Hand conditions

Question 1

What is a mucous cyst?

Answer 1

Outpouching of synovial fluid from DIP joints

Question 2

What is a ganglion?

Answer 2

Outpouching of the synovium that surrounds synovial joint cavities (usually around knees, wrists or ankles) - filled with synovial fluid and can transilluminate

Question 3

Management of mucous cysts and ganglions?

Answer 3

Leave alone

Excise if causing problems

Question 4

What is trigger finger?

Answer 4

When a finger gets stuck in flexion due to nodules on the flexor tendons getting stuck as they run under the pully

Question 5

Typical presentation of trigger finger?

Answer 5

finger gets stuck in flexion and has to be pulled to extend

tender over pully A1 (at the base of the finger)

Question 6

Management of trigger finger?

Answer 6

Wait - often resolves spontaneously
Steroid injection into tendon sheath (up to 2 times)
surgical release

Question 7

What goes through the carpal tunnel?

Answer 7

4 x flexor digitorum profundus tendons 
4 x flexor digitorum superficialis tendons 
1 x flexor pollucis longus tendon 
Median nerve 
(9 tendons 1 nerve)

Question 8

What is carpal tunnel syndrome?

Answer 8

compression neuropathy due to compression of the median nerve

Question 9

Which area on the hand is supplied by the median nerve and will be affected in carpal tunnel syndrome?

Answer 9

thumb and first 2.5 fingers (palm spared due to palmar cutaneous branch of median nerve which skips the carpal tunnel and goes over the flexor reticulum)

Question 10

When can symptoms be worse in carpal tunnel syndrome?

Answer 10

At night - especially numbness

Question 11

Typical presentation of carpal tunnel syndrome?

Answer 11

Pain/weakness/pins in needles in bits of hand supplied by the median nerve
Numbness that is worse at night
Wasting of muscles in the thenar eminence

Question 12

What are the 2 clinical tests that can be done to confirm a diagnosis of carpal tunnel syndrome?

Answer 12

Tinel test = tap over median nerve
Phalens test = hold wrist flexed for 1 min
Both will make symptoms worse in carpal tunnel syndrome

Question 13

What is DeQuervain’s Tenosynovitis and how does it present?

Answer 13

Repetitive strain injury to the first dorsal compartment (extensor pollucis longus and brevis) - pain and swelling over wrist at the base of the thumb

Question 14

Which condition is De Quervain’s Tenosynovitis associated with?

Answer 14

Rheumatoid arthritis

Question 15

Management of De Quervain’s Tenosynovitis?

Answer 15

NSAIDs, rest, splint
Steroid injection
Surgical decompression

Question 16

Management of carpal tunnel syndrome?

Answer 16

Steroid injections
Nighttime splint
Surgical decompression

Question 17

What is the difference between Dupytrens contracture and trigger finger?

Answer 17

Dupytrens is progressive flexion contractures due to thickening and contracture of the palmar fascia, trigger finger is fingers getting stuck in flexion due to nodules that have developed on the flexor tendons getting stuck under the pullys along the digits

Question 18

What are the 2 surgical management options for Dupytrens contracture?

Answer 18

Fasciectomy = removal of diseased palmar fascia 
Fasciotomy = division of cords

Question 19

Give 6 risk factors/associated conditions with carpal tunnel syndrome?

Answer 19

Distal radial fractures 
Diabetes
Rheumatoid arthritis 
Pregnancy 
Chronic renal failure 
Hypothyroidism 
(last 3 result in fluid retention so there is less space so compression)

Question 20

What type of collagen is produced in Dupytrens contracture?

Answer 20

Type III

Question 21

What is a positive Finkelstein’s test a sign of?

Answer 21

De Quervain’s tenosynovitis