Hand conditions Flashcards
What is Dupuytrens contracture
thickening and contracture of subdermal fascia leading to flexion deformity of the fingers
non-pathological fibres in Dupuytrens
bands
pathological fibres in Dupuytrens
cords
pathology of dupuytrens
proliferation of myofibroblasts and production of abnormal collagen (type 3 instead of type 1)
how does dupuytrens usually start
as a palmar pit or nodule
most commonly affected fingers in dupuytrens
ring and little fingers
risk factors of dupuytrens
male scandanavian family history alcoholic liver disease phenytoin therapy diabetes
Other fibromatoses which may occur in conjunction with dupuytrens
Peyronies disease in the penis
Ledderhose disease in the feet
what degree of contracture can be tolerated at the MCPj
30 degrees
surgical intervention of dupuytrens
fasciectomy (removes diseased tissue) or fasciotomy (divides cords)
newer treatments for dupuytrens
collagenase injections and percutaneous needle fasciotomy
what is trigger finger
when a swelling on a tendon causes it to be caught on the edge of the pulley (usually A1)
features of trigger finger
notable click may be heard before the finger flexes into a locked position, requiring manipulation to regain extension
most common fingers affected by trigger finger
middle and ring
treatment of trigger finger
tendon sheath injection with steroid and local anaesthetic
surgical division of the A1 pulley
Heberdens nodes
bony thickening of DIPJ seen in OA
Bouchard nodes
bony thickening of PIPJ seen in OA
treatment OA in hands
removal of osteophytes, excision of cysts, arthrodesis if severe
common thumb joint affected by OA
1st CMC
Joints which tend to be spared in RA
DIPs
disease progress in RA
synovitis and tenosyovitis
erosions of the joint
joint instability and tendon rupture
deformities seen in RA
volar MCPj subluxation
ulnar deviation
swan neck deformity
boutonniere deformity
what is a swan neck deformity
hyperextension at PIP with flexion at DIP
what is a boutonniere deformity
flexion at PIP with hyperextension at DIP
what is a ganglion cyst
outpouching of the synovial cavity
features of ganglion cysts
firm, smooth and rubbery and should transilluminate
what can cause ganglion cysts
partial tears during spraining
treatment of ganglion cysts
percutaneous rupture
surgical excision
what is the 2nd most common soft tissue swelling of the hand
giant cell tumour of the tendon sheath
where are giant cell tumours usually found
palmar surface, especially around the PIP joint of the index and middle fingers
features of giant cell tumours
well circumscribed, may or may not cause pain
histological features of giant cell tumours
multinucleated giant cells and haemosiderin
treatment of giant cell tumours
excision
what is a mucous cyst
outpouching of the synovial fluid from the DIPj
with what condition are mucous cysts associated with
OA
what is dequervains tenosynovitis
spontaneous, painful condition of the tendons of the thumb side of the wrist
presents swollen and red
test for dequervains tenosynovitis
finklesteins test - grip thumb in fist and ulnar deviate which causes pain
management of dequervains tenosynovitis
NSAIDs, splinting and rest
steroid injections
decompressive surgery
what is paronychia
infection within the nail fold, common in children
what increases the risk of paronychia
nail biting
management of paronychia
elevation, antibiotics and incision with drainage
features of flexor tendon sheath infection
infection starts at sheath then tracks up palm and arm
extremely painful
limited extension
tracking lymphangitis
management of flexor tendon sheath infection
surgical emergency
washout of tendon sheath
what is a subungal haematoma
bruise under the nail
treatment of subungal haematoma
trephine - heated paperclip melts through nail and relieves pressure
type 1 nailbed injury
soft tissue only
type 2 nailbed injury
soft tissue and nail
type 3 nailbed injury
soft tissue and nail and bone
type 4 nailbed injury
proximal 1/3 of phalanx
type 5 nailbed injury
proximal to DIPj
how to reduce a PIPj dislocation
pull it
what is a bennetts fracture
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
