Hand pathologies

Question 1

Dupuytren’s Contracture

Answer 1

Proliferative Connective tissue disorder

Question 2

Dupuytren’s Contracture Characteristics

Answer 2

Formation of nodules and a cord

Progresses to contractures at the MCP and PIP joints

Question 3

Dupuytren’s Contracture Pathology

Answer 3

Proliferation of myofibroblast cells

Production of abnormal collagen
- Type 3 instead of Type 1

Question 4

Dupuyten’s Contracture commonly affected digits

Answer 4

Ring finger

Little finger

Question 5

Dupuytren’s Contracture Risk Factors

Answer 5

male gender
North European/ Scandinavian 
Alcoholic Cirrhosis 
phenytoin THerapy
Diabetes
Other fibromatoses 
- Peyronie's Disease (penis)
-Lederhose Disease (plantar)

Question 6

Dupuytren’s Contracture Treatment

Answer 6

Surgery

Removal of diseased tissue
- fasciectomy

Division of cords
-fasciotomy

Amputation (only if severe0

Question 7

Trigger. Finger

Answer 7

Tendonitis of a flexor tendon

Question 8

Trigger finger pathogenesis

Answer 8

Tendonitis leads to nodular enlargement

Tendon gets trapped under the fascial puller (most commonly affects A1 pulley)

Finger is trapped in flexed position

Question 9

Trigger finger- common digits

Answer 9

Ring finger

Middle finger

Question 10

Trigger Finger Treatment

Answer 10

Injection of steroid around the tendon

If recurrent
- Surgery to incise the affected pulley to allow free movement

Question 11

Osteoarthritis

Answer 11

Degenerative disease of joints resulting in loss of articular cartilage, remodelling of adjacent bone and inflammation

Question 12

Osteoarthritis - Sites affected on hands

Answer 12

Most commonly occur at DIP joint in post-menopausal women

MCP joints are least commonly affected by OA

1st Carpo-metacarpal joint is most commonly affected

Question 13

Osteoarthritis Treatment

Answer 13

Mild to Moderate OA

• Removal of osteophytes
• Excision of associated mucous cysts

Severe OA in the hands
-Arthrodesis

OA in index fingers
- Arthrodesis

OA in other figners
- Replacement and arthroplasty

1st Carpo-metacarpal Joint

• Injection of steroid
• Excision arthroplasty
• Fusion for chronic pain

Question 14

Rheumatoid Arthritis (Stages of hand disease)

Answer 14

Synovitis + Tenosynovitis
- Swelling and Pain

Erosions of the joints
- Inflammatory Pannus

Joint Instability + Tendon Rupture
- Subluxations and chronic tenosynovitis may cause extensor tendon ruptures

Question 15

Common hand deformities in RA

Answer 15

Volar MCP joint subluxation

Ulnar deviation

Swan neck deformity
- Hyperextension at PIPs with flexion at DIPs

Boutonniere’s Deformity

Z-shaped thumb

Question 16

Hand Rheumatoid Arthritis Treatment

Answer 16

Tenosynovectomy
- May prevent tendon rupture

If extensor tendons rupture

• Direct surgical repair cannot be undertaken
• Tendon transfers or joint transfers are required to preserve function

If contractures are present
- Soft tissue releases

Joints with severe arthritis Damage

• Joint replacements
• Fusions