Hand Conditions Flashcards
What is dupuytrens contracture?
Common condition involving the contraction of the longitudinal palmer fascia
Typically starts with painless nodules, fibrous cords and flexion contracture that can severely limit digital movement and quality of life.
Which digits are commonly affected in dupuytrens contracture?
Ulnar digits
What is the pathophysiology of dupuytrens contracture?
Fibroblastic hyperplasia and altered collagen matrix of the palmer fascia. This leads to thickening and contraction of the palmer fascia.
What are the risk factors for dupuytrens contracture?
Male gender Smoking Occupational exposure (use of vibration tools or easy manual work) DM Alcoholic liver disease Some genetic component
What is Huestons test?
Specific test performed for patients with suspected dupuytrens contracture. Positive test is if pts can’t lay hand flat of a tabletop.
What are the differential diagnosis of dupuytrens contracture?
Stenosis tenosynovitis
Ulnar nerve palsy
Trigger finger
When is conservative management used in dupuytrens contracture and what is it?
Early presentation with no functional disability.
Hand therapy
Injectable collagenase clostridium histolyticum (CCM) - ultrasound guided
When is surgical intervention considered in dupuytrens contracture and what is it?
Functional disability, rapidly progressing, MCP contracture >30 degrees and PIP contracture.
Fascieoctomy - regional, segmental, dermofasciotomy, closed and finger amputation
What is the risk of surgical correction of dupuytrens contracture?
Post-op recurrence is up to 66%
What is carpal tunnel syndrome?
Compression of the median nerve within the carpal tunnel of the wrist due to raised pressure within the compartment.
What are the risk factors of carpal tunnel syndrome?
Female gender Increasing age Pregnancy Obesity Previous injury Occupations that involve repetitive had movements
DM, RA, hypothyroidism
What are the two tests that can be done for carpal tunnel syndrome?
Tinel’s test
Phalen’s test
What are the clinical features of carpal tunnel syndrome?
Pain, numbness and/or parasthesia throughout median nerve sensory distribution. Worse at night.
Later signs - weakness of thumb abduction and wasting of thenar eminence
What are the differential diagnosis for carpal tunnel syndrome?
Cervical radiculopathy - may involve arm and necks pain
Pronator teres syndrome (median nerve compression by pronator teres) - sensation of palm and forearm may be lost too
Flexor carpi radialis tenosynovitis - tenderness at the base of the thumb
What can be done if carpal tunnel syndrome diagnosis is uncertain?
Nerve conduction studies
What is the conservative management for carpal tunnel syndrome?
- Wrist splint - worn at night - prevent flexion of wrist - physio and training exercises
- Corticosteroid injections
What is the surgical treatment for carpal tunnel syndrome?
Done when conservative failed and severely limiting cases.
Carpal tunnel release surgery
What are the complication of carpal tunnel surgery?
Persistent CTS symptoms Infection Scar formation Nerve damage Trigger thumb
Long term - untreated CTS can lead to permenant neurological impairment
What nerve has been damaged if the pt is unable to oppose the thumb following surgical release of carpal tunnel syndrome?
Reccurent branch of median nerve which supplies the thenar muscles
What is trigger finger?
Condition in which the finger or thumb click or lock when in flexion preventing a return to extension. It can affect one or more tendons and most occur spontaneously.
What conditions in trigger finger associated with?
RA, amyloidosis, DM
What is the pathophysiology of trigger finger?
Preceded by flexor tenosynovitis - repetitive movements leads to inflammation of the tendon and sheath. This leads to localised nodal formation distal to the pulley(usually A1 pulley). So when finger flexes nodal pulled through but unable to come out other end when extending as it gets stuck. So digit becomes locked.
What are the risk factors for trigger finger?
Occupation or hobby that involves prolonged gripping and use of the hand
Other risk factors : RA, DM, femal gender and increasing age
What are the clinical features of trigger finger?
Intially pt may complain of painless clicking/snapping/catching when tying to extend their finger - can be bilateral
Then may become painful esp over volar aspect of the MCP joint
Examination palpate proximal phalanx to assess for click/pain and lumps of masses
What are the differential diagnosis for trigger finger?
Dupuytrens contracture
Infection
Ganglion
Acromegaly
What is the management for mild cases of trigger finger?
Conservative:
- small splint to keep finger extended at night, activities
- steroid injections
What is the surgical management for trigger finger?
Percutaneous trigger finger release
Surgical decompression
What can occur after surgery of trigger finger?
Adhesions if immediate motion does to begin after surgery
