common conditions of the hand Flashcards
Which gender is Dupuytrens more common in
Males
What age group is duputytrens more common in
older age groups but develops earlier in males
Which race usually gets dupuytrens
Almost exclusively white races
Does dupuytrens have a genetic link
It is autosomal dominant
What is Dupuytrens associated with
Diabetes
alcohol
tobacco
HIV
epilepsy
What is dupuytrens diathesis
Early onset disease which is bilateral and has a strong family history - a more severe version of dupuytrens
There can be ectopic disease where there is a presentation not in the normal area for dupuytrens
What happens in dupuytrens which causes the symptoms
Proliferation of myofibroblasts - everyone has palmar fascia but in dupuytrens, the proliferation of the myofibroblasts causes it to contract - bands of contracture are formed
What are the signs and symptoms of dupuytrens
Usually not painful
Loss of finger extension
Cannot put hand in pocket, grip things or wash face
What are the treatments for dupuytrens
Observe if there is no issues being caused
Radiotherapy
Operative:
Partial fasciectomy
Dermo-fasciectomy
Arthrodesis
amputation
What is partial fasciectomy
Removing the bands of contracture - does not cure the dupuytrens and has a recurrence rate of 50% at 5 years
What is the indication for surgery in dupuytrens
if you pass the table top test you don’t need surgery - if you can place your hand, flat on a table top, you do not need surgery
What is dermo-fasciectomy
Removing bands of contracture and the skin - more radical but has better rates and reduces recurrence of the dupuytrens
What is arthrodesis
fusion of bones over a joint
What is the most common surgical treatment for dupuytrens
Partial fasciectomy -
Removal of the bands of contracture
What is a percutaneous needle fasciotomy
Take a hypodermal needle and put it underneath the skin and scratch through the contractile bands – takes 5-10 minutes to straighten the finger – a splint is then used to keep the finger in the position so the dupuytrens does not recur quickly
What is collagenase treatment
Injecting an enzyme which destroys collagen and is used in dupuytrens treatment
What is the issue with collagenase treatment
If it get’s into the flexor tendons, it can cause them to rupture
What are the tendons that run to the digits
Flexor digitorum and flexor digitorum profundus
What is the function of the sheath for the FDS and FDP
The tendons run in the sheath and thickenings in the sheath which act as pulleys keep the tendon close to the bone
Who most commonly gets trigger finger
Women
40s-60s
Which fingers most commonly get trigger finger
Ring finger is most common
Then thumb
Then middle finger
What causes trigger finger
Local trauma
What is trigger finger associated with
Rheumatoid arthritis, diabetes and gout
How is trigger finger diagnosed
The history makes it quite clear
Clicking sensation when moving the digit
Lump in the palm under the pulley at the base of the finger
What is the treatment for trigger finger
Steroids put into the flexor tendon sheath which reduces the collagen strength and allows the pulley to stretch
Splints can be used
Surgical
Percutaneous release and open surgery
What is de quervain’s syndrome
Severe pain on the radial side of the wrist near the snuff box
Aggravated by thumb movement
Who is de quervain’s more common in
Females
Middle age
Young women who have just had children
How is de quervain’s syndrome diagnosed
Examine base of the thumb
Finklestein’s test - put thumb into palm and sharply move to ulnar side - if there is sharp pain, then you have de quervain’s syndrome
resisted thumb extension
Exclude osteoarthritis at the base of the thumb
What is the treatment for de quervain’s syndrome
Steroid injection
Splints
Surgical treatment:
Decompression
What is a ganglion
A myxoid degeneration from joint synovia which causes a lump which contains viscous fluid
Who most commonly gets ganglia
Females
20-40 years of age
Where on the hand does ganglia most commonly occur
The dorsum of the hand but can occur at the redial side on the volar
How does ganglia present
A non-tender, firm, smooth lump which often changes in size - It is fixed to deep tissue but not the skin so the skin can move over it
What is the treatment for ganglia
Observe
Aspiration
Surgical:
Excision
What are the symptoms of osteoarthritis of the base of the thumb
Pain, stiffness, swelling, deformity and loss of function
which gender does base of thumb osteoarthritis most commonly occur in
Women
What is the treatment of osteoarthritis at the base of the thumb
Life style modifications
NSAIDS
splints
Steroid injection - common
Surgical:
Trapeziectomy - excision arthroplasty - remove bone and it produces scar tissue in the gap
Fusion
replacement joints
What is the gold standard treatment of osteoarthritis in the thumb
Trapeziectomy - removal of trapezius - causes scar tissue to form in the gap and makes the thumb movement painless - reduces the grip of the patient
