common non arthritic hand conditions Flashcards
what is this?
mucous cyst
what is mucous cyst?
outpouching of synovial fluid from DIP joint and occurs in patients with OA
what may occur to the nail if a mucous cyst becomes very large?
it may cause a ridge
what are ganglions?
outpouching of synovial cavity therefore is commonly found over synovial joints i.e. wrist
what are ganglions filled with?
synovial fluid
True or false- synovial fluid is like water
False- usually very thick, can be gelatenous
why may it be hard to aspirate ganglions with a small standardized needle?
-because they are filled with synovial fluid which is very thick and can sometimes be gelatenous
what do ganglions present like on examination?
- fluctuate, not attached to overlying skin
- can trans illuminate using pen torch
- usually painless but can feel tight (usually pain is from underlying joint)
what is the ganglion management?
- benign neglect (leave until it gets better)
- if patient not happy it can be aspirated however this can often just fill up again
- excision can be done if they are really large or causing symptomatic compression to adjacent nerves
what do tendons run within?
tendons run within flexor tendon sheath
pathophysiology of trigger finger?
- swelling of tendon leads to irritation and more swelling
- tendon gets caught on edge of A1 pulley
- pain over A1 pulley (MC head)
- this causes sticking of finger usually in flexion (triggering)
what may trigger finger present like on examination?
- demonstrate triggering
- tender over A1 pulley
- feel nodules pass beneath pulley
- trigger finger can be released and brought to full extension
what is trigger finger management?
Conservative treatment:
- often resolves spontaneously
- splint to prevent flexion
Tendon sheat injection (most often done)
- steroid + LA
- may be repeated up to x2 and is often curative
Surgery (if injection has been done x2 and it is not cured)
-divide A1 pulley (NO OTHERS)
what does the carpal tunnel contain?
4x FDP tendons (flexor digitorus profundus)
4 x FDS tendons (flexor digitorus superficialis)
flexor pollicis ligament
Median nerve
what does the median nerve do in the hand?
provides motor to LOAF
Lateral 2 lumbricals
Oppolis pollicis
Abductor pollicis brevis
Flexor pollicis brevis
Sensory to palmer aspect of hand, thumb, index, middle and radial half of ring finger
how does carpal tunnel syndrome usually present?
- often sensory involvement to radial 3 1/2 finger
- often worse at night
- relieved by shaking hand
- pain, pins and needles, numbness
who is more commonly affected by carpal tunnel syndrome- males or females?
Females!
what can cause carpal tunnel syndrome?
often idiopathic
- pregnancy
- hypothyroidism
- fluid overload
- RA
what examinations are done in carpal tunnel syndrome?
- Examination of LOAF muscles
- Phalens test
- Tinels test
- Nerve conduction studies
- Kamath and Stothard carpal tunnel questionnaire
what does a score of 3 or more mean on the Kamath and Stothard questionaire?
may be carpal tunnel syndrome
-refer on to nerve conduction studies
what does a score of 5 or more on the Kamath and Stothard questionnaire indicate?
suggest active diagnoses of Carpal tunnel syndrome, nerve conduction studies are not required
what does a score of <3 on the Kamath and Stothard questionnaire suggest?
unlikely to be carpal tunnel syndrome
what is management of carpal tunnel syndrome?
- splintage
- diagnostic steroid injection
- surgery
why may carpal tunnel syndrome present worse at night?
many patients sleep in foetal position or with flexed wrist which makes pain worse
what is DeQuervain’s tenosynovitis?
inflammation within the tendon sheaths within the first extensor compartment (abductor pollicis longus + extensor pollicis brevis)
how does DeQuervains present?
- swelling and pain near the base of the thumb
- may present with redness
- may radiate to forearm
what specil test is used for diagnosing De Quervains syndrome on wrist/hand examination?
Finkelsteins test
-if they have pain over abductor pollicis longus and extensor pollicis brevis then it is a positive test
what is the management for DeQuarvains syndrome?
- NSAIDs
- splint
- rest
- steroid injection in first extensor compartment (may cause thinning of skin and irritation though)
- decompression surgery
what is Dupuytren’s contraction?
-abnormal thickening of the skin in the palm of the hand at the base of your fingers. This thickened area may develop into a hard lump or thick band leading to fingers curling
how does dupuytren’s contracture present?
- thickening of skin, usually starts as palmar pit/ nodule and develops on to larger cords
- PAINLESS
- gradual progression
what causes Dupuytrens contracture?
- genetics (north of scotland, scandanavia- vikings)
- alcohol/cirrhosis
- smoking
- epilepsy/ anti epileptic meds
- trauma
- diabetes
how does Dupuytrens preent on examination?
- feel cords
- MCP/ PIP joint involvement (measure angles of flexion)
- Houstans table top test (patient cant put palm flat on table= suggest surgery)
what is the treatment for Dupuytrens disease?
Conservative: (not much benefit)
- stretches
- activity modification
Surgery: (more beneficial)
- segment fasciectomy
- fasciectomy
- dermofasciectomy
- amputation
what is Paronychia?
infection within nail fold resulting in pus collection that is often found in children
what is Paronychia?
infection within nail fold that is often found in children
what usually causes paronychia?
nail biting
small punctures in skin around nail
what is the management for paromychia?
- antibiotics
- incise and drain collection
- for recurrent cases the nail bed may need to be removed
what is a flexor tendon sheath infection?
- a surgical emergency!!
- infection within the flexor sheath, tracking up palm and arm causing limited (active and passive) extension due to pain
how does flexor tendon sheath infection present?
Kanavel’s cardinal signs:
- affected finger held in fixed flexion
- fusiform swelling over finger
- painful to percuss over sheath
- painful on passive extension
what is the management of flexor tendon sheath infection?
SURGICAL EMERGENCY!!!
initial management- high dose antibiotics + high elevation
surgery- wash out tendon sheath opening up the A1 and A5 pulleys
patients often have to return to surgery to get further wash outs :(
