Common Hand Conditions Flashcards
What is a mucous cyst?
Outpouching of synovial fluid from DIP joint OA
Signs that the “lump” is a mucous cyst?
May be painful and they may periodically fluctuate/discharge
May deform the nail and cause a ridge (due to pressure on the germinal matrix)
Management of a mucous cyst?
Once identified, they can be left alone
Excision is an option
What is a ganglion?
Outpouchings of a synovial cavity; thus, they are more common where there is a high conc. of synovial joints, e.g: in the wrist (usually the dorsum of the wrist or the volar aspect)
Signs that the “lump” is a ganglion?
Tend to fluctuate and they usually resolve with time
Usually painless but they may feel tight
Management of a ganglion?
Benign neglect (they tend to disappear over time)
Aspiration (flexor tendon sheath ganglions tend to resolve with aspiration but wrist ganglions tend to recur)
Excision (must be careful as they sometimes wrap around the radial artery)
What is trigger finger?
Tendons run within flexor tendon sheath (AKA pulleys), so any swelling on the tendon leads to irritation
In trigger finger, the swelling of the tendon causes it to get caught on the edge of the A1 pulley
Signs of trigger finger?
Characteristic sign:
Tendon is caught on the edge of the A1 pulley every time the hand is opened/closed; there is sudden straightening of the finger (like a trigger)
Pain over the A1 pulley (MC head) differentiates it from Dupuytren’s contracture, as well as the lack of thickening
They may need their other hand to extend their finger or they may not be able to extend it all
Examination of trigger finger?
Demonstrate triggering
Feel nodule pass beneath the pulley
Distinguish trigger finger from Dupuytren’s contracture
Management of trigger finger?
Conservative:
• Often resolves spontaneously
• Splint to prevent flexion
Tendon sheath injections are often curative and may be repeated 3x:
• Steroid injections + local anaesthetic
Surgery:
• Under general/local anaesthetic, divide the A1 pulley
What is DeQuervain’s tenosynovitis?
Entrapment tendinitis of the tendons contained within the first dorsal compartment at the wrist; it causes pain during thumb motion
Signs of DeQuervain’s tenosynovitis
Occurs spontaneously and is very painful
Usually, swollen and red
Testing for DeQuervain’s tenosynovitis?
Finklestein’s test:
Patient’s thumb is bent across the palm and covered with their finger
Next, their wrist is bent towards their little finger (sharp ulnar deviation of the hand)
+ve test is if this produces pain
Management of DeQuervain’s tenosynovitis?
Conservative management:
• NSAIDs, splint, rest
Steroid injections
Surgery (decompression)
What is Dupuytren’s contracture?
Thickening and contracture of subdermal fascia leads to fixed flexion deformity of the fingers; sometimes, there is only a pit/nodule
Any finger can be affected but it typically affects the ring and little finger
Signs of Dupuytren’s contracture?
Painless, gradual compression
Causes of Dupuytren’s contracture?
Genetics (AKA Viking's disease) Diabetes mellitus Alcohol/liver cirrhosis Smoking Epilepsy/anti-epileptic drugs Trauma
Assoc. with Peyronie’s (penic), Lederhosen’s (feet)
Examination of Dupuytren’s contracture?
Feel the cords
Check for MCP/PIPJ inv.
Table-top test (is the patient cannot place the palm of their hand flat on the desk, this is late stage disease)
Treatment of Dupuytren’s contracture?
Conservative:
• Activity modification
Surgery: • Segmental fasciectomy • Fasciectomy • Dermofasciectomy • Amputation
Newer treatment:
• Collagenase injection
• Percutaneous needle fasciectomy
What is paronychia?
Infection within the nail fold that often occurs in children, due to nail biting
It can cause a pus collection
Management of paronychia?
Elevation
Oral antibiotics
Incise and drain
What is flexor tendon sheath infection?
Rare but a surgical emergency
Infection within a sheath that tracks up the palm + arm
Signs of flexor tendon sheath infection?
Extremely painful
Limited extension (inc. passively), due to pain
May have tracking/ascending lymphangitis
Management of flexor tendon sheath infection?
Wash out tendon sheath
