Common conditions of the hand

Question 1

epidemiology of Dupuytrens

Answer 1

disease develops earlier in males, usually effects males.autosomal dominant, sporadic in 30% of cases, almost exclusivly caucasian. Associations made to dm, alcohol, tobacco, HIV and epilepsy.

Question 2

pathology of dupuytrens

Answer 2

early onset, bilateral, fhx, myofibroblast (intracellular contractile emelents, regulated by growth factors, prodcution of collagen)

Question 3

functional problems of dupuytrens…

Answer 3

not painful, loss of finger extension, hand in pocket, gripping thighs, washing face.

Question 4

Tx of dupuytrens

Answer 4

partial fasciectomy, percutaneous needle fasciotomy, dermo-fasciectomy, arthrodesis, amputation, collagenase.

Question 5

Trigger finger pathology

Answer 5

2 tendons in each finger which run in the same sheath, there is swelling in the tendon and this catches on the pulley

Question 6

Trigger finger epidemiology

Answer 6

women more frequently, 40-60, ring finger> thumb > middle, repetitive use of hand, local trauma, associated with RA, DM and gout.

Question 7

Trigger finger diagnosis…

Answer 7

hx, clicking sensation with digit movement, volar aspect, lump in the palm under the pulley, may need to use the othher hhand to unlock, clicking may progress to locking. Palpable lump over a1 pulley, feel triggering around the a1 pulley.

Question 8

Trigger finger Tx

Answer 8

nonoperative - splintage, steroid. Operative - percutaneous release, open surgery.

Question 9

De Quervain’s presentation…

Answer 9

several weeks pain localised to the radial side of the wrist, aggrevated by the movement of the thumb, localised swelling and tenderness over the tunnel.

Question 10

De Quervain’s epidemiology

Answer 10

more common in females, 50-60, increase in post-partum and lactating females, activities with abduction of the thum (washerwomans sprain).

Question 11

De Quervain’s pathology

Answer 11

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

Question 12

De Quervain’s clinical examination

Answer 12

examine thumb joints, consider base of thumb OA, Finklestein’s test, resisted thumb extension.

Question 13

De Quervain’s Tx

Answer 13

operative - decompression. Nonoperative - splints, steroid injection.

Question 14

what is the anatomy of a ganglion?

Answer 14

Ganglion - A myxoid degeneration from joint synovia…‘Doctor, I have a lump’
Arise from joint capsule, tendon sheath or ligament

Question 15

ganglion Diagnosis…

Answer 15

lump, firm, nontender, change in size, smooth, occasionally lobulated, normally not fixed to underlying tissues, never fixed to the skin

Question 16

ganglion epidemiology

Answer 16

70% of all discrete swellings in the hand and wrist, more common in females, 20-40, dorsal> volar, may be associated with recurrent injury around the wrist.

Question 17

ganglion Tx

Answer 17

nonoperative - aspiration. Operative - excision including the root.

Question 18

OA Base of thumb presentation

Answer 18

pain, stiffness, swelling, deformity, loss of function

Question 19

OA Base of thumb epidemiology

Answer 19

1 in 3 women, pain opening jars and pinching, dorsal subuxation, metacarpal adduction.

Question 20

OA Base of thumb Tx

Answer 20

nonoperative - NSAID’s, splint, steroid injections. Operative - trapeziotomy (gold standard), fusion, base of thumb replacement