Common Conditions of the Hand Flashcards
What are some elective hand conditions?
Dupuytren's Trigger finger Nerve entrapment -Carpal and cubital tunnel Ganglion OA base of thumb
Who gets Dupuytrens?
Autosomal dominant
30% sporadic
Almost all white
Connection to (Diabetes, alcohol, tobacco, HIV and epilepsy)
What is the pathology of Dupuytrens?
Myofibroblast
- Intracellular contractile elements
- Regulated by GF’s
- Produce collafens
Functional problems of dupuytrens?
Not painful
Loss of finger extension
Gripping things
Treatment for Dupuytrens?
Non-operative = observe or radiotherapy
Operative = fasciectomy (partial or dermo), arthrodesis, amputation
Percutaneous needle fasciotomy
Collagenase
What is a partial fasciectomy?
Most common 2-3 weeks healing Requires physio Cant be cured Recurrence 50% at 5 years
What is a dermo-fasciectomy?
More radical
Requires intensive physio
What is percutaneous needle fasciotomy?
Quick with no wounds and normal activities in 2-3 days
Higher recurrence
Can be repeated
Risk of nerve injury
What is collagenase treatment in dupuytrens?
Costs more
3 Flexor tendon ruptures
3 year recurrence rate of 35%
What is trigger finger?
2 tendons to each finger in a sheath = thickenings in sheath = tendon close to bone which catches
Who gets trigger finger?
W 40-60 Ring > thumb > Middle Repetitive use? Trauma? Associated with RA, DM and gout
What is the diagnosis of trigger finger?
History Clicking with movement of digit Lump in palm May have to use other hand to unlock Clicking may progress to locking
What are the treatments for trigger finger?
Non operative
- Splintage
- Steriods
Operative
- Percutaneous release
- Open surgery
What is De Quervain’s Tenovaginitis?
1st dorsal extensor compartment
Fibro-osseous tunnel at the distal radius
Thickening
Examine thumb joints
How do you diagnose De Quervain’s Tenovaginitis?
Examination
Finklestein’s test
Resisted thumb extension
