Common hand conditions - 01/11/18 Flashcards
What is a mucous cyst?
Outpouching of synovial fluid from DIPjt OA
What are the characteristics of a mucous cyst?
May be painful
May fluctuate/discharge
May deform nail/cause ridge
How is a mucous cyst managed?
May be left alone
Excision
What are ganglions?
Outpouchings of synovial cavity
Where are ganglions common?
Wrist
What are the characteristics of ganglions?
Filled with synovial fluid Fluctuate Usually painless May feel tight Usually resolve with time
How are ganglions managed?
Benign neglect
Family bible
Aspiration
Excision
What do tendons run within?
Flexor tendon sheath
What does any swelling on a tendon lead to?
More swelling
Tendon gets caught on edge on A1 pulley
What is pain over an A1 pulley known as?
Triggering
Sticking of finger
What is trigger finger?
Small nodule on the tendon
As it passes through the edge of the tendon sheath, it catches and gets irritated
Leading to palm soreness
Keeps getting irritated and catches more, becoming bigger
What is found on examination of trigger finger?
Demonstrate triggering
Tender over A1 pulley
Feel nodule pass beneath pulley
Distinguish from dupuytrens
How is trigger finger managed?
Can resolve spontaneously Splint to prevent flexion Tendon sheath injection (Steroid and LA) Can be repeated up to 3x Surgery Under GA or LA Divide A1 pulley
What is DeQuervain’s tenosynovitis and What are the characteristics of it?
Pain at base of thumb on extension Spontaneous Painful Swollen Red Finklestein's test
What is the management of DeQuervains tenosynovitis?
NSAIDs Splint Rest Steroid injection Decompression surgery
Where does dupuytrens contracture lie?
Palmar fascia
What is dupuytrens contracture?
Thickening and contracture of subdermal fascia leading to fixed flexion deformity of fingers
What are the characteristics of dupuytrens contracture?
Painless
Gradual progression
Palmar/pit nodule
Unknown cause
What are some risk factors for Dupuytrens?
Genetics DM Alcohol/Cirrhosis Smoking Epilepsy Trauma Lederhosens feet
What is found on examination of Dupuytrens contracture?
Feel cords
MCP/PIP joint involvement
Measure angles
Table top test
Which joints should be managed urgently if affected in dupuytrens?
PIPs
How is dupuytrens managed?
Stretches Activity modifcation Surgery -Segmental fasciectomy -Fasciectomy -Dermofasciectomy -Amputation Collegenase injection Percutaneous needle fasciotomy
What is paronychia?
Infection within nail fold
Who gets paronychia?
Mostly children
What is a risk factor for paronychia?
Nail biting
What is the management of paronychia?
Elevate
Antibiotics
Incise and drain collection
What is a flexor tendon sheath infection?
Infection within sheath tracking up palm and arm
What are the characteristics of flexor tendon sheath infection?
Rare Surgical emergency Extremely painful Limited extension due to pain May have tracking lymphangitis
What is the management of flexor tendon sheath infections?
Wash out tendon sheath
