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Musculoskeletal System > Common conditions of the Hand > Flashcards

Common conditions of the Hand Flashcards

1
Q

What are some common elective hand conditions?

A 
Dupuytren's disease
Trigger finger
De Quervain's Tenovagintis
Nerve entrapments - carpal/cubital tunnel syndrome. 
Ganglion
Osteoarthritis of base of thumb.
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2
Q

What is Dupuytren’s contracture?

A

When 1 or more of your fingers bends in towards your palm. Usually affects the ring and little fingers.
Eventually can become stuck in the bent position.

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3
Q

What sex is more likely to get Dupuytren’s contracture?

A

Men

8: 1 in 15-64yro
2: 1 in >75yrs

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4
Q

What are some associating factors to Dupuytren’s contracture?

A 
Diabetes
Alcohol
Tobacco
HIV
Epilepsy
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5
Q

What is the pathology behind Dupuytren’s contracture?

A

Myofibroblast formation
Intracellular contractile elements which are regulated by growth factors.
Results in the production of collagen.

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6
Q

What are the functional problems with Dupuytren’s contracture?

A 
Usually not painful
Loss of finger extension (can be active or passive).
Hand in pocket 
Gripping things
Wasting face
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7
Q

What is the treatment for Dupuytren’s contracture?

A 
Observation
Radiotherapy
Partial fasciectomy
Dermo-fasciectomy
Arthrodesis
Amputation
Percutaneous needle fasciotomy.
Collagenase.
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8
Q

What is partial fasciectomy?

A

Multiple mini incisions in the hand to release each digit.
Most common procedure performed in the Uk.
Physiotherapy needed afterwards to resolve stiffness.
Not curative
50% recurrence at 5 years.

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9
Q

What is dermo-fasciectomy?

A

More radical procedure than partial.
Removal of any diseased palmar fascia and any overlying skin it is attached to.
Removal of skin reduces recurrence rates.
Requires intensive physiotherapy.

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10
Q

What is percutaneous needle fasciotomy?

A

Fibrous bands are cut using the bevel of a needle into the palm or fingers.
Quick with no wounds.
Can return to normal activities within 2-3days.
Higher recurrence but can be repeated.
Carries risk of nerve injury.

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11
Q

What is trigger finger?

A

Condition affecting 1 or more tendons in the hand, making it difficult to bend the affected finger or thumb.

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12
Q

Who gets trigger finger?

A 
Women more so than men. 
40-60s
Ring>thumb>middle
Local trauma
Repetitive use of hand
Associated with diabetes, gout, rheumatoid arthritis.
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13
Q

How is trigger finger diagnosed?

A

Patient history
Clicking sensation with movement of the digit
Lump in palm under the pully.
May have to use hand to unlock fingers.
The clicking may progress to locking of fingers.

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14
Q

What are some treatment options for Trigger finger?

A

Splintage
Steroid
Percutaneous release
Open surgery

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15
Q

What is De Quervain’s syndrome?

A

Inflammation of the 2 tendons that control the movement of the thumb and their surrounding sheath. Typically results in pain on the outside of the wrist.

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16
Q

What is a typical patient history of De Quervain’s syndrome?

A

Several weeks of pain localised to radial side of wrist.
Aggravated by the movement of the thumb.
May have seen a localised swelling.
Localised tenderness over tunnel.

17
Q

Who gets De Quervain’s syndrome?

A

Women > Men
50-60yrs
Increased in post partum and lactating females.
Activities with frequent thumb abduction and ulnar deviation.

18
Q

What is the pathology of DE Quervain’s syndrome?

A

1st dorsal extensor compartment.
Fibro-osseous tunnel at distal radius.
Thickening of localised segment.
in 30% of cases 1st compartment is divided by septum.

19
Q

What are some investigations for De Quervain’s Syndrome?

A

Finklestain’s Test - grasps thumb and ulnar deviates the hand the sharply.

Resisted Thumb extension

20
Q

What are some treatment options for De Quervain’s Syndrome?

A

Splints
Steroid injection
Decompressive surgery.

21
Q

What is a ganglion in terms of joints?

A

A myxoid degeneration from joint synovia. Arise from joint capsule, tendon sheath or ligament.

22
Q

Who gets ganglia of the joints?

A

they are 70% of all discrete swellings of the hand/wrist.
Females > Men 2:1
Peak age distribution 20-40yrs.
Dorsal > volar 3:1
May be associated with recurrent injury around the wrist.

23
Q

How is ganglia diagnosed?

A

Present with lump that is firm and not tender.
Changes in size.
Smooth
Occasionally lobulated
Normally not fixed to underlying tissues.
Never fixed to the skin

24
Q

What are the treatment options for ganglia?

A

Observe
Aspiration
Excision including the root.

25
Q

What are the symptoms of OA base of thumb?

A 
Pain
Stiffness
Swelling
Deformity
Loss of function
26
Q

What are the treatment options for oA base of thumb?

A 
Life style modifications 
NSAIDS
Splints
Steroid injections
Trapeziectomy
Fusion
Replacement

Musculoskeletal System (20 decks)

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