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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
Rx for Duputryen's Disease
Partial fascioctomy Percutaneous Fasciotomy Collegenase injection Steroid injectins
26
What is Duputryes Diathesis
Aggressive form of Duputryens disease
27
When does Duputryens diathesis present
Typically earlier (20s-30s)
28
Clinical features of Duputryens Diathesis
Multi-digit and bilateral involvement Faster progression high risk failure rate of surgery due to increased recurrence rate
29
What is a ganglion in the hand
Smooth multiocular swelling of the hand
30
Are dorsal or volar ganglion more common
Dorsal
31
Pathology of hand ganglion
Cyst containing jelly like fluid in communication with joint capsule, tendon sheath or ligament
32
What is the most common position of hand ganglion
Back of wrist
33
Clinical features of ganglion
Lump Firm Non-tender Mobile
34
Ix for hand ganglion
Clinical Dx - not initial testing ``` Consider: Aspiration x-ray USS ESR CRP ```
35
What is the commonest benign lump of the hand/wrist
Ganglion
36
Risk factors for ganglion
Female Age 20-40yrs Trauma
37
Rx for ganglions not causing any issues
Observation Watchful waiting Analgesia
38
Rx for ganglions causing problems
Cyst aspiration | Surgical excision
39
Which has a lower recurrence rate in ganglion aspiration or resection
Surgical resection
40
Complications of ganglion hand surgery
Painful scars Neurovascular damage Recurrence
41
What is the most common form of arthritis to affect the hands
OA base of thumb
42
What is the prevalence of OA base of thumb
1 in 3 F
43
Clinical features OA at base of thumb
``` Pain base of thumb Stiffening Swelling Deformity Decreased ROM Pain opening jarspinching ```
44
Ix for OA base of thumb
History Clinical assessment X-ray: May show degenerative changes
45
Non-operative Rx for OA base of thumb
Lifestyle modifications NSAIDs Splintage Steroid injections
46
Operative Rx for OA base of thumb
Trapeziectomy (gold standard) Fusion (Arthrodesis) Replacement
47
Gold standard surgical Rx for OA base of thumb
Trapeziectomy
48
What is De Quervain's Syndrome
Stensoing tenosynovitis of extensor pollicis brevis and abductor pollicis longus tendons (1st dorsal extensor compartment)
49
Who is De Quervains common in
Females Age 50-60 Increased risk in post partum lactating females Repeated use of these tendons
50
Causes of De Quervains
Often unknown | Overuse of the tendons
51
Clinical features De Quervains syndrome
``` Pain along back of thumb Pain base of thumb Pain radial side wrist Pain worse when tendon is stretched Swelling Decreased ROM ```
52
Ix for De Quervains syndrome
Clinical Dx | Finkelsteins test
53
What is Finkelsteins test
Pain elicited by gripping the thumn into the palm of the same hand with passive ulnar deviation
54
Non-operative Rx De Quervains
``` Rest Avoidance of precipitating factors analgesia (NSAIDs) Splintage ICE therapy ```
55
Operative Rx for De Quervains
Steroid injections | Surgery
56
Which is the most commonly fractures carpal bone
Scaphoid
57
What is the main worrying complication of Scaphoid fracture
AVN
58
Ix for Scaphoid fracture
Dedicated scaphoid x-ray series
59
Rx for clinically detected but radiologically undetected scaphoid fracture
Case and re-xray in 2 weeks
60
What does missed scaphoid fractures increase the chance of developing long term
OA

Musculoskeletal (13 decks)

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