Adult Hand Problems

Question 1

what is a ganglion cyst?

Answer 1

outpouchings of synovial fluid at joints

Question 2

where are ganglion cysts common?

Answer 2

DIPs (mucous cyst)
wrist
ankle
knee (Baker’s cyst)

Question 3

what condition are ganglion cysts associated with?

Answer 3

OA

Question 4

presentation of ganglion cyst

Answer 4

pain due to underlying OA

firm, smooth, rubbery cysts that trans-illuminate

Question 5

management of ganglion cysts

Answer 5

DO NOT try to burst
needle aspiration (common reoccurrence)
excision (cosmetic reasons)

Question 6

what is trigger finger?

Answer 6

stenosing tenosynovitis leads to swelling of sheath which catches on A1 pulley

Question 7

presentation of trigger finger

Answer 7

pain and clicking over MC head with triggering (sticking in flexion)

Question 8

what do you need to distinguish trigger finger from?

Answer 8

Dupuytren’s

Question 9

difference between trigger finger and Dupuytren’s?

Answer 9

Dupuytren’s is unable to straighten

Question 10

management of trigger finger

Answer 10

most resolve spontaneously
splint to prevent flexion
surgical division of A1 pulley BUT NOT others

Question 11

what is DeQuervain’s tenosynovitis?

Answer 11

inflammation of sheath over radial styloid process at wrist that involves tendons that move the thumb (APL and EBP)

Question 12

who is DeQuervain’s tenosynovitis more common in?

Answer 12

women
pregnancy
RA

Question 13

presentation of DeQuervain’s tenosynovitis

Answer 13

red
swollen
pain

Question 14

diagnosis of DeQuervain’s tenosynovitis

Answer 14

Finklestein’s test

Question 15

what do you need to rule out in DeQuervain’s tenosynovitis?

Answer 15

CMC OA

Question 16

management of DeQuervain’s tenosynovitis

Answer 16

conservative

surgical decompression

Question 17

what is Dupuytren’s contracture?

Answer 17

proliferative connective tissue disorder with hyperplasia of palmar fascia forming contractures at MCP and PIP joints leading to FFD

Question 18

what is Dupuytren’s contracture associated with?

Answer 18

genetics
DM
alcohol/cirrhosis
phenytoin
AEDs
trauma
Lederhosen's
Peyronie's

Question 19

who is Dupuytren’s contracture more common in?

Answer 19

men

Question 20

presentation of Dupuytren’s contracture

Answer 20

painless gradual progression of flexion

Question 21

diagnosis of Dupuytren’s contracture

Answer 21

feel cords

table top test (unable to flatten hand)

Question 22

management of Dupuytren’s contracture

Answer 22

lifestyle
stretches
fasciectomy
amputation

Question 23

what is a sebaceous cyst?

Answer 23

cyst that originates at hair follicles and is filled with keratin

Question 24

presentation of sebaceous cyst

Answer 24

slow growing

painless

Question 25

management of sebaceous cyst

Answer 25

can become infected so need excision

Question 26

what is paronychia?

Answer 26

infection within the nail fold

Question 27

cause of paronychia

Answer 27

often in children due to nail biting

Question 28

presentation of paronychia

Answer 28

pus and other inflammatory features around nail bed

Question 29

management of paronychia

Answer 29

antibiotics

incision and drainage

Question 30

presentation of scaphoid fracture

Answer 30

pain and tenderness in anatomical snuffbox

Question 31

presentation of radial nerve palsy

Answer 31

wrist drop

Question 32

what is Boxer’s fracture?

Answer 32

5th metacarpal

Question 33

which direction is IPJS dislocation

Answer 33

always posterior due to hyperextension or direct axial blow

Question 34

management of IPJs dislocation

Answer 34

buddy strap OR

volar slab in Edinburgh position