Hand conditions

Question 1

What is Dupuytrens contracture

Answer 1

thickening and contracture of subdermal fascia leading to flexion deformity of the fingers

Question 2

non-pathological fibres in Dupuytrens

Answer 2

bands

Question 3

pathological fibres in Dupuytrens

Answer 3

cords

Question 4

pathology of dupuytrens

Answer 4

proliferation of myofibroblasts and production of abnormal collagen (type 3 instead of type 1)

Question 5

how does dupuytrens usually start

Answer 5

as a palmar pit or nodule

Question 6

most commonly affected fingers in dupuytrens

Answer 6

ring and little fingers

Question 7

risk factors of dupuytrens

Answer 7

male 
scandanavian
family history 
alcoholic liver disease 
phenytoin therapy 
diabetes

Question 8

Other fibromatoses which may occur in conjunction with dupuytrens

Answer 8

Peyronies disease in the penis

Ledderhose disease in the feet

Question 9

what degree of contracture can be tolerated at the MCPj

Answer 9

30 degrees

Question 10

surgical intervention of dupuytrens

Answer 10

fasciectomy (removes diseased tissue) or fasciotomy (divides cords)

Question 11

newer treatments for dupuytrens

Answer 11

collagenase injections and percutaneous needle fasciotomy

Question 12

what is trigger finger

Answer 12

when a swelling on a tendon causes it to be caught on the edge of the pulley (usually A1)

Question 13

features of trigger finger

Answer 13

notable click may be heard before the finger flexes into a locked position, requiring manipulation to regain extension

Question 14

most common fingers affected by trigger finger

Answer 14

middle and ring

Question 15

treatment of trigger finger

Answer 15

tendon sheath injection with steroid and local anaesthetic

surgical division of the A1 pulley

Question 16

Heberdens nodes

Answer 16

bony thickening of DIPJ seen in OA

Question 17

Bouchard nodes

Answer 17

bony thickening of PIPJ seen in OA

Question 18

treatment OA in hands

Answer 18

removal of osteophytes, excision of cysts, arthrodesis if severe

Question 19

common thumb joint affected by OA

Answer 19

1st CMC

Question 20

Joints which tend to be spared in RA

Answer 20

DIPs

Question 21

disease progress in RA

Answer 21

synovitis and tenosyovitis
erosions of the joint
joint instability and tendon rupture

Question 22

deformities seen in RA

Answer 22

volar MCPj subluxation
ulnar deviation
swan neck deformity
boutonniere deformity

Question 23

what is a swan neck deformity

Answer 23

hyperextension at PIP with flexion at DIP

Question 24

what is a boutonniere deformity

Answer 24

flexion at PIP with hyperextension at DIP

Question 25

what is a ganglion cyst

Answer 25

outpouching of the synovial cavity

Question 26

features of ganglion cysts

Answer 26

firm, smooth and rubbery and should transilluminate

Question 27

what can cause ganglion cysts

Answer 27

partial tears during spraining

Question 28

treatment of ganglion cysts

Answer 28

percutaneous rupture | surgical excision

Question 29

what is the 2nd most common soft tissue swelling of the hand

Answer 29

giant cell tumour of the tendon sheath

Question 30

where are giant cell tumours usually found

Answer 30

palmar surface, especially around the PIP joint of the index and middle fingers

Question 31

features of giant cell tumours

Answer 31

well circumscribed, may or may not cause pain

Question 32

histological features of giant cell tumours

Answer 32

multinucleated giant cells and haemosiderin

Question 33

treatment of giant cell tumours

Answer 33

excision

Question 34

what is a mucous cyst

Answer 34

outpouching of the synovial fluid from the DIPj

Question 35

with what condition are mucous cysts associated with

Answer 35

OA

Question 36

what is dequervains tenosynovitis

Answer 36

spontaneous, painful condition of the tendons of the thumb side of the wrist presents swollen and red

Question 37

test for dequervains tenosynovitis

Answer 37

finklesteins test - grip thumb in fist and ulnar deviate which causes pain

Question 38

management of dequervains tenosynovitis

Answer 38

NSAIDs, splinting and rest steroid injections decompressive surgery

Question 39

what is paronychia

Answer 39

infection within the nail fold, common in children

Question 40

what increases the risk of paronychia

Answer 40

nail biting

Question 41

management of paronychia

Answer 41

elevation, antibiotics and incision with drainage

Question 42

features of flexor tendon sheath infection

Answer 42

infection starts at sheath then tracks up palm and arm extremely painful limited extension tracking lymphangitis

Question 43

management of flexor tendon sheath infection

Answer 43

surgical emergency | washout of tendon sheath

Question 44

what is a subungal haematoma

Answer 44

bruise under the nail

Question 45

treatment of subungal haematoma

Answer 45

trephine - heated paperclip melts through nail and relieves pressure

Question 46

type 1 nailbed injury

Answer 46

soft tissue only

Question 47

type 2 nailbed injury

Answer 47

soft tissue and nail

Question 48

type 3 nailbed injury

Answer 48

soft tissue and nail and bone

Question 49

type 4 nailbed injury

Answer 49

proximal 1/3 of phalanx

Question 50

type 5 nailbed injury

Answer 50

proximal to DIPj

Question 51

how to reduce a PIPj dislocation

Answer 51

pull it

Question 52

what is a bennetts fracture

Answer 52

extensor tendon of the thumb pulls the thumb downwards as the fracture means it is not attached to the rest of the hand fracture subluxation