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MUSCULOSKELETAL > Hand Conditions and Injury > Flashcards

Hand Conditions and Injury Flashcards

1
Q

What is a mucous cyst?

A

Out-pouching of the DIP joint synovial fluid

Found in OA

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2
Q

What symptoms do mucous cysts usually have for the patient?

A
  • painful
  • sometimes there is discharge
  • deform nail, causing ridge
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3
Q

How is a mucous cyst usually treated?

A

may be left alone

OR in some cases = excision

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4
Q

How is a ganglion cyst defined?

A
  • Outpouchings of synovial cavity
  • Filled with synovial fluid

=> more common where high concentration of synovial joints eg. wrist

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5
Q

What symptoms can a ganglion cyst cause?

A
  • Fluctuate (not always there)
  • painless
  • may feel tight
  • Usually resolve with time
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6
Q

How are ganglions managed?

A
  • Left alone
  • aspirated (difficult as fluid inside is so viscous)
  • excision if causing difficulty to patient
    (e. g. keeps catching it on clothes etc)
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7
Q

Tendons in the fingers run within what?

A

The Flexor tendon sheath

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8
Q

What can finger tendon swelling lead to?

A

Trigger Finger (catches in flexion)

swollen tendon gets caught on A1 pulley

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9
Q

What is the function of pulleys in the fingers?

A

Anchor tendons to bones for more effective fine movement

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10
Q

Explain the different stages of Trigger Finger

A

Early: Finger sticks in flexion but can spring back to extension after period of time

Middle: Pt needs to use their other hand to extend the finger

Late: Patient cannot extend the finger at all

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11
Q

What methods of examination can confirm a suspected trigger finger?

A

demonstrate triggering

tender over A1 pulley

feel nodule pass beneath pulley

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12
Q

How is Trigger Finger treated?

A

Often resolves spontaneously
=> splint to prevent flexion

Tendon sheath inj.

- steroid + Local anaesthetic
- often curative
- may be repeated up to 3x

Surgery

- under General or Local Anaesthetic
- divide A1 pulley (not A2 or 4 as these are the most important)
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13
Q

What hand condition is characterised by a painful, red and swollen thumb that has come on spontaneously?

A

De Quervains Tenosynovitis

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14
Q

What examination can be used to test for De Quervains?

A

Finklestein’s test

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15
Q

How is De Quervains managed?

A

First:

  • NSAIDS
  • splint
  • rest

Next:
- steroid injection

Finally:
- surgical decompression

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16
Q

What group of people are particularly likely to get De Quervains?

A

Pregnant women

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17
Q

What condition thickens and contracts the subdermal fascia leading to a fixed flexion deformity of the fingers?

A

Dupuytrens Contracture

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18
Q

How do Dupuytren’s contractures usually begin?

A

Usually starts as palmar pit/nodule

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19
Q

What can predispose to Dupuytren’s Contracture?

A
  • genetics (?Viking)
  • Diabetes Mellitus
  • alcohol/cirrhosis
  • smoking
  • epilepsy/anti-epileptic medication
  • ?trauma
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20
Q

What examination is most useful in determining a Dupuytrens contracture?

A

Table top test

If patient cant extend fingers far enough their hand will not be flat on the table

21
Q

How is Dupuytren’s contracture usually treated conservatively?

A
  • stretches

- activity modification

22
Q

What surgical treatments are available for a Dupuytrens Contracture?

A
  • non-segmental/ segmental fasciectomy
  • dermofasciectomy (skin graft)
  • amputation if severe (past PIP)
  • percutaneous needle fasciotomy
    (release that can be repeated)
23
Q

What is a Paronychia?

A
  • infection within nail fold
  • May result in pus collection
  • often in children
24
Q

What action is a large risk for paronychia formation?

A

Nail biting

25
Q

How are paronychias usually treated?

A
  • elevate (as with any infection)
  • antibiotics
  • incise and drain collection
26
Q

How does an infection within the tendon sheath usually present?

