Conditions of Hand and Wrist Flashcards
What is Dupuytren’s contracture
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
Causes / associations of Dupuytren’s
Genetic (AD) - mostly white race
Smoking and Alcohol
Epilepsy, Diabetes, HIV
Peyronie’s disease, Knuckle pads
What is Dupuytren’s diathesis
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
Treatment of Dupuytren’s
Fasciectomy (partial or dermo)
Collagenase injection
Percutaneous Needle Injection
What is trigger finger
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)
What is trigger finger associated with
RA
DM
Gout
Who is most affected by trigger finger
Women
40-60 age
Causes of trigger finger
Repetitive use of hand
Trauma
Treatment of trigger finger
Steroid injection into region of nodule, but not nodule itself (if not child, renal failure or DM)
Surgery - percutaneous release or open
What is De Quervain’s Disease (stenosing tenovaginosis)
Pain over the radial styloid process and thickening of the Abductor Pollicis Longus and Extensor Pollicis Brevis tendons (1st dorsal extensor compartment)
Clinical presentation of De Quervain’s
Pain over lateral wrist aggravated by thumb movement (i.e. lifting a teapot)
Swelling over wrist
FEMALES
Age 50-60
Diagnosis of De Quervain’s
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
Cause of De Quervain
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
Treatment of De Quervain’s
1st
- NSAIDs
- Steroid (hydrocortisone) injection around tendons in their sheath
2nd
- Decompression of tendons by splitting tendon sheaths
What is a ganglion
Smooth cyst from the degeneration of joint synovial, containing jelly-like fluid in communication with tendon sheaths or joint capsules