Common hand conditions Flashcards
What is a mucous cyst?
Outpouching of synovial fluid at distal interphalangeal joint
What causes mucous cysts?
Osteoarthritis
How do mucous cysts present?
Regular appearance Pain/painless Fluctuating Discharging Deformed nail bed
How are mucous cysts managed?
Nothing
Excision
Why might mucous cysts warrant an x-ray?
To determine extent of osteoarthritis
What are ganglions?
Outpouchings of the synovial cavity
Ganglions are most commonly found around the wrist for what reason?
The greater the number of synovial joints the greater the likelihood of synovial cavity outpouching
What are ganglions filled with?
Synovial fluid
How do ganglions present?
Fluctuating
Painless +/- tightness
How are ganglions managed?
Self resolving
Why is surgical management avoided in the treatment of ganglions?
They come back
Are ganglions related to osteoarthritis?
Occasionally - most often not
What is allan’s test used for?
To determine if the blood supply of the hand is intact
What is trigger finger?
Inflammation and swelling of the tendons running within the flexor tendon sheath causing catching on the pulleys
How does trigger finger present?
Pain over A1 pulley (metacarpal head)
Sticking of finger in flexion
+/- forced extension
What should be avoided in the management of trigger finger?
Immobilisation
What should be found on the hand examination of someone with trigger finger?
Tenderness over A1 pulley
Fixed flexion
Palpable tendon nodule
How is trigger finger managed?
Conservatively (spontaneous resolution, splinting)
Steroid & local anaesthetic injection (curative)
Surgery
Which compartment does DeQuervians tenosynovitis affect?
First extensor compartment
How does DeQuervians tenosynovitis present?
Spontaneous
Painful radial wrist
Swelling
Erythema
What test will be positive in DeQuervians tenosynovitis?
Finkelstein’s (ulnar deviation of the hand)
How is DeQuervians tenosynovitis managed?
NSAIDs Splint Rest Steroid injection Surgical decompression
Where is the pathology in Dupuytrens contracture?
Palmar fascia
How common is Dupuytrens contracture?
Very
What is Dupuytrens contracture?
Thickening of palmar fascia causing fixed flexion deformity of the fingers
How does Dupuytrens contracture present?
Painless
Gradual
Begins as palmar pit or nodule
What conditions are associated with Dupuytrens contracture?
Alcoholism Liver cirrhosis Diabetes mellitus Smoking Epilepsy medications
What is Dupuytren’s diathesis?
Tendency towards more aggressive disease i.e
Lederhosen’s (feet)
Peyronie’s (penis
What should be found on examination of someone with Dupuytren’s disease?
Palpable cords
MCP and/or DIP joint involvement
Positive table top test
How is Dupuytren’s disease managed?
Conservative (stretching, activity modification)
Surgical (fasciotomy, amputation)
Collagenase injection?
Dupuytren’s contracture reoccurs after treatment. T/F
True - within several years
What is paronychia?
Infection within the nail fold
What is a risk factor for paronychia?
Nail biting
Which age range most commonly gets paronychia?
Children
How is paronychia managed?
Elevation
Antibiotics
Excision and drainage of pus
How common is flexor tendon sheath infection?
Rare but surgical emergency
How does flexor tendon sheath infection present?
Tracking up palm and arm
Extremely painful
Loss of movement (even passive) due to pain
Tracking lymphangitis
How is flexor tendon sheath infection managed?
Tendon sheath wash out
