Hand disorder Flashcards
A 62 year old man presents after his wife commented on the unusual shape of his fingers. On examination, he has a hard swelling adjacent to the distal interphalangeal joint of his index finger of the right hand with lateral deviation of the finger tip. There is no sensory disturbance and the swelling is not tender. Which pathological process underpins the underlying diagnosis?
Rheumatoid arthritis Osteoarthritis Infection with atypical organisms Deposition of immune complexes Malignancy
The description fits with Heberdens nodes. These are bony outgrowths that occur in the distal interphalangeal joint in association with osteoarthritis. They may skew the finger tip sideways. Bouchards nodes are similar, but affect the proximal interphalangeal joint.
A 42 year old lady who has systemic lupus erythematosus presents to the clinic with a 5 day history of a painful purple lesion on her index finger. On examination, she has a tender red lesion on the index finger. What is the diagnosis?
Heberdens nodes Oslers nodes Bouchards nodes Malignant fibrous histiocytoma Osteoclastoma
Osler nodes are normally described as tender, purple/red raised lesions with a pale centre. These lesions occur as a result of immune complex deposition. These occur most often in association with endocarditis. However, other causes include SLE, gonorrhoea, typhoid and haemolytic anaemia.
A 52 year old male presents with discomfort in the fingers of his left hand. On examination, the ring and little fingers of his left hand are flexed and unable to extend completely. He is able to make a fist with the hand. Palpation reveals thickened nodules on the medial half of the palm. What is the most likely diagnosis?
de Quervain's tenosynovitis Tendon sheath infection Dupuytren's contracture Ganglion Heberden's nodes
Discomfort of the hand is not uncommon in Dupuytrens contracture, true pain is unusual. The disease most commonly affects the ring and little fingers.
A 62 year old lady presents with a non tender lump overlying the distal interphalangeal joint of the index finger. On examination, she has a hard, non tender lump overlying the joint and deviation of the tip of the finger. What is the nature of the lesion?
Oslers nodes Bouchards nodes Heberdens nodes Osteosarcoma Infective collection
Heberdens nodes may produce swelling of the distal interphalangeal joint with deviation of the finger tip.
A 17 year old boy is brought to the clinic by his mother who is concerned about a lesion that has developed on the dorsal surface of his left hand. On examination, he has a soft fluctuant swelling on the dorsal aspect of the hand, it is most obvious on making a fist. What is the nature of the lesion?
Ganglion Osteosarcoma Malignant fibrous histiocytoma Bouchards nodes Oslers nodes
Ganglions commonly occur in the hand and are usually associated with tendons. They are typically soft and fluctuant. They do not require removal unless they are atypical or causing symptoms.
A 63 year old lady presents with a three month history of pins and needles in the fingers of the right hand, particularly at night. On examination, there is some loss of the sensation over the palmar aspect of the lateral three fingers and wasting of the thenar eminence. What is the underlying diagnosis?
Radial nerve injury Ulnar nerve injury Psychosomatic illness Wrist arthritis Carpal tunnel syndrome
Carpal tunnel syndrome commonly produces pain at night as the wrists are flexed during sleep. Compromise of the median nerve may produce wasting of the thenar eminence muscles.
