Hand conditions

Question 1

who gets dupuytrens ?

Answer 1

autosomal dominant, sporadic 30%
males
white
associated with DM, alcohol, tobacco, HIV, epilepsy

Question 2

what is the pathology of dupytrens ?

Answer 2

myofibroblasts
intracellular contractile elements
regulated by growth factors
production of collagen

Question 3

what are problems with dupytrens ?

Answer 3

usually not painful
functional problems - loss of finger extension
grip

Question 4

what is non-operative treatment for dupytrens ?

Answer 4

observe
radiotherapy
splints DONT work

Question 5

what is operative treatment for dupytrens ?

Answer 5

partial fasciectomy - can’t be cured, stiffness needs physio
dermo-fasciectomy - less common, intense physio
arthrodesis
amputation

percutaneous needle fasciotomy
collagenase

Question 6

what is the pathology of trigger finger ?

Answer 6

thickenings in tendon sheath to finger results in the tendon catching on the pulley system

Question 7

who gets trigger finger ?

Answer 7

F>M
40-60
ring>thumb>middle
local trauma
associated with RA, DM, gout

Question 8

how is trigger finger diagnosed ?

Answer 8

Hx
clicking sensation with digit movement
lump in palm under pulley
may have to unlock 
clicking may progress to locking

Question 9

what is non-operative treatment of trigger finger ?

Answer 9

splint age

steroids

Question 10

what is operative management of trigger finger ?

Answer 10

percutaneous release

open surgery

Question 11

what is de Quervain syndrome ?

Answer 11

inflammation of the tendons that control the thumb
causing pain
1st dorsal extensor segment
fibre-osseous tunnel at distal radius, thickening of localised segment

Question 12

how does de Quervain syndrome present ?

Answer 12

several week Hx of radial sided wrist pain
aggravated by movement of the thumb
may have seen localised swelling
localised tenderness over tunnel

Question 13

who gets de Quervain syndrome ?

Answer 13

F>M 6:1
50-60
post party and lactating females
activities with frequent thumb abduction

Question 14

what is an important differential to de Quervain syndrome ?

Answer 14

OA at the base of the thumb

Question 15

what are important tests for de Quervain syndrome ?

Answer 15

Finklestien’s test - thumb in fist and adducting wrist causes pain
resisted thumb extension

Question 16

what are treatment options for de Quervain syndrome ?

Answer 16

non-operative - splints, steroids

operative - decompression

Question 17

what is a ganglion ?

Answer 17

a myxoid degeneration from joint syndovia

arise from joint capsule, tendon sheath or ligament

Question 18

who gets ganglia ?

Answer 18

F>M 2:1
20-40
dorsal>palmer 3:1
70% of all hand/wrist swellings
associated with recurrent injury

Question 19

what are clinical features of a ganglia ?

Answer 19

present with lump
firm, non-tender
change in size
smooth
occasionally lobulated
normally not fixed to underlying tissues
never fixed to skin

Question 20

what is the treatment for a ganglia ?

Answer 20

non-operative - observe, aspiration

operative - excision including root

Question 21

what is the presentation of OA at base of thumb ?

Answer 21

pain
stiffness
swelling
deformity
loss of function
1 in 3 women

Question 22

what is the non-operative management of OA ?

Answer 22

life style modifications
NSAIDs
splint
steroid injection

Question 23

what is the operative management of OA ?

Answer 23

trapeziectomy - gold standard, moderate pinch grip, interposition flap or ligament reconstuction
fusion
replacement