Hand Flashcards
What is Dupuytren’s Contracture
connective tissue disorder where the specialised palmar fascia undergoes hyperplasia with normal fascial bands forming nodules and cords, progressing to contractures at the MCP and PIP joints
What type of collagen is layed down in Dupuytren’s Contracture
Type III
Is Dupuytren’s Contracture more commonly unilateral or bilateral
Half of cases are bilateral
What fingers are most commonly affected by Dupuytren’s contracture
Little and ring fingers
Is Dupuytren’s more common in males or females
Males (10:1)
causes of Dupuytren’s contracture
Family history
Alcohol
Diabetes
What drug is associated with causing Dupuytren’s contracture
Phenytoin
What is Peyronie’s disease
Dupuytren’s contracture and affecting the penis, with other fibromatoses
What is Ledderhose disease
Dupuytren’s contracture affecting the feet, with other fibromatoses
Tx of Dupuytren’s contracture
Fasciectomy - removal of all diseased tissue
Fasciotomy - division of cords
How many degrees of contracture can be tolerated at the MCP joints in Dupuytren’s before surgery is considered
30 degrees
How many degrees of contracture can be tolerated at the PIP joints in Dupuytren’s before surgery is considered
None - any contracture at the PIPs is an indication for surgery
What is trigger finger
tendonitis of a flexor tendon to a digit
What pulley is usually affected in trigger finger
A1 pulley (MCP head)
Presentation of trigger finger
Clicking sensation of the affected finger - the nodule catches on and then passes underneath the pulley
Pain as finger locks in flexion and can’t be extended
Forcible extension of affected finger
Most common fingers affected by trigger finger
Middle and ring fingers
Condition associated with causing trigger finger
Diabetes
Tx of trigger finger
Steroid injection around the tendon within the sheath
Stiffness and thickening of the DIP joints in OA
Heberden’s nodes
Stiffness and thickening of the PIP joints in OA
Bouchard’s nodes
What wrist abnormality may be seen in OA
dorsal ganglion cyst (mucus cyst)
Tx of OA in the DIP joints
mild-moderate:
removal of osteophytes and any mucus cyst
severe:
arthrodesis
Tx of OA in the PIP joints
index finger:
arthrodesis to preserve pincer grip
other fingers:
replacement arthroplast §
causes of OA at the MCP joints
previous injury
occupational stress
gout
infection
Tx of OA in the MCP joints
MCP joint replacement
- complications common (ulnar drift, extensor tendon subluxation)
In addition to DIP and PIPs, what other joint in the hand is commonly affected by OA
1st CMC joint (i.e. the base of the thumb)
what joints in the hands tend to be spared by RA and why
DIPs
- not enough synovium around these joints
3 stages of RA in the hands
- Synovitis & Tenosynovitis
- Erosions of the joints
- Joint instability and tendon rupture
Main deformities of the hands in RA
Volar MCPJ subluxation
Ulnar deviation
Swan neck deformity
Boutonniere deformity
Z-shaped thumb
What is Swan neck deformity
Hyperextension of PIPJ and flexion at DIPJ
What is Boutonniere deformity
Flexion of PIPJ and hyperextension at DIPJ
What surgical procedures are available for RA in the hands, and give their indication
Tenosynovectomy - to prevent tendon rupture
Tendon transfer - if tendon has already ruptured
Soft tissue release - for contractures
Replacements/Fusion - severe disease
What is a ganglion cyst
mucinous filled cysts that are found adjacent to a tendon or synovial joint
Most common locations for ganglion cysts
DIPj of hand - mucus cyst or flexor tendon
Wrist - dorsal or volar surface
Foot or ankle
Knee (Baker’s cyst)
Presentation of a ganglion cyst
firm, smooth, rubbery, transilluminable
Tx of a ganglion cyst
Leave alone
Excision (mainly cosmetic reasons)
- high risk of recurrence
Presentation of a giant cell tumour of the tendon sheath
palmar surface PIPj of index or middle finger well circumscribed \+/- pain can erode into bone (xray)
Tx of giant cell tumour of the tendon sheath
Excision to prevent local spread
What is DeQuervain’s Tenosynovitis
inflamed tendon sheath of the first extensor compartment of the forearm
Presentation of DeQuervain’s Tenosynovitis
extreme pain on moving thumb
Ix DeQuervain’s Tenosynovitis
Finkelstein’s test
- put thumb into fist and ulnar deviate to reproduce pain
Mx DeQuervain’s Tenosynovitis
NSAIDs
Splint
Steroid injection
