Hand Pathology Flashcards
does trigger finger mainly affect F or M
F
What is trigger finger characterised by
Catching or locking of the finger
Clinical features of trigger finger
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
Ix for trigger finger
Clinical Dx
Non-operative Rx trigger finger
Splintage
Rest
Analgesia
Steroid injection
Operative Rx for trigger finger
Intractable cases may require surgery:
Percutaneous release
associated conditions of trigger finger
DM RA Gout Thyroid disease Amyloidosis
Complications of trigger finger
Recurrence
What causes Carpal Tunnel
Compression of the median as it passes through the carpal tunnel
What is the most common entrapment neuropathy
Carpal tunnel
Risk factors of carpal tunnel
Pregnancy DM Obesity Acromegaly RA Hypothyroidism Female sex Alteration in carpal tunnel space Smoking
Symptoms of Carpal Tunnel
Numbness in median n. distribution Tingling in median are distribution Pain Nocturnal pain Nocturnal paraesthesia
What is the median n. sensory distribution of the hand
Lateral 3.5 digits
Ix for Carpal Tunnel
Usually clinical Dx
Tinel’s Test
Phalens Test
Nerve conduction studies (EMG)
Describe Tinel’s test
Tapping over anterior wrist
+ve if this elicits symptoms
Describe Phalen’s Test
Backward praying for 60 seconds
+ve if this elicits symptoms
Conservative Rx for Carpal Tunnel
Wrist splint Rest Weight reduction NSAIDs Steroid injections
Surgical Rx of Carpal Tunnel
Carpal Tunnel release surgery
Which gender is Duputryens Contracture most common in
M
What is Duputryens disease
Painless progressive thickening of palmar fascia with skin puckering and tethering
Risk factors for Duputryens
M>F Increasing age FH High alcohol intake DM Smoking Hepatic cirrhosis
Clinical features of Duputryens
Thickening or nnodules in palm Flexion contracture of finger Loss ROM of affected finger \+ve Hueston's table top test Difficulties with manual activities
Ix for Duputryens
Clinical (O/E)
Hueston’s Table top test
Maybe consider USS
Duputryens Rx in asymptomatic patients
Watchful waiting
Rx for Duputryen’s Disease
Partial fascioctomy
Percutaneous Fasciotomy
Collegenase injection
Steroid injectins
What is Duputryes Diathesis
Aggressive form of Duputryens disease
When does Duputryens diathesis present
Typically earlier (20s-30s)
Clinical features of Duputryens Diathesis
Multi-digit and bilateral involvement
Faster progression
high risk failure rate of surgery due to increased recurrence rate
What is a ganglion in the hand
Smooth multiocular swelling of the hand
Are dorsal or volar ganglion more common
Dorsal
Pathology of hand ganglion
Cyst containing jelly like fluid in communication with joint capsule, tendon sheath or ligament
What is the most common position of hand ganglion
Back of wrist
Clinical features of ganglion
Lump
Firm
Non-tender
Mobile
Ix for hand ganglion
Clinical Dx - not initial testing
Consider: Aspiration x-ray USS ESR CRP
What is the commonest benign lump of the hand/wrist
Ganglion
Risk factors for ganglion
Female
Age 20-40yrs
Trauma
Rx for ganglions not causing any issues
Observation
Watchful waiting
Analgesia
Rx for ganglions causing problems
Cyst aspiration
Surgical excision
Which has a lower recurrence rate in ganglion aspiration or resection
Surgical resection
Complications of ganglion hand surgery
Painful scars
Neurovascular damage
Recurrence
What is the most common form of arthritis to affect the hands
OA base of thumb
What is the prevalence of OA base of thumb
1 in 3 F
Clinical features OA at base of thumb
Pain base of thumb Stiffening Swelling Deformity Decreased ROM Pain opening jarspinching
Ix for OA base of thumb
History
Clinical assessment
X-ray:
May show degenerative changes
Non-operative Rx for OA base of thumb
Lifestyle modifications
NSAIDs
Splintage
Steroid injections
Operative Rx for OA base of thumb
Trapeziectomy (gold standard)
Fusion (Arthrodesis)
Replacement
Gold standard surgical Rx for OA base of thumb
Trapeziectomy
What is De Quervain’s Syndrome
Stensoing tenosynovitis of extensor pollicis brevis and abductor pollicis longus tendons (1st dorsal extensor compartment)
Who is De Quervains common in
Females
Age 50-60
Increased risk in post partum lactating females
Repeated use of these tendons
Causes of De Quervains
Often unknown
Overuse of the tendons
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
Ix for De Quervains syndrome
Clinical Dx
Finkelsteins test
What is Finkelsteins test
Pain elicited by gripping the thumn into the palm of the same hand with passive ulnar deviation
Non-operative Rx De Quervains
Rest Avoidance of precipitating factors analgesia (NSAIDs) Splintage ICE therapy
Operative Rx for De Quervains
Steroid injections
Surgery
Which is the most commonly fractures carpal bone
Scaphoid
What is the main worrying complication of Scaphoid fracture
AVN
Ix for Scaphoid fracture
Dedicated scaphoid x-ray series
Rx for clinically detected but radiologically undetected scaphoid fracture
Case and re-xray in 2 weeks
What does missed scaphoid fractures increase the chance of developing long term
OA
