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Musculoskeletal > Hand and Wrist Problems > Flashcards

Hand and Wrist Problems Flashcards

1
Q

what is dupuytren’s contracture

A

a proliferative connective tissue disorder where the specialised palmer fascia undergoes hyperplasia with normal fascial bands forming nodules and cord progressing to contractures at MCP and PIP joints

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2
Q

what is the pathophysiology of dupuytren’s contracture

A

proliferation of myofibroblast cells and the production of abnormal collagen (type 3 rather than type 1). The skin of the hand may be adherent to the disease fascia and puckered. Palpable nodules may be present

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3
Q

where does dupuytrens contracture mostly affect

A

ring and little fingers approx 1/2 cases bilateral

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4
Q

what causes dupuytrens contracture

A

males (10:1) familial (autosomal dominant) feature of alcohol cirrhosis side effect of phenytoin therapy diabetes can also occur with other fibromatoses including peyronies (effects penis) and ledderhose (affects feet)

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5
Q

what is involved in examination of dupuytrens contracture

A

feel cords MCP/PIP joint involvement = measure angles table-top test = can you put your hand flat on table

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6
Q

when would surgery be offered in dupuytrens contracture

A

mild contractures may be tolerated but surgical treatment can be offered if contractures are interfering with function. Up to 30o of contracture can be tolerated at MCP joint but the PIPJ readily stiffens and any contracture here is usually indication for surgery

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7
Q

what does surgery in dupuytrens contracture involve

A

either removal of all diseased tissue (fasciectomy) or division of cords (fasciotomy recurrence can occur severe contractures (finger in palm) may be most appropriately treated with amputation

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8
Q

what newer treatments are coming in for dupuytrens contracture

A

collagenase injection or percutaneous needle fasciotomy

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9
Q

what is trigger finger

A

tendonitis of a flexor tendon to a digit can result in nodular enlargement of affected tendon, usually distal to the fasical pulley over the metacarpal neck (the A1 pulley)

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10
Q

what fingers most commonly affected in trigger finger and what disease causes a risk of it

A

any finger but middle and ring most common diabetics at risk

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11
Q

what is symptoms of tigger finger

A

movement of finger produces a clicking sensation, as this nodule catches on and then passes through pulley this painful and finger lock in flexed position as nodule passes under pulley but cant go back through on extension

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12
Q

how to tell difference between trigger finger and dupuytrens

A

dupuytrens never opens in trigger finger it does even though patient may have to forcibly manipulate finger to regain extension

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13
Q

how is trigger finger treated

A

in most cases a steroid injection around tendon within sheath will work surgery can be offered in recurrent cases - incision of pulley to allow tendon to move freely (due to system of other pulleys, division of A1 does not affect function)

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14
Q

what do you call the stiffness and bony thickening seen in OA on DIP joints

A

heberden’s nodes DIP OA very common in post menopausal women

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15
Q

what do you call the bony swelling seen in OA of PIP joints

A

bouchards nodes

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16
Q

treatment options for OA in DIP joints

A

mild = removal of oteophytes and excision of any mucous cyst severe = arthrodesis may be performed

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17
Q

how is treatment options for OA in PIP joints

A

index finger = arthrodesis may be required to preserve pinch grip other fingers = replacement arthroplasty may be required however results are variable and reoperation rates high

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18
Q

rarely OA can affect MCP joints, what causes this

A

very specific cause eg previous injury, occupational stress, gout or infection

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19
Q

surgical treatment is possible for OA of MCP joint, what is it

A

MCP joint replacement may relieve pain and improve ROM but complications common (ulnar drift, extensor tendon subluxation)

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20
Q

the 1st carpo-metacarpal (trapziometacarpal joint) at base of thumb is commonly affected by OA, particularly in women, how is this treated

A

injection of steroid can help an acute flare up whilst excision arthroplasty (trapeziectomy) or fusion may cure chronic pain

21
Q

what is the treatment of primary OA of the joints between the scaphoid, trapezium and trapezoid (STT) joint

A

selected fusion of these carpal bones or wrist fusion may be required for severe symptoms

