Common Conditions of the Hand and Foot Flashcards
What is Dupuytren’s contracture?
Nodular hypertrophy of the palmar fascia
- NOT the skin
- NOT the tendons
Where in the hand is Dupuytren’s contracture common?
Ring and little fingers
What is the epidemiology of dupuytren’s contracture?
Most common in middle aged men
Caucasian
-North european (Viking lands)
Sporadic in 30% of cases
What is Dupuytren’s diathesis?
Early onset disease
Bilateral
Family history
Ectopic disease
- Peyronie’s disease
- Ledderhose disease
What is Peyronie’s disease?
A connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis affecting an estimated 5% of men.
Specifically, scar tissue forms in the tunica albuginea, the thick sheath of tissue surrounding the corpora cavernosa causing pain, abnormal curvature, erectile dysfunction, indentation, loss of girth and shortening.
What is Ledderhose disease
(what are its other names
Plantar fibromatosis or Morbus Ledderhose is a fibromatosis, like Dupuytren’s contracture.
When suffering from Ledderhose disease benign nodules grow at the arch of the foot. Initially these nodules are usually painless but as they grow they can cause considerable pain when walking. The nodules can also inflame causing additional pain.
Name some causes of Dupuytren’s contracture
Familial (most common) - Viking Gene
Alcohol excess
Phenytoin Treatment
Smoking
What are the clinical features of Dupuytren’s contracture?
Usually not painful
Loss of finger extension (active or passive)
“Cant get hand in pocket”,
“trouble gripping things”
“Fingers in the way when washing face”
What are Garrod’s Pads?
Garrod’s pads (also known as violinist’s pads) are a cutaneous condition characterized by calluses on the dorsal aspect of the interphalangeal joints, i.e. the back side of the finger joints. They are often seen in violin, viola, and cello players, along with fiddler’s neck and other dermatologic conditions peculiar to string musicians
What are the 4 broad causes of Garrod’s pads?
Idiopathic
Genetic
Acquired
-Repetative Trauma
Associated with other acquired conditions
- Dupuytren’s
- Peyronie’s disease
- Lederhose disease
What are ganglion cysts?
What are they filled with? DO they have synovial lining?
Aka Gideon’s Disease, or a Bible Cyst, is a mucin filled cyst attached to a synovial cavity like a joint or tendon.
NO synovial lining
These cysts are caused by leakage of thick clear fluid from the joint into the surrounding tissue.
What do ganglion cycts look and feel like?
Who are they most common in?
More obvious on flexion
More common dorsally Firm, non tender Smooth Dont adhere to skin Benign
What are the treatments for a ganglion cyst?
Reassure and observe
Aspiration
- easy, quick,
- can do on recurrence until they stop coming back
Hit with a bible?
Operative excision
- High patient dissatisfaction
- Not really advised
What causes trigger finger?
Inflammaed nodule of tendon
Nodule gets trapped behind tendon sheath and finger becomes stuck in flexed position
What is the medical term for trigger finger?
Stenosing tenosynovitis
What are the common fingers effected by stenosing tenosyntovitis?
Ring and middle fingers common
Who is stenosing tenosynovitis common with?
What is it associated with?
Middle age women
Neonates- resolves in 30%
Associated with
- Carpal tunnel syndrome
- De Quervain’s tenosynovitis
How do you treat stenosing tenosynovitis?
Splintage
-Stops you waking up with trigger finger)
Steroid (very popular)
Operative
- Percutaneous release
- Open surgery
What is De Quervain’s syndrome?
A tenosynovitis of the sheath or tunnel that surrounds two tendons that control movement of the thumb.
What are the signs and symptoms of de Quervain’s syndrome?
Pain
-radial side of the wrist,
Spasms,
Tenderness,
Occasional burning sensation in the hand, and swelling over the thumb side of the wrist, and difficulty gripping with the affected side of the hand.
The onset is often gradual.
Pain is made worse by movement of the thumb and wrist, and may radiate to the thumb or the forearm.
What should you consider as a differential in De Quervain’s syndrome?
Base of thumb osteoarthritis
-> examine joints
What is the Finglestein’s test?
Put thumb in palm and adduct wrist
like marching
What is the epidaemiology of De Quervain’s syndrome?
M:F = 1:6
Increased in post partum and lactating females
Describe the sensory area the median nerve supplies in the hand
Palmar side:
- lateral 2/3 of the palm
- Thumb, index, middle and half of ring finger
Dorsal side:
-From just proximal to PIP joint to tip of index, middle and half of ring finger
What are the signs and symptoms of carpal tunnel syndrome?
Numbness Tingling Pain Night Pain Clumsiness
What is the epidemiology of carpal tunnel syndrome?
