Hand Injuries Flashcards
What is Dupuytren’s contracture
AD Palpable fibrosis of palmar aponeurosis
Loss of finger extension
Ring and little finger bend inward and can’t be extended
Fixed flexion deformity
Painless
Can be bilateral
Who is at risk of Dupuytren’s?
M>F Alcohol Liver disease Smoking HIV Epilepsy - phenytoin DM Manual labour Trauma
What is the treatment of Dupuytren’s
Partial fasiectomy - gold standard Arthrodesis Amputation Physio after surgery SPLINTS / steroid DONT WOKR
When do you consider surgery
When can’t straighten MTP / flatten hand
Percutaneous needle fasciotomy
Quick
No wound
High recurrence and risk of nerve injury
What are the symptoms of trigger finger?
Clicking sensation when move finger
Lump / nodule in palm where tendon is
Stiffness
May have to unlock fingers
What causes trigger finger
Swelling / inflammation in tendon catches on tendon sheath
Causes finger to lock in flexion
RA, DM, gout = more common
How do you Rx
Steroid injection + splint after
Percutaneous release if don’t respond
What causes De Quervain’s?
Frequent thumb abduction Ulnar deviation F>M Lactating + post-partum Manual / clerical workers Inflammatory arthritis
What is De Quervain’s
Thickening / inflammation of sheath containing APL and EPB
What are the symptoms
Several weeks pain Localised to radial wrist Aggravated by thumb movement / abduction Localised swelling possible Tendernes over radial side
How do you Dx
Examine thumb
+Ve FInklesein - pain along distal radius with resisted thumb extension
How do you Rx
Analgesia Rest / splint NSAID Steroid injection May need decompression
What should you consider
Base of thumb OA
What is a ganglion
Myxoid degeneration from joint synovium
how does it present
Firm non tender lump Smooth Not fixed to underlying tissue or skin Dorsal > volar 70% of discrete swellings in hand
How and when do you treat
Only treat if pain or pressure on median or ulnar nerve
Excision / aspiration
Other swellings in hand - Hebrden, Bouchard, Osler
Hebreden - bony outgrowth + chronic swelling on DIP
Bouchards - hard bony outgrowth on PIP
Osler - painful red raised lesion due to immune complex deposition
What is Carpal tunnel and what is present in carpal tunnel
Compression of median nerve in carpal tunnel
Flexor polices longus
4 tendons flexor digitorium superficalis
4 tendons flexor digitorum profundus
What causes carpal tunnel
Developmental Trauma - radius fracture Ganglion Fibroma Lipoma RA Gout TB Amyloid - myeloma
What are the symptoms of carpal tunnel
Nocturnal pain in thumb / index and middle finger
Paraesthesia in median nerve distribution
Wasting of thenar muscles
Weakness thumb abduction - APB
Often get relief by shaking
Who is more at risk
Pregnant
Hypothyroid
How do you Dx carpal tunnel
What makes diagnosis
Tinnel Phalens - makes Sx APB power - weak Sensation Electrophysiologicl studies / nerve conduction make Dx
How do you Rx
Steroid injection
Wrist splint
Surgical decompression - division of flexor retinaculum
What happens if you damage median nerve at level of elbow
Unable to pronate
Weak wrist flexion
Ulnar deviation
What are the symptoms of cubital tunnel
Numbness 4th + 5th finger
Weakness
Muscle wasting
Pain worse when leaning on elbow
What causes
OA
RA
Cervical spine / elbow injury
Prior trauma
How do you Dx
+ve Tinel and Phalens
X-ray
Nerve conduction
How do you treat
Steroid injection
Physio
Surgery if resistant for debridement
What are the cardinal signs of flexor tenosynovitis
Kanaval signs
Tenderness over tendon
Pain on passive extension
Universal swelling
What else can you get
Infection of tendon
May look like a cellulitis
