Hand and Wrist Pathology Flashcards
What is Dupuytren’s contracture?
Inherited disease of progressive permanent tightening of fibrous tissue of the palmar fascia, causing flexion of digits
What sex is more likely to be affected by Dupuytren’s?
M>F
8:1
What ethnic group is most likely to be affected by Dupuytren’s?
Caucasian
What causes Dupuytren’s?
Genetic susceptibility
Manual labour
Phenytoin treatment
Alcoholic liver disease
DM
Trauma
What is Dupuytren’s Diathesis?
Genetic predisposition to the condition
- Early onset disease
- Bilateral disease
- Family history
- Ectopic disease
How does Dupuytren’s present?
Not usually painful
Loss of finger extension
Impaired Function
- Hand in pocket
- Gripping things
- Washing face
What is the management of Dupuytren’s?
Observe
Partial fasciectomy
Dermo-fasciectomy
Percutaneous Needle Fasciotomy
Collagenase injection
When should surgical management of dupuytrens be considered?
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
What is De Quervain’s Tenovaginitis?
Inflammation/thickening of the tendon and tendon sheath of abductor pollicis longus and extensor pollicis brevis
What sex is most likely to be affected by De Quervains Tenovaginitis?
F>M
6:1
What causes De Quervain’s Tenovaginitis?
Activities with frequent thumb abduction and ulnar deviation
Lactating and post-partum females
How does De Quervains Tenovaginitis present?
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
What test is used to diagnose De Quervains Tenovaginitis?
Finklestein’s Test
- Patient bends thumb to palm, wraps fingers over thumb, bend wrist toward little finger/ulnar deviation, causing pain over radial side
What is the management of De Quervain’s Tenovaginitis?
Analgesia
Steroid injection
Immobilisation with thumb splint
Surgical decompression
What is trigger finger?
Swelling/inflammation of tendons of the hand, causing it to catch within the tendon sheath, making it difficult to flex the affected finger
What finger is most affected by trigger finger?
Ring > thumb > middle
What sex is most likely to be affected by trigger finger?
F>M
8:1
What causes trigger finger?
Repetitive use of hand
Local trauma
Associated conditions
- RA
- DM
- Gout
How does trigger finger present?
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
What is the management of trigger finger?
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
What is a ganglion?
Benign mass located on the wrist arising from joint capsule, joint tendon sheath or joint ligament
What sex is most likely to be affected by ganglion?
F>M
2:1
What wrist location is the most common site of ganglion?
Dorsal > volar
3:1
What causes ganglion?
May be associated with recurrent injury around the wrist
How do ganglions present?
Soft non-tender lump
Fluctuant
What is the management of ganglions?
Reassure and observe, often dissapear spontaneously after 3 months
Aspiration
Exicision
What is the most commonly fractured bone of the hand?
Scaphoid bone, due to falling on outstretched hand
How are scaphoid fractures managed?
Splint immobilisation
For undisplaced, cast for 6-8 weeks
For displaced, surgical fixation
Give a complication of fracturing the scaphoid bone
If proximal fracture, avascular necrosis can occur as this area lacks good blood supply
