Common Hand Conditions Flashcards
What is a mucous cyst
An outpouching of snovial fluid from DIP joint OA
Describe what a mucous cyst can do
Produce pain
Fluctuate / discharge
Deform nail, cause ridge
What is the treatment for a mucous cyst
Left along
Excised
What is a ganglion
Outpouching of synovial cavity filled with synovial fluid
Where is a ganglion more commonly located
Where there is a high concentration of synovial joint
What is the treatment of ganglions
usually leave alone
sometimes excised or aspirated but usually reappear
When a ganglion is aspirated, what is produced
A thick gelatinous substance
What is the main difficulty with volar ganglions
They are very close to the radial artery
Where might the synovial fluid of a ganglion come from
The flexor tendon at the base of the fingers
What do tendons in the hand run within
The flexor tendon sheath
What is the common presentation of a patient with trigger finger
The sticking of one finger (usually in flexion)
On examination of trigger finger, what is the main difference between this and Dupuytrens
In Dupuytrens you can feel the cord
Where would you feel a nodule in a patient with trigger finger
On the MCP and when the patient bends their finger the nodule underneath the tendon is palpable
What is the conservative management for Trigger finger
Often resolves spontaneously
Splint to prevent flexion
What is the step in between conservation and surgery
Tendon sheath injection
- steroid +LA
- often curative
- may be repeated up to 3x
What is the surgical management for a atient with Trigger Finger
Under GA or LA
divide the A pulley
What part of the hand does DeQuervain’s tenosynovitis affect
The 1st extensor
What do patients with DeQuervain’s tenosynovitis complain of
Pain in the thumbs and the tendons
Why does pain arise in DeQuervain’s tenosynovitis
Tendons are passing through an inflammed sheath which is very tender and often quite swollen
What is the test for DeQuervains tenosyovitis
Finklestein’s test
What is the management for DeQuervains
NSAIDs Splint Rest Steroid injection Surgery - decompression
Describe Finklestein’s test
Make a fist with the thumb inside and ulnar deviate
What is Dupuytren’s contracture
Thickening and contracture of subdermal fascia leading to fixed deformity of fingers
How far up cant the cords in Dupuytren’s contracture go?
As far up as the DIP joint
In the early stages, what can Dupuytren’s contracture come out as
A bit of a pit
Dupuytren’s contracture is generally painful or painless?
Painless
What fingers are most commonly affected by Dupuytren’s contracture
ring and little fingers but it can also affect the thumb
What is a big indication for surgery
When the patient can’t put their hands flat on the table
What other parts of the body can be affected by Dupuytren’s contracture
Penis and feet
What joints of the hands are involved in Dupuytren’s contracture
MCP and PIP but not the DIP
What is the conservative management for Dupuytren’s contracture
Stretches and activity modification
What are the surgical options for Dupuytren’s contracture
Segmental fasciotomy
fasciectomy
demofasciectomy
amputation
Does Dupuytren’s contracture ever come back
always
The skin graft in a dermofasciectomy usually comes from where and why
From the inner arm
It does not grow hair and skin is in excess
What is paronychia
Infection within the nail fold
What is the main risk of paronychia
Nail biting
What is the management for paronychia
Elevate
Antibiotics
Incise and drain collection
Who is most likely to develop a paronychia
Children
What is a flexor tendon sheath infection
An infection within the sheath, tracking up the palm and arm
Describe the symptoms of a flexor tendon sheath infection
Extreme pain
limited extension dye ti pain
erythema
What is the treatment for a flexor tendon sheath infection and when should this be done?
A wash out tendon sheath
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