling of extensor tendon in thumb compartment
presents = spontaneous, painful, swollen/red, finklesteins or eichoffs test, common postpartum
manage = NSAIDs, splint w thumb extension for 6 weeks continuously, rest, steroid injection, surgery
what is dupuytren’s contracture? presents? management?
thickening of special subdermal palmar fascia - initially lumps in palm & gradually fingers pulled in
presents = painless, gradual progression, usually starts at a pit or nodule. mostly male disease
management = conservative treatment doesn’t work, surgery like fasciectomy, amputation
what are causes of dupuytren’s contracture?
genetics is main cause (could be smoking, diabetes, alcohol, smoking)
what is paronychia? management?
infection with nail fold (children is risk as nail biting). may result in pus collection
management = elevate antibiotics, incise & drain
what is the flexor tendon sheath infection? presentation? management?
rare but important as surgical emergency since infection with sheath
presents as limited extension including passive due to pain = kanavel’s cardinal signs (affected finger held flexed, fusiform swelling over finger, painful to percuss sheath
management = wash out tendon sheath
what collagen type is dysfunctional in dupuytrens?
collagen type III
