common conditions of the hand

Question 1

Which gender is Dupuytrens more common in

Answer 1

Males

Question 2

What age group is duputytrens more common in

Answer 2

older age groups but develops earlier in males

Question 3

Which race usually gets dupuytrens

Answer 3

Almost exclusively white races

Question 4

Does dupuytrens have a genetic link

Answer 4

It is autosomal dominant

Question 5

What is Dupuytrens associated with

Answer 5

Diabetes
alcohol
tobacco
HIV
epilepsy

Question 6

What is dupuytrens diathesis

Answer 6

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

Question 7

What happens in dupuytrens which causes the symptoms

Answer 7

Proliferation of myofibroblasts - everyone has palmar fascia but in dupuytrens, the proliferation of the myofibroblasts causes it to contract - bands of contracture are formed

Question 8

What are the signs and symptoms of dupuytrens

Answer 8

Usually not painful
Loss of finger extension
Cannot put hand in pocket, grip things or wash face

Question 9

What are the treatments for dupuytrens

Answer 9

Observe if there is no issues being caused
Radiotherapy

Operative:
Partial fasciectomy
Dermo-fasciectomy
Arthrodesis
amputation

Question 10

What is partial fasciectomy

Answer 10

Removing the bands of contracture - does not cure the dupuytrens and has a recurrence rate of 50% at 5 years

Question 10

What is the indication for surgery in dupuytrens

Answer 10

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

Question 11

What is dermo-fasciectomy

Answer 11

Removing bands of contracture and the skin - more radical but has better rates and reduces recurrence of the dupuytrens

Question 12

What is arthrodesis

Answer 12

fusion of bones over a joint

Question 13

What is the most common surgical treatment for dupuytrens

Answer 13

Partial fasciectomy -
Removal of the bands of contracture

Question 14

What is a percutaneous needle fasciotomy

Answer 14

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

Question 15

What is collagenase treatment

Answer 15

Injecting an enzyme which destroys collagen and is used in dupuytrens treatment

Question 16

What is the issue with collagenase treatment

Answer 16

If it get’s into the flexor tendons, it can cause them to rupture

Question 17

What are the tendons that run to the digits

Answer 17

Flexor digitorum and flexor digitorum profundus

Question 18

What is the function of the sheath for the FDS and FDP

Answer 18

The tendons run in the sheath and thickenings in the sheath which act as pulleys keep the tendon close to the bone

Question 19

Who most commonly gets trigger finger

Answer 19

Women
40s-60s

Question 20

Which fingers most commonly get trigger finger

Answer 20

Ring finger is most common
Then thumb
Then middle finger

Question 21

What causes trigger finger

Answer 21

Local trauma

Question 22

What is trigger finger associated with

Answer 22

Rheumatoid arthritis, diabetes and gout

Question 23

How is trigger finger diagnosed

Answer 23

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

Question 24

What is the treatment for trigger finger

Answer 24

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

Question 25

What is de quervain’s syndrome

Answer 25

Severe pain on the radial side of the wrist near the snuff box
Aggravated by thumb movement

Question 26

Who is de quervain’s more common in

Answer 26

Females
Middle age
Young women who have just had children

Question 27

How is de quervain’s syndrome diagnosed

Answer 27

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

Question 28

What is the treatment for de quervain’s syndrome

Answer 28

Steroid injection
Splints

Surgical treatment:
Decompression

Question 29

What is a ganglion

Answer 29

A myxoid degeneration from joint synovia which causes a lump which contains viscous fluid

Question 30

Who most commonly gets ganglia

Answer 30

Females
20-40 years of age

Question 32

Where on the hand does ganglia most commonly occur

Answer 32

The dorsum of the hand but can occur at the redial side on the volar

Question 33

How does ganglia present

Answer 33

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

Question 34

What is the treatment for ganglia

Answer 34

Observe
Aspiration

Surgical:
Excision

Question 35

What are the symptoms of osteoarthritis of the base of the thumb

Answer 35

Pain, stiffness, swelling, deformity and loss of function

Question 36

which gender does base of thumb osteoarthritis most commonly occur in

Answer 36

Women

Question 37

What is the treatment of osteoarthritis at the base of the thumb

Answer 37

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

Question 38

What is the gold standard treatment of osteoarthritis in the thumb

Answer 38

Trapeziectomy - removal of trapezius - causes scar tissue to form in the gap and makes the thumb movement painless - reduces the grip of the patient