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Musculoskeletal + Rheumatology > Hand and Wrist Pathology > Flashcards

Hand and Wrist Pathology Flashcards

1
Q

What is Dupuytren’s contracture?

A

Inherited disease of progressive permanent tightening of fibrous tissue of the palmar fascia, causing flexion of digits

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2
Q

What sex is more likely to be affected by Dupuytren’s?

A

M>F

8:1

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3
Q

What ethnic group is most likely to be affected by Dupuytren’s?

A

Caucasian

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4
Q

What causes Dupuytren’s?

A

Genetic susceptibility

Manual labour

Phenytoin treatment

Alcoholic liver disease

DM

Trauma

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5
Q

What is Dupuytren’s Diathesis?

A

Genetic predisposition to the condition

  • Early onset disease
  • Bilateral disease
  • Family history
  • Ectopic disease
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6
Q

How does Dupuytren’s present?

A

Not usually painful

Loss of finger extension

Impaired Function

  • Hand in pocket
  • Gripping things
  • Washing face
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7
Q

What is the management of Dupuytren’s?

A

Observe

Partial fasciectomy

Dermo-fasciectomy

Percutaneous Needle Fasciotomy

Collagenase injection

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8
Q

When should surgical management of dupuytrens be considered?

A

Consider surgical treatment of Dupuytren’s contracture when the metacarpophalangeal joints cannot be straightened and thus the hand cannot be placed flat on the table

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9
Q

What is De Quervain’s Tenovaginitis?

A

Inflammation/thickening of the tendon and tendon sheath of abductor pollicis longus and extensor pollicis brevis

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10
Q

What sex is most likely to be affected by De Quervains Tenovaginitis?

A

F>M

6:1

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11
Q

What causes De Quervain’s Tenovaginitis?

A

Activities with frequent thumb abduction and ulnar deviation

Lactating and post-partum females

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12
Q

How does De Quervains Tenovaginitis present?

A

Several weeks of pain localised to radial side of wrist

Pain aggravated by movement of the thumb, particularly abduction against resitance

Tenderness over base of thumb and radial styloid process

No sensory deficits

Ulnar deviation of wrist recreates pain

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13
Q

What test is used to diagnose De Quervains Tenovaginitis?

A

Finklestein’s Test

  • Patient bends thumb to palm, wraps fingers over thumb, bend wrist toward little finger/ulnar deviation, causing pain over radial side
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14
Q

What is the management of De Quervain’s Tenovaginitis?

A

Analgesia

Steroid injection

Immobilisation with thumb splint

Surgical decompression

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15
Q

What is trigger finger?

A

Swelling/inflammation of tendons of the hand, causing it to catch within the tendon sheath, making it difficult to flex the affected finger

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16
Q

What finger is most affected by trigger finger?

A

Ring > thumb > middle

17
Q

What sex is most likely to be affected by trigger finger?

A

F>M

8:1

18
Q

What causes trigger finger?

A

Repetitive use of hand

Local trauma

Associated conditions

  • RA
  • DM
  • Gout
19
Q

How does trigger finger present?

A

Clicking sensation with movement of digit

Painful lump in palm under pulley

May have to use other hand to unlock

Clicking may progress to locking

20
Q

What is the management of trigger finger?

A

Splintage

  • Affected finger is taped to plastic splint to reduce movement

Steroid injections

Percutaneous release

  • Tendon sheath is cut

Open surgery

  • Releasing affected sheath to allow tendon to move freely again
21
Q

What is a ganglion?

A

Benign mass located on the wrist arising from joint capsule, joint tendon sheath or joint ligament

22
Q

What sex is most likely to be affected by ganglion?

A

F>M

2:1

23
Q

What wrist location is the most common site of ganglion?

A

Dorsal > volar

3:1

24
Q

What causes ganglion?

A

May be associated with recurrent injury around the wrist

25
Q

How do ganglions present?

A

Soft non-tender lump

Fluctuant

26
Q

What is the management of ganglions?

A

Reassure and observe, often dissapear spontaneously after 3 months

Aspiration

Exicision

27
Q

What is the most commonly fractured bone of the hand?

A

Scaphoid bone, due to falling on outstretched hand

28
Q

How are scaphoid fractures managed?

A

Splint immobilisation

For undisplaced, cast for 6-8 weeks

For displaced, surgical fixation

29
Q

Give a complication of fracturing the scaphoid bone

A

If proximal fracture, avascular necrosis can occur as this area lacks good blood supply

Musculoskeletal + Rheumatology (16 decks)

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