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MSK SB > Hand Problems > Flashcards

Hand Problems Flashcards

1
Q

fingertip injuries

A

subungual haematoma

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2
Q

what are 5 types of nail injuries

A 
Type 1- Soft tissue only
Type 2- Soft tissue + nail
Type 3- Soft tissue + nail + bone
Type 4- Proximal ⅓ of phalanx
Type 5- proximal to DIPjt
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3
Q

Tx for 5 types of nail injuries

A

Level 1 + 2 = dressing only
Level 3 = repair nail bed + stabilise bone
Level 4 = as above unless > ablate
Level 5 - if tip not available, terminalise of V-Y flap

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4
Q

what is a boxers fracture

A

minimally comminuted, transverse fractures of the 5th metacarpal

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5
Q

features of boxers fracture

A

minimal displacement
no rotation
more distal

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6
Q

Tx of boxers fracture

A

‘Buddy strap’

early mobilisation

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7
Q

what is a mallet finger

A

disruption of the extensor mechanism of the finger at the distal interphalangeal joint

stave injury

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8
Q

what can mallet finger refer to

A

avulsion bony injury or just tendinous injury

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9
Q

Ex of mallet finger

A

resiste finger extension

tenderness/bruising

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10
Q

Tx of mallet finger

A

mallet splint 6/52
large avulsions - wire
dermatotenodesis - chronic cases

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11
Q

PIPjt dislocation

A

common

vital to be treated acutely - pull to reduce, buddy strap

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12
Q

problems with delayed presentation of PIPjt dislocation

A

impossible to reduce

may require fusion

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13
Q

PIPjt fracture Tx

A

needs fixation/stabilisation

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14
Q

what is Bennett’s fracture

A

fracture of the base of the first metacarpal bone which extends into the carpometacarpal (CMC) joint

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15
Q

principles of mutilating injury

A 
Preserve amputated parts on ice
Early debridement - excise everything dirty
Establish stable bony support
Establish vascularity
Repair all tissues- nerves, tendons
Establish skin cover- grafts/flaps
Prevent/treat infection
Aggressive mobilisation
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16
Q

hand burns Tx

A

Excise damaged skin and perform split skin grafts early
Aggressive mobilisation to prevent finger stiffness
Escharotomy

17
Q

what is eschar

A

Thick, leathery, inelastic skin which can form after burns

May require surgical release to allow movement

18
Q

what is a mucous cyst

A

outpouching of synovial fluid from DIPjt OA

19
Q

symptoms/signs of mucous cysts

A

may be painful
may fluctuate/discharge
may deform nail, cause ridge

20
Q

pathogenesis of trigger finger

A
  • Tendons run within flexor tendon sheath
  • Any swelling on tendon leads to irritation
    • more swelling
    • tendon gets caught on edge on A1 pulley
21
Q

symptoms/signs of trigger finger

A

pain over A1 pulley (MS head)
Sticking of finger, usually in flexion
may or may not be able to extend
can use other hand to extend finger

22
Q

Ex of trigger finger

A

demonstrate triggering
tender over A1 pulley
feel nodule pass beneath pulley
NB- distinguish from Dupuytrens

23
Q

Mx of trigger finger

A

Conservative - can resolve spontaneously
- splint to prevent flexion

Tendon sheath injection

  • steroid + LA
  • can be repeated 3x

Surgery
- divide A1 pulley

24
Q

what is De Quervain Tenosynovitis

A

entrapment tendinitis of the tendons contained within the first dorsal compartment at the wrist; it causes pain during thumb motion

25
Q

symptoms of DeQuervains

A

spontaneous
painful
swollen/red

26
Q

what test can be done to confirm DeQuervains

A

Finklestein’s test - patient puts thumb into a fist and then ulna deviate. Very painful if DeQuerains is present

27
Q

Mx of DeQuervains

A 
NSAIDs
Splint 
Rest
Steroid injection
Surgery - decompression
28
Q

what is Dupuytren’s contracture

A

proliferation of myofibroblast cells and the production of abnormal collagen (type 3 rather than type 1)
thickening and contracture of subdermal fascia leading to fixed flexion deformity of fingers

29
Q

what does Dupuytren’s contracture cause

A
  • skin of the hand may be adherent to the disease fascia and puckered
  • progressing to contractures at the MCP and PIP joints
30
Q

symptoms/signs of Dupuytren’s

A

painless, gradual progression

starts as palmar pit/nodule

31
Q

causes of Dupuytren’s

A

DM
Alcohol/cirrhosis
smoking

32
Q

Ex of Dupuytren’s

A

Feel cords
MCP/PIP joint involvement - measure angles
Table-top tests

33
Q

Tx of Dupuytren’s

A

Conservative - stretches

Surgery

  • segmental fasciectomy
    - fasciectomy
    - dermofasciectomy
    - amputation
34
Q

what are newer treatment options for Dupuytrens

A
  • collagenase injection

- percutaneous needle fasciotomy

35
Q

what is paronychia

A

infection within the nail fold
often in children - nail biting!
may result in pus collection

36
Q

Mx of paronychia

A

elevate
antibiotics
incise and drain collection

37
Q

surgical emergency in the hand

A

flexor tendon sheath infection

38
Q

how does a flexor tendon sheath infection present

A

infection within sheath, tracking up the palm and arm
extremely painful
limited extension, including passive

39
Q

Mx of tendon sheath infection

A

wash out tendon sheath

MSK SB (15 decks)

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