A

Tracking up palm + arm
Extremely painful
limited extension (including passive), due to pain
May have tracking lymphangitis

27
Q

How is a tendon sheath infection usually treated?

A

wash out tendon sheath

surgical emergency

28
Q

What part of a hand history is the most important?

A
  • dominant hand
  • PMHx
  • DM
  • arthritis
  • cardio-resp (for GA factors)
  • Occupation
  • Hobbies/sports
29
Q

If there is a history of trauma what points of the history are most important?

A
  • crush/ sharp/ burn
  • gloves/protective items worn?
  • timing of injury - especially if partial/complete amputation
  • Degloving (skin seperation)
  • Estimate level of energy
30
Q

What should you look for when examining a hand injury?

A 
Wound
Nails
Deformity
Swelling
Point of tenderness
Movement
Neurological
31
Q

When inspecting a hand injury wound, what is important to look for?

A 
Where
How long
How deep
Clean/dirty
Skin loss
Obvious structures in wound
e.g. bone/tendon/foreign bodies/dirt/grit
32
Q

What is the name given to a collection of blood under the nail bed and nail plate?

A

Subungual haematoma

33
Q

How is a subungual haematoma treated?

A

If pressure causing pain => Trephine

  • Needle through nail plate and bed to relieve pressure and blood
34
Q

What is the drawback of relieving the pressure in a subungual haematoma?

A

Nail may eventually fall off

BUT will grow back

35
Q

How are nail and nail bed injuries classified, and what does each class affect?

A 
Type 1- Soft tissue only
Type 2- Soft tissue + nail
Type 3- Soft tissue + nail + bone
Type 4- Proximal ⅓ of phalanx
Type 5- proximal to DIP Joint
36
Q

How is each level of nail/nailbed injury treated?

A

Level 1 + 2- dressing only
Level 3- repair nail bed + stabilise bone
Level 4- as above unless <5mm of nail bed ➞ ablate

If tip of finger = not available, terminalise or V-Y flap

37
Q

What is a Boxers fracture?

A

Fracture of the 5th Metacarpal near the MCP joint

38
Q

How is a Boxers Fracture treated?

A 
Buddy Strap (to adj. finger)
Early mobilisation
39
Q

An avulsion fracture of the DIP joint is given what name?

A

Mallet Finger

40
Q

How would a Mallet fracture present on examination?

A

resisted finger extension

tenderness/bruising

41
Q

How is Mallet Finger treated?

A

Constant mallet splint for 6 weeks

Occasionally fix large displaced avulsion fragment using wire

Dermatotenodesis (chronic cases)

42
Q

How is a PIP joint dislocation treated acutely?

A

pull to reduce
buddy strap

delayed presentation may not reduce => bone fusion

43
Q

Where is a Bennetts Fracture usually found?

A

At 1st MCP joint

44
Q

How is the hand divided into sections when discussing tendon injury?

A 
I - distal to FDS tendon
II - No mans land
III - Lumbrical Origin
IV - Carpal Tunnel
V - Muscle Tendon Junction
45
Q

What are the basic principles for a patient presenting with an extensive and mutilating injury to the hand?

A
  • Preserve amputated parts on ice
  • Early debridement
  • Establish stable bony support
  • Establish vascularity
  • Repair all tissues- nerves, tendons
  • Establish skin grafts/flaps
  • Prevent/treat infection
  • Aggressive mobilisation
46
Q

Why is a zig-zag incision used to surgically repair a dupuytrens contracture?

A

A straight incision would heal as a scar which is difficult and painful to flex

Zig-zag scar allows movement with less pain

47
Q

What is considered the “Standard Burns Treatment”

A

respiratory
infection
dehydration
pain relief

48
Q

What treatments are specifically used for burns in the hands?

A
  • Excise damaged skin
  • perform split skin grafts early
  • Aggressive mobilisation to prevent finger stiffness
  • Escharotomy (releasing burnt skin)
49
Q

What is Eschar?

A

Thick, leathery, inelastic skin which can form after burns

May require surgical release to allow movement

MUSCULOSKELETAL (27 decks)

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