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Musculoskeletal > Hand Pathology > Flashcards

Hand Pathology Flashcards

1
Q

does trigger finger mainly affect F or M

A

F

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2
Q

What is trigger finger characterised by

A

Catching or locking of the finger

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3
Q

Clinical features of trigger finger

A

Clicking sensation with movement of digit
Lump in palmar aspect under pulley
May have to use the other hand to passively release finger
Clicking may progress to locking

all with flexion

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4
Q

Ix for trigger finger

A

Clinical Dx

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5
Q

Non-operative Rx trigger finger

A

Splintage
Rest
Analgesia
Steroid injection

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6
Q

Operative Rx for trigger finger

A

Intractable cases may require surgery:

Percutaneous release

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7
Q

associated conditions of trigger finger

A 
DM 
RA 
Gout 
Thyroid disease 
Amyloidosis
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8
Q

Complications of trigger finger

A

Recurrence

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9
Q

What causes Carpal Tunnel

A

Compression of the median as it passes through the carpal tunnel

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10
Q

What is the most common entrapment neuropathy

A

Carpal tunnel

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11
Q

Risk factors of carpal tunnel

A 
Pregnancy 
DM 
Obesity 
Acromegaly 
RA 
Hypothyroidism 
Female sex 
Alteration in carpal tunnel space 
Smoking
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12
Q

Symptoms of Carpal Tunnel

A 
Numbness in median n. distribution 
Tingling in median are distribution 
Pain 
Nocturnal pain 
Nocturnal paraesthesia
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13
Q

What is the median n. sensory distribution of the hand

A

Lateral 3.5 digits

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14
Q

Ix for Carpal Tunnel

A

Usually clinical Dx
Tinel’s Test
Phalens Test
Nerve conduction studies (EMG)

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15
Q

Describe Tinel’s test

A

Tapping over anterior wrist

+ve if this elicits symptoms

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16
Q

Describe Phalen’s Test

A

Backward praying for 60 seconds

+ve if this elicits symptoms

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17
Q

Conservative Rx for Carpal Tunnel

A 
Wrist splint 
Rest 
Weight reduction 
NSAIDs
Steroid injections
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18
Q

Surgical Rx of Carpal Tunnel

A

Carpal Tunnel release surgery

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19
Q

Which gender is Duputryens Contracture most common in

A

M

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20
Q

What is Duputryens disease

A

Painless progressive thickening of palmar fascia with skin puckering and tethering

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21
Q

Risk factors for Duputryens

A 
M>F
Increasing age
FH 
High alcohol intake 
DM 
Smoking
Hepatic cirrhosis
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22
Q

Clinical features of Duputryens

A 
Thickening or nnodules in palm 
Flexion contracture of finger 
Loss ROM of affected finger 
\+ve Hueston's table top test 
Difficulties with manual activities
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23
Q

Ix for Duputryens

A

Clinical (O/E)
Hueston’s Table top test
Maybe consider USS

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24
Q

Duputryens Rx in asymptomatic patients

A

Watchful waiting

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25
Q

Rx for Duputryen’s Disease

A

Partial fascioctomy
Percutaneous Fasciotomy
Collegenase injection
Steroid injectins

26
Q

What is Duputryes Diathesis

A

Aggressive form of Duputryens disease

27
Q

When does Duputryens diathesis present

A

Typically earlier (20s-30s)

28
Q

Clinical features of Duputryens Diathesis

A

Multi-digit and bilateral involvement
Faster progression
high risk failure rate of surgery due to increased recurrence rate

29
Q

What is a ganglion in the hand

A

Smooth multiocular swelling of the hand

30
Q

Are dorsal or volar ganglion more common

A

Dorsal

31
Q

Pathology of hand ganglion

A

Cyst containing jelly like fluid in communication with joint capsule, tendon sheath or ligament

32
Q

What is the most common position of hand ganglion

A

Back of wrist

33
Q

Clinical features of ganglion

A

Lump
Firm
Non-tender
Mobile

34
Q

Ix for hand ganglion

A

Clinical Dx - not initial testing

Consider:
Aspiration 
x-ray 
USS 
ESR 
CRP
35
Q

What is the commonest benign lump of the hand/wrist

A

Ganglion

36
Q

Risk factors for ganglion

A

Female
Age 20-40yrs
Trauma

37
Q

Rx for ganglions not causing any issues

A

Observation
Watchful waiting
Analgesia

38
Q

Rx for ganglions causing problems

A

Cyst aspiration

Surgical excision

39
Q

Which has a lower recurrence rate in ganglion aspiration or resection

A

Surgical resection

40
Q

Complications of ganglion hand surgery

A

Painful scars
Neurovascular damage
Recurrence

41
Q

What is the most common form of arthritis to affect the hands

A

OA base of thumb

42
Q

What is the prevalence of OA base of thumb

A

1 in 3 F

43
Q

Clinical features OA at base of thumb

A 
Pain base of thumb
Stiffening 
Swelling 
Deformity 
Decreased ROM 
Pain opening jarspinching
44
Q

Ix for OA base of thumb

A

History
Clinical assessment
X-ray:
May show degenerative changes

45
Q

Non-operative Rx for OA base of thumb

A

Lifestyle modifications
NSAIDs
Splintage
Steroid injections

46
Q

Operative Rx for OA base of thumb

A

Trapeziectomy (gold standard)
Fusion (Arthrodesis)
Replacement

47
Q

Gold standard surgical Rx for OA base of thumb

A

Trapeziectomy

48
Q

What is De Quervain’s Syndrome

A

Stensoing tenosynovitis of extensor pollicis brevis and abductor pollicis longus tendons (1st dorsal extensor compartment)

49
Q

Who is De Quervains common in

A

Females
Age 50-60
Increased risk in post partum lactating females
Repeated use of these tendons

50
Q

Causes of De Quervains

A

Often unknown

Overuse of the tendons

51
Q

Clinical features De Quervains syndrome

A 
Pain along back of thumb 
Pain base of thumb
Pain radial side wrist 
Pain worse when tendon is stretched 
Swelling 
Decreased ROM
52
Q

Ix for De Quervains syndrome

A

Clinical Dx

Finkelsteins test

53
Q

What is Finkelsteins test

A

Pain elicited by gripping the thumn into the palm of the same hand with passive ulnar deviation

54
Q

Non-operative Rx De Quervains

A 
Rest 
Avoidance of precipitating factors 
analgesia (NSAIDs)
Splintage
ICE therapy
55
Q

Operative Rx for De Quervains

A

Steroid injections

Surgery

56
Q

Which is the most commonly fractures carpal bone

A

Scaphoid

57
Q

What is the main worrying complication of Scaphoid fracture

A

AVN

58
Q

Ix for Scaphoid fracture

A

Dedicated scaphoid x-ray series

59
Q

Rx for clinically detected but radiologically undetected scaphoid fracture

A

Case and re-xray in 2 weeks

60
Q

What does missed scaphoid fractures increase the chance of developing long term

A

OA

Musculoskeletal (13 decks)

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