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MSK Week 5 2017/18 > 9: Common hand conditions > Flashcards

9: Common hand conditions Flashcards

1
Q

What cysts commonly appear at the DIP joint?

A

Mucous cyst

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2
Q

What causes mucous cysts?

A

Outpouching of synovial fluid secondary to joint damage in OA

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3
Q

What are some symptoms associated with mucous cysts?

A

Pain

Discharge

Nail deformity

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4
Q

How are mucous cysts treated surgically?

A

Excision

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5
Q

Are mucous cysts the same as ganglion cysts?

A

No

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6
Q

What is a ganglion (cyst)?

A

Outpouching of synovial CAVITY

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7
Q

Are ganglion cysts painful?

A

No

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8
Q

If a ganglion cyst is fluctuating and causing functional problems, how may it be treated?

A

Aspiration (will probably recur)

Excision

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9
Q

Which artery may be damaged during aspiration of a ganglion cyst?

A

Radial artery

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10
Q

What stops flexor tendons from bowstringing by holding them to the bone?

A

Flexor tendon sheathes

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11
Q

What structures, found on the flexor tendon sheath, can catch inflamed tendons and cause trigger finger?

A

Pulleys

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12
Q

Which particular pulley is involved in trigger finger?

A

A1 pulley

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13
Q

What are the symptoms of trigger finger?

A

Pain

Flexion > LOCKING > Forced extension to unlock it

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14
Q

What gets caught on the A1 pulley in trigger finger?

A

Inflamed nodule of tendon

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15
Q

If trigger finger doesn’t resolve itself, how can it be treated?

A

Steroid injections into tendon sheath

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16
Q

Steroid injections often ___ trigger finger.

A

cure

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17
Q

How many steroid injections should be given for trigger finger before considering alternative therapy?

A

3

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18
Q

What surgical options exist for trigger finger?

A

Division of A1 pulley

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19
Q

What may be damaged in trigger finger surgery?

A

Digital arteries

Digital nerves

20
Q

Why can the A1 pulley be sacrificed without causing functional issues in the hand?

A

There aren’t any pulleys distal to it

21
Q

What does DeQuervain’s tenosynovitis affect?

A

Extensor tendons of the thumb

22
Q

What test is done on examination for DeQuervain’s tenosynovitis?

A

Finklestein test

Thumb into fist, adduct fist

Will be painful

23
Q

How is DeQuervain’s tenosynovitis treated?

A

NSAIDs

Splint

Rest

Steroid injections

Decompression

24
Q

What is Dupuytren’s contracture?

A

Contraction/fibrosis of PALMAR FASCIA

25
Q

What sort of deformity occurs due to Dupuytren’s contracture?

A

Fixed flexion deformity of fingers

26
Q

What particular aspect of the palmar fascia fixes the palmar skin to the hand?

A

Palmar aponeurosis

27
Q

What pathological process occurs in the specific cells of the palmar fascia implicated in Dupuytren’s contracture?

A

Metaplasia

Fibroblast > Myofibroblast (muscle - CONTRACTILE)

28
Q

Is Dupuytren’s painful?

A

No

29
Q

Dupuytren’s contracture has a gradual onset. How does it initially present?

A

Palmar pit / nodule

30
Q

What are some possible causes of Dupuytren’s?

A

Genetics

Diabetes

Alcohol

Smoking

31
Q

What are the two offshoots of Dupuytren’s which you should know about?

A

Ledderhose disease - plantar fascia

Peyronie’s disease - penis

32
Q

What movement of the MCP joints is lost in Dupuytren’s contracture?

A

Hyperextension

but patients don’t usually notice as we don’t hyperextend very much

33
Q

Can the deformity of

a) MCP joints
b) PIP joints

be corrected following Dupuytren’s contracture?

A

a) Yes

b) No

34
Q

Dupuyren’s contracture may be treated ___ or ___.

A

conservatively

surgically

35
Q

Why are zig-zag incisions made in Dupuytren’s contracture surgery?

A

Incisions PERPENDICULAR to the the flexor creases of skin will always heal with a contracture

36
Q

Why are nerves always at risk in finger surgery?

A

Tendons often pull nerves into unusual positions

37
Q

Contractile ___ cause symptoms of Dupuytren’s.

A

cords

38
Q

Why is the skin overlying cords also removed in Dupuytren’s surgery?

A

Skin also contains myofibroblasts which may allow for recurrence

39
Q

Why is revision surgery for Dupuytren’s highly risky?

A

Digital nerve displacement

40
Q

What are alternative surgeries for Dupuytren’s?

A

Needle fasciectomy

Collagenase injections (dissolves cords)

41
Q

The recurrence rate of Dupuytren’s is (low / high).

A

high recurrence rate

42
Q

What is an infection of the nail fold called?

A

Paronychia

43
Q

Who tends to get paronychia?

Why?

A

Children

Nail biting

44
Q

How is paronychia treated?

A

Antibiotics

Drain pus

45
Q

What is an important hand infection which must be treated immediately to prevent deformity?

A

Flexor tendon sheath infection

46
Q

What are the features of flexor tendon sheath infection?

A

Extreme pain; tracking up palm and arm

Tracking lymphangitis

47
Q

How is flexor tendon sheath infection treated?

A

Fluroscopically

MSK Week 5 2017/18 (12 decks)

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