> 80% oler than 40 years
1:2 = male: female
What are the causes of carpal tunnel syndrome?
P = Pregnancy R = RA A = Arthritis (degenerative) G = Growth hormone abnormalities M = Metabolic (hypothyroid, Gout, DM) A = alcoholism T = tumours I = idiopathic (mostly) C = connective tissue disorders
- Fracture (acute Carpal tunnel syndrome)
- Occupation? (vibration)
If you had only 1 question to ask a patient you thought had carpal tunnel what would it be?
“Do you wake up at night with a numb hand?”
How do you treat carpal tunnel syndrome?
Underlying problem
Splint
Sometimes steroid but by this point your thinking or surgery
Operative:
-Capral tunnel decompression/release
(almost guarenteed to get rid of night symptoms)
What is the most common fractured bone in the carpus?
Where do 80% of these fractures occur?
Scaphoid
80% occur at waist of scaphoid
It is often difficult to see a scaphoid fracture on X-ray.
What should you do to be absolutely sure you havent missed a scaphoid fracture?
Repeat x-ray at 2 weeks or MRI
Name 2 complications of a scaphoid fracture
Risk of non-union
Avascular necrosis if fracture in proximal third
Why can avascular necrosis occur in scaphoid fracture?
Retrograde blood supply to distal pole so proximal pole can recieve no blood during fracture
Avascular necrosis of proximal pole
What is Ulnar collateral ligamnet injury of thumb also called?
What is it?
Gamekeeper’s thumb (also known as skier’s thumb or UCL tear)
Injury to the ulnar collateral ligament (UCL) of the thumb.
The UCL is torn at (or in some cases even avulsed from) its insertion site into the proximal phalanx of the thumb in the vast majority (approximately 90%) of cases. This condition is commonly observed among gamekeepers and Scottish fowl hunters, as well as athletes (such as volleyballers). It also occurs among people who sustain a fall onto an outstretched hand.
Who is Ulnar Collateral ligament injury of thumb common in?
This condition is commonly observed among gamekeepers and Scottish fowl hunters, as well as athletes (such as volleyballers). It also occurs among people who sustain a fall onto an outstretched hand.
What is Bennett’s fracture?
Intra-articular fracture at base of 1st metacarpal
This intra-articular fracture is the most common type of fracture of the thumb, and is nearly always accompanied by some degree of subluxation or frank dislocation of the carpometacarpal joint.
What causes displacemnet in Bennett’s fracture?
Proximal dull from abductor pollicis longus
What is the aetiology of Bennett’s fracture?
Axial compression of slightly flexed Carpometacarpal joint
- FOOSH
- Boxing
What is a Boxer’s fracture?
Fracture of little finger metacarpal neck
May also be the ring finger
Swelling will be seen
Why does an ulnar nerve palsy lead to claw hand?
Why does it occur in a LOW ulnar nerve lesion?
In the hand the ulnar nerve supplies the medial two lumbricals of the hand
As lumbricals normally flex the MCPJ, palsy of ulnar nerve leads to hyperextension of ulnar two fingers
Sparing of nerve supply to ulnar side FDP flexes finger.
Higher nerve lesion will show hyperextension but not flexed fingers
Compare ulnar clawing and dorso-ulnar sensation in an ulnar nerve lesion at the level of the wrist and elbow
Wrist:
- Ulnar clawing = severe
- Dorso-ulnar sensation = spared
Elbow:
- Ulnar clawing = moderate
- Dorso-ulnar sensation = lost
What is the Ulnar Nerve Paradox?
Ulnar nerve innervates the medial half of the FDP (little and ring)
Lesion at elbow, FDP also denervated
Lesion at wrist, FDP is still intact causing more severe “clawing” of ulnar two fingers
Osteoarthritis of the hand is most common in what joints?
Distal Interphalangeal joints
Carpal-Metacarpal Joints thumb (Base of thumb)
What are the symptoms and signs of osteoarthritis in the hand?
Night pain
Pain associated with use
-Opening jars, pinching
Pain with passive motion
Crepitus
What sign may you see in very severe base of thumb arthritis?
Squaring of the base of thumb
- Subluxation of the base as the thumb slips out dorsally
What are the treatments of osteoarthritis of the hand?
Life style modifications
NSAIDs
Splint
Steroid injections
Operative
-Trapexiectomy (gold standard, lose a but of pinch strength but good pain relief)
- Fusion (usually more young men from traumatic, rare)
- Replacement (lots of different designs because they dont know what’s best)
Give 4 x-ray changes seen in osteoarthritis
Narrowing of joint space
Subchondral sclerosis
Subchondral cysts
Osteophyte Formation
