Hand abnormalities Flashcards
What is Dupuytren’s contracture?
Increase in thickness of the subdermal fascia that overlies the tendons leading to fixed deformity of the finger.
Can affect any finger but most commonly affects the ring finger.
What is Dupuytren’s contracture associated with?
Genetic More common in men Diabetics Alcohol/cirrhosis Smoking Also connected to Peyronie's disease (affects the penis) and plantar fibromatosis
Treatment of Dupuytrens disease
Stretching and activity modification as conservative management.
Surgery- removal of all the diseased tissue (faciectomy)
What is trigger finger?
Tendonitis of the flexor tendon to a digit which can result in nodular enlargement
Which flexor tendon is usually affected
A1 pulley on the ring or middle fingers
Describe trigger finger and its symptoms
Movement of the finger produces a clicking sensation as the nodule passes through the pulley. The finger may get stuck in flexion because the nodule may not be able to pass back during extension. They patient may have to manually re-extend their finger.
Causes pain
Treatment of trigger finger
Injection of steroid around the tendon sheath
Surgery if it is a persistent case- involves incising the pulley.
Ganglion cyst
Outpouching of synovial cavity filled with synovial fluid. They fluctuate and are usually painless. Common in the wrist
Treatment of ganglion cysts
Many patients want them excised for cosmetic reasons- however they will be left with a scar which is also not particularly desirable.
Could try needle aspiration however be aware of the volar gangion and radial artery.
Excision can occur if they are causing localised discomfort.
Mucous cysts
Outpouching of synovial fluid at the DIP joint. It may fluctuate or discharge and may be painful.
Treatment of mucous cysts
Perfectly benign condition- get the patient to come to terms with it
DeQeurvains tenosynovititis
A tendon sheath holds the tendon that sits on the radius (has a convex surface therefore tendon likely to slip off without a tendon sheath)
If there is inflammation of the tendon sheath this can be painful
Presentation of DeQeurvains tenosynovitis
Painful and spontaneous. Red and swollen.
Finklesteins test
Treatment of DeQeurvains tenosynovitis
Steroid injection
NSAIDs
Splint
Surgery to decompress.
Paronychia
Infection in the nail fold which may result with pus collecting. Usually seen in children.
