HAND - Common Musculoskeletal problems Flashcards
What are Common musculoskeletal problems with the hand
Dupuytren’s Disease Trigger Finger De Quervain’s Tenovaginitis Nerve entrapments - Carpal Tunnel Syndrome - Cubital Tunnel Syndrome Ganglion OA Base of Thumb
What is Dupuytrens disease
It’s the contraction of bands in palmar aponeurosis. The bands thicken which pull the fingers in flexion
What is epidemiology of Dupuytrens disease
15 – 64’s
M : F = 8 : 1 in
>75s
M : F = 2 : 1
Disease develops earlier in males
What are risk factors of Dupuytrens disease (x6)
Diabetes Alcohol Tobacco HIV Epilepsy liver disease
What are the genetics of Dupuytrens disease
Autosomal dominant variable penetrance
Sporadic in 30% of cases
Onset may be sex linked
Almost exclusively white races
Few sporadic reports in other races
What are symptoms of Dupuytrens disease
Not painful
Loss of finger extension – active or passive
What is non-operative treatment of Dupuytrens disease
Non-operative
- Observe
- Splints don’t work
- Radiotherapy
What are operative treatments for Dupuytrens disease
Partial fasciectomy (common) Dermo-fasciectomy (common)
Percutaneous Needle Fasciotomy (more modern)
Arthrodesis
Amputation
Collagenase (more modern) (Meat tenderiser)
Describe a Partial fasciectomy (common)
Most common procedure performed in UK
Good correction can be achieved
Wounds can take 2-3 weeks to heal
Stiffness requires physiotherapy
Can’t be cured
Recurrence 50 % at 5 years
Describe a Dermo-fasciectomy (common)
More radical procedure – only really used in aggressive early dup diseae patients)
Removal of skin from palm and underlying facia - may reduce recurrence rates
Requires intensive physiotherapy
Only sparingly used
Describe Arthrodesis
If joints are flexed in a unchangeable position then the joint can be excised and moved to a better position.
Describe Percutaneous Needle Fasciotomy (more modern) – done routinely in practice
Quick
No wounds
Return to normal activities 2-3 days
Does not prevent traditional surgery in future
Higher recurrence
(? 50% at 3 years)
Can be repeated
Risk of Nerve Injury
Describe Collagenase
Injected in and dissolves collagen in the band
Presented 3 year recurrence rate 34.8%
3 Flexor Tendon Ruptures – PROBLEM
Cost
Await longer term recurrence rates
AND IS NOT USED IN ABERDEEN
What is trigger finger
Trigger finger is a condition that causes pain, stiffness, and a sensation of locking or catching when you bend and straighten your finger.
What is epidemiology of trigger finger
Women more frequent than men
40s-60s
What is aetiology of trigger finger
Repetitive use of hand?
Local trauma
Associations
RA, DM, Gout
What are presenting symptoms of trigger finger
Clicking sensation with movement of digit
Lump in palm under pulley
May have to use other hand to ‘unlock’
‘Clicking’ may progress to ‘locking’
What can be felt on examination of trigger finger
Palpable lump in palm over A1 pulley
Feel the triggering around the A1-pulley when bend and extend finger
What are non-operative options for trigger finger
Splintage Steroid (more common) – resolves 50% cases
What areoperative options for trigger finger
Percutaneous release (knife in to release pulley)
Open surgery
What is Epidemiology of De Quervain’s Tenovaginitis
M:F 1:6
Age 50s - 60s
What is Aetiology of De Quervain’s Tenovaginitis
Increased in post-partum and lactating females
Activities with frequent thumb abduction and ulnar deviation
Where does De Quervain’s Tenovaginitis occur
Occurs in the 1st dorsal extensor compartment
What are Presenting symptoms of De Quervain’s Tenovaginitis
Several weeks pain localised to radial side of wrist (over radial styloid)
Aggravated by movement of the thumb
May have seen a localised swelling over radial styloid
Localised tenderness over tunnel
What is examination for De Quervain’s Tenovaginitis
Examine thumb joints and looks for tendernous
Finklestein’s Test
Resisted thumb extension
What is Non-operative treatment for De Quervain’s Tenovaginitis
Splints (night-time)
Steroid injection (will settle 50% of cases)
what is Operative treatment for De Quervain’s Tenovaginiti
Decompression
What is a ganglion
A ganglion cyst is a fluid-filled swelling that develops near a joint or tendon. The cyst can range from the size of a pea to the size of a golf ball.
How common are ganglion
70% of all discrete swellings in the hand and wrist are ganglia
What is pathophysiology of ganglion
Arise from joint capsule tendons sheath or ligaments as out pouchings in which fluid that usuaully librucates the joints is pumped through a relatively small base creating a swelling. The fluid within is gradulally concentrated, removing the water leaving stuff that is fairly firm.
What are presenting symptoms of a ganglion
Present with lump Firm, non-tender It Changes in size (can get smaller or bigger) Smooth Occasionally lobulated Normally not fixed to underlying tissues Never fixed to the skin
What is epidemiology of ganglion
More common in females (2:1)
Wide age distribution (peak 20-40yrs)
What is Non operative treatment for a ganglion
Reassure & Observe
Aspiration
What is operative treatment for a ganglion
Excision (all the way down the hole in the capsule (root)
How common is Osteoarthritis on base of thumb
Commonest arthritis in human body
What is epidemiology of Osteoarthritis on base of thum
1 in 3 woman
What are presenting symptoms of Osteoarthritis on base of thumb
Pain opening jars / pinching
Pain on base of thumb (worse at night and activity)
Stiffness
Swelling
Deformity
Loss of function
What is Non operative treatment for Osteoarthritis on base of thumb
Life style modifications
NSAIDS
Splint
Steroid Injection
What is the gold standard operative treatment for Osteoarthritis on base of thumb
Trapeziectomy
