Conditions of Hand and Wrist Flashcards

1
Q

What is Dupuytren’s contracture

A

A progressive, painless fibrotic thickening of the palmar fascia with skin puckering and tethering.
Ring and little fingers mostly affected - loss of finger extension (difficulty gripping
Often bilateral and symmetrical.
As disease progresses, may be MCP flexion
If IP joints are affected, hand can be very disabled
Disease develops earlier in males

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2
Q

Causes / associations of Dupuytren’s

A

Genetic (AD) - mostly white race
Smoking and Alcohol
Epilepsy, Diabetes, HIV
Peyronie’s disease, Knuckle pads

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3
Q

What is Dupuytren’s diathesis

A

More aggressive Dupuytren’s disease - usually involves more than one of Dupuytren’s family (Dupuytren’s, Knuckle pads, Ledderhose, Peyronie’s, Frozen shoulder)

  • earlier onset
  • more progressive
  • Strong FH
  • more recurrence
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4
Q

Treatment of Dupuytren’s

A

Fasciectomy (partial or dermo)
Collagenase injection
Percutaneous Needle Injection

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5
Q

What is trigger finger

A

A disproportion of the tendon to its sheath giving a fixed flexion deformity where full extension of the finger cannot be achieved. The nodule moves with the flexor tendon on extension, but becomes jammed on the proximal side of the pulley and has to be flicked straight, producing triggering.

  • if aided by other hand, a click may be felt
  • ring and middle fingers most affected (thumb in children)
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6
Q

What is trigger finger associated with

A

RA
DM
Gout

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7
Q

Who is most affected by trigger finger

A

Women

40-60 age

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8
Q

Causes of trigger finger

A

Repetitive use of hand

Trauma

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9
Q

Treatment of trigger finger

A

Steroid injection into region of nodule, but not nodule itself (if not child, renal failure or DM)

Surgery - percutaneous release or open

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10
Q

What is De Quervain’s Disease (stenosing tenovaginosis)

A

Pain over the radial styloid process and thickening of the Abductor Pollicis Longus and Extensor Pollicis Brevis tendons (1st dorsal extensor compartment)

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11
Q

Clinical presentation of De Quervain’s

A

Pain over lateral wrist aggravated by thumb movement (i.e. lifting a teapot)
Swelling over wrist
FEMALES
Age 50-60

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12
Q

Diagnosis of De Quervain’s

A

Examine thumb joint - consider OA of base of thumb but DQ tends to be more proximal

Finklestein’s Test - pain is elicited by sharply pulling on the relaxed thumb to cause ulnar deviation

Resisted thumb extension

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13
Q

Cause of De Quervain

A

Unknown but exacerbated by activities with frequent thumb abduction and ulnar deviation (i.e. wringing clothes - Washerwoman’s sprain)

Increased in postpartum and lactating females

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14
Q

Treatment of De Quervain’s

A

1st

  • NSAIDs
  • Steroid (hydrocortisone) injection around tendons in their sheath

2nd
- Decompression of tendons by splitting tendon sheaths

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15
Q

What is a ganglion

A

Smooth cyst from the degeneration of joint synovial, containing jelly-like fluid in communication with tendon sheaths or joint capsules

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16
Q

Diagnosis of ganglion

A

FEMALES
May be associated with recurrent wrist trauma
Firm, Non-Tender, Smooth lump
Changed in size
Normally not fixed to underlying tissue and never fixed to skin

17
Q

Treatment of ganglion

A

May disappear spontaneously so treatment usually not needed unless causing pain or pressure (i.e. on median or ulnar nerve in wrist or large popliteal nerve in knee)

  • Local pressure may disperse it (BIBLE BASH)
  • Aspiration
  • Surgical Excision - less recurrence, painful scars, neuromuscular damage (esp. in volar wrist ganglia)
18
Q

Presentation of OA of the thumb

A

Pain, Stiffness, Swelling, Deformity
Loss of function - i.e. painful opening jars / pinching)
Dorsal subluxation, Metacarpal Adduction and Hyperextension

19
Q

Treatment of OA of base of thumb

A
  1. Trapeziectomy - lowest complication rate, good pain relief
    Arthrodesis - may be best for patients who value pain relief and reliable strength more than mobility (i.e. young manual workers)
    Reconstruction
20
Q

Non-op treatment of base of thumb

A

Thumb exercises
NSAIDs
Splints
Steroid injections