Disorders of the hand Flashcards
What is duputryens contractures?
Scarring the palmar fascia that acts to keep the palm fixed. Lumps are formed and it causes fingers to be unable to fully extend. this causes issues such as not being able to put hands in pockets, grip things, or wash face
What is the classic presentation
Early onset disease, bilateral disease, family history and sometimes disease in other regions such as the penis, knuckles and soles of feet
Who gets dupuytrens?
Mainly males autosmal dominat, sporadic in30% of cases white people associations with Diabetes Epilepsy Alcohol Tobacco HIV
How do you treat dupuytrens
Non- operative: observe, cant splint, radiotherapy
Operative
Partial fasciectomy- remove fascia, very popular.
Demofasciectomy- remove fascia and skin
Collagenase injection, dissolves collagen ,has been reported to rupture tendons
What is trigger finger?
Finger is unable to straighten unless popped in. Arises due to thickenings in the tendon sheath, these form a pulley although swelling causes the pulley to catch
Who gets a trigger finger?
Women more frequently than men 40s-60s ring finger most common Repetitive use of hand local trauma rheumatoid ahtritis, diabetes, gout
How do you treat trigger finger?
Non operative: splint, steroid
Operative- percutaneous release, open surgery (more common in patients with RA and DM
What is De Quervain’s syndrome?
What simple clincal test can be carried out to test for it?
Several weeks localised pain on radial side of wrist
Aggrivated by thumb movement
May have localised swellings
Localised tenderness over the tunnel
Finklestein’s test- grab thumb with other four fingers and pull down
Who gets De Quervians syndrome?
Females
50’s-60’s
increased post partum and delivery
activities with frequent thumb abduction and ulnar deviation
What causes De Quervians syndrome
Caused by tendon sheath getting a boner (becoming thick and hard)
How is De Quervians syndrome treated
Non operative: Splints, steroid injection (may cause skin erosion
Operative: decompression of both sides
What is a hand ganglion?
Who gets them?
Swelling of the hand a wrist, presents as “i have a lump”
females
20-40 years
more common on dorsal surface
May be associated with recurring wrist injury
What is the presenting picture
Lump Firm, non tender chanegs in size smooth not fixed to underlying tissue never fixed to skin
What is treatment of ganglia?
Non operative: reassure and observe, aspirate, hit with a bible
Operative: excision- very high dissatisfaction
What are the common symptoms of OA at the base of the thumb
Pain Stiffness swelling deformity loss of function
