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Orthopaedics > Hand > Flashcards

Hand Flashcards

1
Q

What is Dupuytren’s Contracture

A

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

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2
Q

What type of collagen is layed down in Dupuytren’s Contracture

A

Type III

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3
Q

Is Dupuytren’s Contracture more commonly unilateral or bilateral

A

Half of cases are bilateral

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4
Q

What fingers are most commonly affected by Dupuytren’s contracture

A

Little and ring fingers

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5
Q

Is Dupuytren’s more common in males or females

A

Males (10:1)

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6
Q

causes of Dupuytren’s contracture

A

Family history
Alcohol
Diabetes

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7
Q

What drug is associated with causing Dupuytren’s contracture

A

Phenytoin

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8
Q

What is Peyronie’s disease

A

Dupuytren’s contracture and affecting the penis, with other fibromatoses

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9
Q

What is Ledderhose disease

A

Dupuytren’s contracture affecting the feet, with other fibromatoses

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10
Q

Tx of Dupuytren’s contracture

A

Fasciectomy - removal of all diseased tissue

Fasciotomy - division of cords

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11
Q

How many degrees of contracture can be tolerated at the MCP joints in Dupuytren’s before surgery is considered

A

30 degrees

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12
Q

How many degrees of contracture can be tolerated at the PIP joints in Dupuytren’s before surgery is considered

A

None - any contracture at the PIPs is an indication for surgery

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13
Q

What is trigger finger

A

tendonitis of a flexor tendon to a digit

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14
Q

What pulley is usually affected in trigger finger

A

A1 pulley (MCP head)

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15
Q

Presentation of trigger finger

A

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

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16
Q

Most common fingers affected by trigger finger

A

Middle and ring fingers

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17
Q

Condition associated with causing trigger finger

A

Diabetes

18
Q

Tx of trigger finger

A

Steroid injection around the tendon within the sheath

19
Q

Stiffness and thickening of the DIP joints in OA

A

Heberden’s nodes

20
Q

Stiffness and thickening of the PIP joints in OA

A

Bouchard’s nodes

21
Q

What wrist abnormality may be seen in OA

A

dorsal ganglion cyst (mucus cyst)

22
Q

Tx of OA in the DIP joints

A

mild-moderate:
removal of osteophytes and any mucus cyst

severe:
arthrodesis

23
Q

Tx of OA in the PIP joints

A

index finger:
arthrodesis to preserve pincer grip

other fingers:
replacement arthroplast §

24
Q

causes of OA at the MCP joints

A

previous injury
occupational stress
gout
infection

25
Q

Tx of OA in the MCP joints

A

MCP joint replacement

- complications common (ulnar drift, extensor tendon subluxation)

26
Q

In addition to DIP and PIPs, what other joint in the hand is commonly affected by OA

A

1st CMC joint (i.e. the base of the thumb)

27
Q

what joints in the hands tend to be spared by RA and why

A

DIPs

- not enough synovium around these joints

28
Q

3 stages of RA in the hands

A
  1. Synovitis & Tenosynovitis
  2. Erosions of the joints
  3. Joint instability and tendon rupture
29
Q

Main deformities of the hands in RA

A

Volar MCPJ subluxation

Ulnar deviation

Swan neck deformity

Boutonniere deformity

Z-shaped thumb

30
Q

What is Swan neck deformity

A

Hyperextension of PIPJ and flexion at DIPJ

31
Q

What is Boutonniere deformity

A

Flexion of PIPJ and hyperextension at DIPJ

32
Q

What surgical procedures are available for RA in the hands, and give their indication

A

Tenosynovectomy - to prevent tendon rupture

Tendon transfer - if tendon has already ruptured

Soft tissue release - for contractures

Replacements/Fusion - severe disease

33
Q

What is a ganglion cyst

A

mucinous filled cysts that are found adjacent to a tendon or synovial joint

34
Q

Most common locations for ganglion cysts

A

DIPj of hand - mucus cyst or flexor tendon

Wrist - dorsal or volar surface

Foot or ankle

Knee (Baker’s cyst)

35
Q

Presentation of a ganglion cyst

A

firm, smooth, rubbery, transilluminable

36
Q

Tx of a ganglion cyst

A

Leave alone
Excision (mainly cosmetic reasons)
- high risk of recurrence

37
Q

Presentation of a giant cell tumour of the tendon sheath

A 
palmar surface 
PIPj of index or middle finger 
well circumscribed 
\+/- pain 
can erode into bone (xray)
38
Q

Tx of giant cell tumour of the tendon sheath

A

Excision to prevent local spread

39
Q

What is DeQuervain’s Tenosynovitis

A

inflamed tendon sheath of the first extensor compartment of the forearm

40
Q

Presentation of DeQuervain’s Tenosynovitis

A

extreme pain on moving thumb

41
Q

Ix DeQuervain’s Tenosynovitis

A

Finkelstein’s test

  • put thumb into fist and ulnar deviate to reproduce pain
42
Q

Mx DeQuervain’s Tenosynovitis

A

NSAIDs
Splint
Steroid injection

Orthopaedics (16 decks)

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