22
Q

what is treatment in OA of the radio-carpal joint of wrist which usually occurs as consequence of trauma (eg scaphoid non-union, carpal dislocation)

A

wirst arthroplasty or fusion

23
Q

what are the three stages in which RA occurs in hands

A

1 = synovitis and tenosynovitis 2 = erosions of joints (as inflammatory pannus denudes joints of articular cartilage) 3 = joint instability and tendon rupture

24
Q

what are the end stages of RA in hand (these arent really common anymore due to DMARDs)

A

volar MCPJ subluxation ulnae deviation swan neck deformity (hyperextension at PIPJ with flexion DIPJ) boutonniere deformity (flexion at PIPJ with hyperextension at DIPJ) Z shaped thumb

25
Q

what treatments are available for the complications of RA in hands

A

tenosynovectomy to prevent tendon rupture soft tissue release (lengthening) for contractures MCP replacement, PIP replacement or fusion and wrist replacement or fusion may be required resection of distal ulna may be required for DRUJ arthritis

26
Q

what is a giant cell tumour of the tendon sheath

A

2nd most common soft tissue swelling of hand (after ganglions) that are usually on palmar surface especially around PIP joint of index and middle fingers

27
Q

what do giant cell tumours of tendon sheath look like histologically

A

contain multinucleated giant cells and haemosiderin (which gives brown appearance)

28
Q

what is consequence of giant cell tumour of tendon sheath

A

may or not cause pain, they can envelop the digital nerve or artery and can erode into bone

29
Q

how is giant cell tumour of tendon sheath treated

A

excision usually recommended to prevent local spread and treat symptoms recurrence not uncommon (10-20%)

30
Q

what is a mucous cyst

A

out pouching of synovial fluid from DIP joint OA

31
Q

what do mucous cysts look like

A
32
Q

what are symptoms of mucous cysts

A

typical appearance may be painful may fluctuate / discharge may deform nail and cause ridge

33
Q

how are mucous cysts treated

A

may be left alone or excised

34
Q

what are ganglions

A

out pouching of synovial cavity filled with synovial fluid therefore more common where there is high concentration of synovial joints eg wrist

35
Q

other than wrist, where else can ganglions occur

A

foot and ankle as well as knee (bakers cyst)

36
Q

what are symptoms of ganglion cyst

A

fluctuate in size, usually painless but may feel tight

37
Q

how are ganglions treated

A

usually resolve with time sometimes aspirated with big bore needle but 50% chance of recurrence if do this. if reoccurs after this, can excise it but this rarely happens as by time of surgery it is gone. Aspiration / excision may damage radial nerve = damage determined by Alan test (old people used to hit them with bible - dont do this lol)

38
Q

what is dequervains tenosynovitis

A

inflammation of the tendon sheath in wrist and lower thumb - first extensor compartment (ALP an EBP)

39
Q

what are symptoms of dequervains tenosynovitis

A

spontaneous painful when using thumb swollen / red

40
Q

how is dequervains tenosynovitis diagnosed

A

finklestein’s test (examiner grasping and ulnar deviating the hand when the person has their thumb held within their fist. If sharp pain occurs along the distal radius, de Quervain’s tenosynovitis is likely)

41
Q

how is dequervains tenosynovitis

A

NSAIDs, splint and rest steroid injection in more severe cases failing that, surgical decompression

42
Q

what is paronychia

A

infection within the nail fold which often occurs in children

43
Q

what is risk factor for paronychia

A

nail biting

44
Q

what are symptoms of paronychia

A

red, tenderness and swelling discolouration and thickening of nail plate cuticle pulls away from nail bed

45
Q

how is paronychia treated

A

elevate antibiotics incise and drain collection

46
Q

what is flexor tendon sheath infection

A

infection within sheath tracking up palm and arm - it is rare but a surgical emergency!!

47
Q

what are symptoms of flexor tendon sheath infection

A

extremely painful even by slightest movement and limited extension due to pain may have tracking lymphangitis

48
Q

how is flexor tendon sheath infection treated

A

elevate it and wash out tendon sheath

Musculoskeletal (55 decks)

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