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Musculoskeletal > HAND - Common Musculoskeletal problems > Flashcards

HAND - Common Musculoskeletal problems Flashcards

1
Q

What are Common musculoskeletal problems with the hand

A 
Dupuytren’s Disease 
Trigger Finger 
De Quervain’s Tenovaginitis
Nerve entrapments
-	Carpal Tunnel Syndrome
-	Cubital Tunnel Syndrome
Ganglion
OA Base of Thumb
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2
Q

What is Dupuytrens disease

A

It’s the contraction of bands in palmar aponeurosis. The bands thicken which pull the fingers in flexion

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3
Q

What is epidemiology of Dupuytrens disease

A

15 – 64’s
M : F = 8 : 1 in
>75s
M : F = 2 : 1

Disease develops earlier in males

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4
Q

What are risk factors of Dupuytrens disease (x6)

A 
Diabetes
Alcohol
Tobacco
HIV
Epilepsy
liver disease
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5
Q

What are the genetics of Dupuytrens disease

A

Autosomal dominant variable penetrance

Sporadic in 30% of cases

Onset may be sex linked

Almost exclusively white races

Few sporadic reports in other races

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6
Q

What are symptoms of Dupuytrens disease

A

Not painful

Loss of finger extension – active or passive

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7
Q

What is non-operative treatment of Dupuytrens disease

A

Non-operative

  • Observe
  • Splints don’t work
  • Radiotherapy
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8
Q

What are operative treatments for Dupuytrens disease

A 
Partial fasciectomy (common)
Dermo-fasciectomy (common)

Percutaneous Needle Fasciotomy (more modern)

Arthrodesis
Amputation

Collagenase (more modern) (Meat tenderiser)

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9
Q

Describe a Partial fasciectomy (common)

A

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

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10
Q

Describe a Dermo-fasciectomy (common)

A

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

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11
Q

Describe Arthrodesis

A

If joints are flexed in a unchangeable position then the joint can be excised and moved to a better position.

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12
Q

Describe Percutaneous Needle Fasciotomy (more modern) – done routinely in practice

A

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

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13
Q

Describe Collagenase

A

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

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14
Q

What is trigger finger

A

Trigger finger is a condition that causes pain, stiffness, and a sensation of locking or catching when you bend and straighten your finger.

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15
Q

What is epidemiology of trigger finger

A

Women more frequent than men

40s-60s

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16
Q

What is aetiology of trigger finger

A

Repetitive use of hand?
Local trauma
Associations
RA, DM, Gout

17
Q

What are presenting symptoms of trigger finger

A

Clicking sensation with movement of digit
Lump in palm under pulley
May have to use other hand to ‘unlock’
‘Clicking’ may progress to ‘locking’

18
Q

What can be felt on examination of trigger finger

A

Palpable lump in palm over A1 pulley

Feel the triggering around the A1-pulley when bend and extend finger

19
Q

What are non-operative options for trigger finger

A 
Splintage
Steroid (more common) – resolves 50% cases
20
Q

What areoperative options for trigger finger

A

Percutaneous release (knife in to release pulley)

Open surgery

21
Q

What is Epidemiology of De Quervain’s Tenovaginitis

A

M:F 1:6

Age 50s - 60s

22
Q

What is Aetiology of De Quervain’s Tenovaginitis

A

Increased in post-partum and lactating females

Activities with frequent thumb abduction and ulnar deviation

23
Q

Where does De Quervain’s Tenovaginitis occur

A

Occurs in the 1st dorsal extensor compartment

24
Q

What are Presenting symptoms of De Quervain’s Tenovaginitis

A

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

25
Q

What is examination for De Quervain’s Tenovaginitis

A

Examine thumb joints and looks for tendernous

Finklestein’s Test

Resisted thumb extension

26
Q

What is Non-operative treatment for De Quervain’s Tenovaginitis

A

Splints (night-time)

Steroid injection (will settle 50% of cases)

27
Q

what is Operative treatment for De Quervain’s Tenovaginiti

A

Decompression

28
Q

What is a ganglion

A

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.

29
Q

How common are ganglion

A

70% of all discrete swellings in the hand and wrist are ganglia

30
Q

What is pathophysiology of ganglion

A

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.

31
Q

What are presenting symptoms of a ganglion

A 
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
32
Q

What is epidemiology of ganglion

A

More common in females (2:1)

Wide age distribution (peak 20-40yrs)

33
Q

What is Non operative treatment for a ganglion

A

Reassure & Observe

Aspiration

34
Q

What is operative treatment for a ganglion

A

Excision (all the way down the hole in the capsule (root)

35
Q

How common is Osteoarthritis on base of thumb

A

Commonest arthritis in human body

36
Q

What is epidemiology of Osteoarthritis on base of thum

A

1 in 3 woman

37
Q

What are presenting symptoms of Osteoarthritis on base of thumb

A

Pain opening jars / pinching

Pain on base of thumb (worse at night and activity)

Stiffness

Swelling

Deformity

Loss of function

38
Q

What is Non operative treatment for Osteoarthritis on base of thumb

A

Life style modifications

NSAIDS

Splint

Steroid Injection

39
Q

What is the gold standard operative treatment for Osteoarthritis on base of thumb

A

Trapeziectomy

Musculoskeletal (22 decks)

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