disorders of the hand Flashcards
what are the three group of muscles of the hand ?
long extensors
long flexors
intrinsic muscles
where does a ganglion cyst arise from ?
joint or tendon sheath
what are the causes of ganglion cysts ?
trauma
mucoid degeneration
synovial herniation
what is the most common place for ganglion cysts ?
scapholunate joint
dorsal wrist ganglion
what is the treatment for ganglion cysts ?
watch and wait aspirate
may need surgical excision
what is de quervain tenosynovitis ?
stenosing tenosynovitis of the first dorsal extensor compartment
what are the risk factors for De Quervain’s tenosynovitis ?
overuse
post traumatic
postpartum
how is a diagnosis of De Quervain’s tenosynovitis made ?
radial sided wrist pain made worse with finkelstein maneuver (ulnar deviation of a closed wrist )
what is trigger finger ?
inhibition of smooth tendon gliding due to mechanical impingement at the level of A1 pulley
what are the types of trigger fingers ?
congenital of the thumb - usually resolve
acquired - middle aged
what is the management of trigger finger ?
conservative - steroid injection
surgical - release of A1 pulley
what are the common congenital hand anomalies ?
polydactyly
syndactyly
congenital trigger thumb
what is dupuytren’s disease ?
benign proliferative disorder , characterized by decreased hand function caused by hand contractures and painful fascial nodules
what are the anatomic location of dupuytren’s disease ?
ring
small
middle
in that order
what are the risk factors of dupuytrens disease ?
alcohol
genetic
geographical
what test is used for the diagnosis of dupuytren’s disease ?
Hueston tabletop test
ask patient to lay hand flat on the table look for MCPJ or PIPJ
what is the surgery for dupuytren’s disease ?
palmar fasciectomy
what is a felon infection ?
pulp space infection
what is the treatment of felon ?
incision and drainage
what is pyogenic flexor tenosynovitis ?
Infection of the synovial sheath that surrounds the flexor tendon
what is the most common organism associated with Pyogenic flexor tenosynovitis ?
staph aureus
what is the presentation of Pyogenic flexor tenosynovitis ?
Kanavel’s signs :
flexed posture
tenderness
pain with passive extension
fusiform swelling
what are the different finger extensor tendon injuries ?
mallet finger - rupture or avulsion of distal tendon insertion
boutonniere deformity - rupture of the central slip ( flexed PIP )
what is carpal tunnel syndrome and what is the presentation ?
median nerve entrapment neuropathy
numbing and tingling sensation of the radial 3 and a half fingers
thenar or weakness atrophy
what is the aetiology of carpal tunnel ?
either decrease in the size of the canal : osteoarthritis, trauma, acromegaly
orr increase in the size of thee contents : pregnancy, rheumatoid arthritis, alcoholism
what are the signs associated with carpal tunnel ?
tinel’s sign - tapping on the medial nerve
phalen’s test - volar flexion against gravity for 60 seconds produces symptoms
treatment for carpal tunnel ?
conservative - splint, steroid injection, medication
surgery - release of the transverse carpal ligament
what is volkmann’s ischemic contracture ?
deformity of the hand and wrist that is caused by contracture of forearm muscles
what are the causes of volkmann’s ischemic contracture ?
following fractures
after burns
bleeding disorders
what is the clinical picture of volkmann’s ischemic contracture ?
claw like hand
diminished sensation
loss of hand function
