Hand conditions Flashcards
who gets dupuytrens ?
autosomal dominant, sporadic 30%
males
white
associated with DM, alcohol, tobacco, HIV, epilepsy
what is the pathology of dupytrens ?
myofibroblasts
intracellular contractile elements
regulated by growth factors
production of collagen
what are problems with dupytrens ?
usually not painful
functional problems - loss of finger extension
grip
what is non-operative treatment for dupytrens ?
observe
radiotherapy
splints DONT work
what is operative treatment for dupytrens ?
partial fasciectomy - can’t be cured, stiffness needs physio
dermo-fasciectomy - less common, intense physio
arthrodesis
amputation
percutaneous needle fasciotomy
collagenase
what is the pathology of trigger finger ?
thickenings in tendon sheath to finger results in the tendon catching on the pulley system
who gets trigger finger ?
F>M 40-60 ring>thumb>middle local trauma associated with RA, DM, gout
how is trigger finger diagnosed ?
Hx clicking sensation with digit movement lump in palm under pulley may have to unlock clicking may progress to locking
what is non-operative treatment of trigger finger ?
splint age
steroids
what is operative management of trigger finger ?
percutaneous release
open surgery
what is de Quervain syndrome ?
inflammation of the tendons that control the thumb
causing pain
1st dorsal extensor segment
fibre-osseous tunnel at distal radius, thickening of localised segment
how does de Quervain syndrome present ?
several week Hx of radial sided wrist pain
aggravated by movement of the thumb
may have seen localised swelling
localised tenderness over tunnel
who gets de Quervain syndrome ?
F>M 6:1
50-60
post party and lactating females
activities with frequent thumb abduction
what is an important differential to de Quervain syndrome ?
OA at the base of the thumb
what are important tests for de Quervain syndrome ?
Finklestien’s test - thumb in fist and adducting wrist causes pain
resisted thumb extension
what are treatment options for de Quervain syndrome ?
non-operative - splints, steroids
operative - decompression
what is a ganglion ?
a myxoid degeneration from joint syndovia
arise from joint capsule, tendon sheath or ligament
who gets ganglia ?
F>M 2:1 20-40 dorsal>palmer 3:1 70% of all hand/wrist swellings associated with recurrent injury
what are clinical features of a ganglia ?
present with lump firm, non-tender change in size smooth occasionally lobulated normally not fixed to underlying tissues never fixed to skin
what is the treatment for a ganglia ?
non-operative - observe, aspiration
operative - excision including root
what is the presentation of OA at base of thumb ?
pain stiffness swelling deformity loss of function 1 in 3 women
what is the non-operative management of OA ?
life style modifications
NSAIDs
splint
steroid injection
what is the operative management of OA ?
trapeziectomy - gold standard, moderate pinch grip, interposition flap or ligament reconstuction
fusion
replacement
