Hand

Question 1

What is Dupuytren’s Contracture

Answer 1

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

Question 2

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

Answer 2

Type III

Question 3

Is Dupuytren’s Contracture more commonly unilateral or bilateral

Answer 3

Half of cases are bilateral

Question 4

What fingers are most commonly affected by Dupuytren’s contracture

Answer 4

Little and ring fingers

Question 5

Is Dupuytren’s more common in males or females

Answer 5

Males (10:1)

Question 6

causes of Dupuytren’s contracture

Answer 6

Family history
Alcohol
Diabetes

Question 7

What drug is associated with causing Dupuytren’s contracture

Answer 7

Phenytoin

Question 8

What is Peyronie’s disease

Answer 8

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

Question 9

What is Ledderhose disease

Answer 9

Dupuytren’s contracture affecting the feet, with other fibromatoses

Question 10

Tx of Dupuytren’s contracture

Answer 10

Fasciectomy - removal of all diseased tissue

Fasciotomy - division of cords

Question 11

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

Answer 11

30 degrees

Question 12

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

Answer 12

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

Question 13

What is trigger finger

Answer 13

tendonitis of a flexor tendon to a digit

Question 14

What pulley is usually affected in trigger finger

Answer 14

A1 pulley (MCP head)

Question 15

Presentation of trigger finger

Answer 15

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

Question 16

Most common fingers affected by trigger finger

Answer 16

Middle and ring fingers

Question 17

Condition associated with causing trigger finger

Answer 17

Diabetes

Question 18

Tx of trigger finger

Answer 18

Steroid injection around the tendon within the sheath

Question 19

Stiffness and thickening of the DIP joints in OA

Answer 19

Heberden’s nodes

Question 20

Stiffness and thickening of the PIP joints in OA

Answer 20

Bouchard’s nodes

Question 21

What wrist abnormality may be seen in OA

Answer 21

dorsal ganglion cyst (mucus cyst)

Question 22

Tx of OA in the DIP joints

Answer 22

mild-moderate:
removal of osteophytes and any mucus cyst

severe:
arthrodesis

Question 23

Tx of OA in the PIP joints

Answer 23

index finger:
arthrodesis to preserve pincer grip

other fingers:
replacement arthroplast §

Question 24

causes of OA at the MCP joints

Answer 24

previous injury
occupational stress
gout
infection

Question 25

Tx of OA in the MCP joints

Answer 25

MCP joint replacement | - complications common (ulnar drift, extensor tendon subluxation)

Question 26

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

Answer 26

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

Question 27

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

Answer 27

DIPs | - not enough synovium around these joints

Question 28

3 stages of RA in the hands

Answer 28

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

Question 29

Main deformities of the hands in RA

Answer 29

Volar MCPJ subluxation Ulnar deviation Swan neck deformity Boutonniere deformity Z-shaped thumb

Question 30

What is Swan neck deformity

Answer 30

Hyperextension of PIPJ and flexion at DIPJ

Question 31

What is Boutonniere deformity

Answer 31

Flexion of PIPJ and hyperextension at DIPJ

Question 32

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

Answer 32

Tenosynovectomy - to prevent tendon rupture Tendon transfer - if tendon has already ruptured Soft tissue release - for contractures Replacements/Fusion - severe disease

Question 33

What is a ganglion cyst

Answer 33

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

Question 34

Most common locations for ganglion cysts

Answer 34

DIPj of hand - mucus cyst or flexor tendon Wrist - dorsal or volar surface Foot or ankle Knee (Baker's cyst)

Question 35

Presentation of a ganglion cyst

Answer 35

firm, smooth, rubbery, transilluminable

Question 36

Tx of a ganglion cyst

Answer 36

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

Question 37

Presentation of a giant cell tumour of the tendon sheath

Answer 37

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

Question 38

Tx of giant cell tumour of the tendon sheath

Answer 38

Excision to prevent local spread

Question 39

What is DeQuervain's Tenosynovitis

Answer 39

inflamed tendon sheath of the first extensor compartment of the forearm

Question 40

Presentation of DeQuervain's Tenosynovitis

Answer 40

extreme pain on moving thumb

Question 41

Ix DeQuervain's Tenosynovitis

Answer 41

Finkelstein's test - put thumb into fist and ulnar deviate to reproduce pain

Question 42

Mx DeQuervain's Tenosynovitis

Answer 42

NSAIDs Splint Steroid injection