Hand Conditions

Question 1

What is dupuytrens contracture?

Answer 1

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.

Question 2

Which digits are commonly affected in dupuytrens contracture?

Answer 2

Ulnar digits

Question 3

What is the pathophysiology of dupuytrens contracture?

Answer 3

Fibroblastic hyperplasia and altered collagen matrix of the palmer fascia. This leads to thickening and contraction of the palmer fascia.

Question 4

What are the risk factors for dupuytrens contracture?

Answer 4

Male gender 
Smoking 
Occupational exposure (use of vibration tools or easy manual work)
DM 
Alcoholic liver disease 
Some genetic component

Question 5

What is Huestons test?

Answer 5

Specific test performed for patients with suspected dupuytrens contracture. Positive test is if pts can’t lay hand flat of a tabletop.

Question 6

What are the differential diagnosis of dupuytrens contracture?

Answer 6

Stenosis tenosynovitis
Ulnar nerve palsy
Trigger finger

Question 7

When is conservative management used in dupuytrens contracture and what is it?

Answer 7

Early presentation with no functional disability.

Hand therapy
Injectable collagenase clostridium histolyticum (CCM) - ultrasound guided

Question 8

When is surgical intervention considered in dupuytrens contracture and what is it?

Answer 8

Functional disability, rapidly progressing, MCP contracture >30 degrees and PIP contracture.

Fascieoctomy - regional, segmental, dermofasciotomy, closed and finger amputation

Question 9

What is the risk of surgical correction of dupuytrens contracture?

Answer 9

Post-op recurrence is up to 66%

Question 10

What is carpal tunnel syndrome?

Answer 10

Compression of the median nerve within the carpal tunnel of the wrist due to raised pressure within the compartment.

Question 11

What are the risk factors of carpal tunnel syndrome?

Answer 11

Female gender
Increasing age
Pregnancy 
Obesity 
Previous injury 
Occupations that involve repetitive had movements 

DM, RA, hypothyroidism

Question 12

What are the two tests that can be done for carpal tunnel syndrome?

Answer 12

Tinel’s test

Phalen’s test

Question 13

What are the clinical features of carpal tunnel syndrome?

Answer 13

Pain, numbness and/or parasthesia throughout median nerve sensory distribution. Worse at night.

Later signs - weakness of thumb abduction and wasting of thenar eminence

Question 14

What are the differential diagnosis for carpal tunnel syndrome?

Answer 14

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

Question 15

What can be done if carpal tunnel syndrome diagnosis is uncertain?

Answer 15

Nerve conduction studies

Question 16

What is the conservative management for carpal tunnel syndrome?

Answer 16

• Wrist splint - worn at night - prevent flexion of wrist - physio and training exercises
• Corticosteroid injections

Question 17

What is the surgical treatment for carpal tunnel syndrome?

Answer 17

Done when conservative failed and severely limiting cases.

Carpal tunnel release surgery

Question 18

What are the complication of carpal tunnel surgery?

Answer 18

Persistent CTS symptoms 
Infection 
Scar formation 
Nerve damage 
Trigger thumb 

Long term - untreated CTS can lead to permenant neurological impairment

Question 19

What nerve has been damaged if the pt is unable to oppose the thumb following surgical release of carpal tunnel syndrome?

Answer 19

Reccurent branch of median nerve which supplies the thenar muscles

Question 20

What is trigger finger?

Answer 20

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.

Question 21

What conditions in trigger finger associated with?

Answer 21

RA, amyloidosis, DM

Question 22

What is the pathophysiology of trigger finger?

Answer 22

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.

Question 23

What are the risk factors for trigger finger?

Answer 23

Occupation or hobby that involves prolonged gripping and use of the hand

Other risk factors : RA, DM, femal gender and increasing age

Question 24

What are the clinical features of trigger finger?

Answer 24

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

Question 25

What are the differential diagnosis for trigger finger?

Answer 25

Dupuytrens contracture
Infection
Ganglion
Acromegaly

Question 26

What is the management for mild cases of trigger finger?

Answer 26

Conservative:

• small splint to keep finger extended at night, activities
• steroid injections

Question 27

What is the surgical management for trigger finger?

Answer 27

Percutaneous trigger finger release

Surgical decompression

Question 28

What can occur after surgery of trigger finger?

Answer 28

Adhesions if immediate motion does to begin after surgery