Disorders of the hand

Question 1

Dupuytren’s Contracture

Answer 1

Dupuytren’s contracture is the localised thickening and contraction of the palmar aponeurosis leading to flexion deformity of the adjacent fingers.

Question 2

dupuytrens risk factors

Answer 2

Risk factors include: smoking, alcohol, hypothyroidism and HIV.

Question 3

presentation of dupuytrens

Answer 3

It presents with fixed flexion of the fingers, most commonly the 4th and 5th digits, associated with the palpable thickening of the palmar aponeurosis.

Question 4

treatment of dupuytrens contracture

Answer 4

Treatment usually involves steroid injections and physical therapy. In more severe cases other treatments may be used, such as collagenase injections, radiation therapy, needle aponeurotomy and surgery.

Question 5

Rheumatoid arthritis causes pain and swelling of the finger joints, often bilateral. It can cause two types of deformity:

Answer 5

• Swan neck deformity
• Boutonnière deformity

Question 6

swan neck deformity presentation

Answer 6

hyperextension of the proximal interphalangeal joint and flexion of the metacarpophalangeal joint and distal interphalangeal joint.

This is due to lax tissues on the palmar aspect of the proximal interphalangeal joint as a result of adjacent synovitis.

Question 7

Boutonnière deformity presentation

Answer 7

– flexion of the proximal interphalangeal joint and hyperextension of the metacarpophalangeal joint and distal interphalangeal joint.

Question 8

Osteoarthritis of Finger Joints

Answer 8

Osteoarthritis most commonly affects the 1st carpometacarpal joint and it is more common in women than in men.

Question 9

presentation of OA in finger joints

Answer 9

It presents with pain, swelling, squaring of the hand, stiffness and Heberden’s nodes (swellings of the distal interphalangeal joints) or Bouchard’s nodes (swellings of the proximal interphalangeal joints).

Question 10

Psoriatic arthropathy is

Answer 10

the asymmetrical oligoarthritis of psoriasis patients.

It most commonly affects the distal interphalangeal joints and presents with fusiform (sausage-shaped) swelling of the digits with onycholysis (separation of the nails from the nail bed).

Question 11

Psoriatic Arthropathy treatment

Answer 11

Mild cases can be treated with NSAIDs alone, but more severe cases may require disease modifying anti-rheumatic drugs (DMARDs).

Question 12

Rheumatoid Nodules

Answer 12

Rheumatoid nodules are an extra-articular manifestation of rheumatoid arthritis. They affect around 20% of people with rheumatoid arthritis and are usually found in smokers with a more aggressive form of rheumatoid arthritis.

Question 13

presentation of rheumatoid nodules

Answer 13

The nodules are usually non-tender and occur in regions exposed to minor trauma.

Question 14

management of rheumatoid nodules

Answer 14

They don’t always require treatment, but if they restrict movement or start to cause pain, DMARDs may help to reduce the size of the nodules.

Question 15

Gouty Tophi

Answer 15

are nodular masses of monosodium urate crystals that are deposited in soft tissues.

Question 16

cause of gouty tophi

Answer 16

They are a late complication of hyperuricaemia. This condition is most commonly seen on the fingers but can be found on the ears or elbows. The nodular masses themselves are usually painless.

Question 17

managment of gouty tophi

Answer 17

They don’t always require treatment, but large tophi should be removed to prevent damage to the joint or loss of range of motion.