Hand Problems Flashcards
fingertip injuries
subungual haematoma
what are 5 types of nail injuries
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
Tx for 5 types of nail injuries
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
what is a boxers fracture
minimally comminuted, transverse fractures of the 5th metacarpal
features of boxers fracture
minimal displacement
no rotation
more distal
Tx of boxers fracture
‘Buddy strap’
early mobilisation
what is a mallet finger
disruption of the extensor mechanism of the finger at the distal interphalangeal joint
stave injury
what can mallet finger refer to
avulsion bony injury or just tendinous injury
Ex of mallet finger
resiste finger extension
tenderness/bruising
Tx of mallet finger
mallet splint 6/52
large avulsions - wire
dermatotenodesis - chronic cases
PIPjt dislocation
common
vital to be treated acutely - pull to reduce, buddy strap
problems with delayed presentation of PIPjt dislocation
impossible to reduce
may require fusion
PIPjt fracture Tx
needs fixation/stabilisation
what is Bennett’s fracture
fracture of the base of the first metacarpal bone which extends into the carpometacarpal (CMC) joint
principles of mutilating injury
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
hand burns Tx
Excise damaged skin and perform split skin grafts early
Aggressive mobilisation to prevent finger stiffness
Escharotomy
what is eschar
Thick, leathery, inelastic skin which can form after burns
May require surgical release to allow movement
what is a mucous cyst
outpouching of synovial fluid from DIPjt OA
symptoms/signs of mucous cysts
may be painful
may fluctuate/discharge
may deform nail, cause ridge
pathogenesis of trigger finger
- Tendons run within flexor tendon sheath
- Any swelling on tendon leads to irritation
- more swelling
- tendon gets caught on edge on A1 pulley
symptoms/signs of trigger finger
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
Ex of trigger finger
demonstrate triggering
tender over A1 pulley
feel nodule pass beneath pulley
NB- distinguish from Dupuytrens
Mx of trigger finger
Conservative - can resolve spontaneously
- splint to prevent flexion
Tendon sheath injection
- steroid + LA
- can be repeated 3x
Surgery
- divide A1 pulley
what is De Quervain Tenosynovitis
entrapment tendinitis of the tendons contained within the first dorsal compartment at the wrist; it causes pain during thumb motion
symptoms of DeQuervains
spontaneous
painful
swollen/red
what test can be done to confirm DeQuervains
Finklestein’s test - patient puts thumb into a fist and then ulna deviate. Very painful if DeQuerains is present
Mx of DeQuervains
NSAIDs Splint Rest Steroid injection Surgery - decompression
what is Dupuytren’s contracture
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
what does Dupuytren’s contracture cause
- skin of the hand may be adherent to the disease fascia and puckered
- progressing to contractures at the MCP and PIP joints
symptoms/signs of Dupuytren’s
painless, gradual progression
starts as palmar pit/nodule
causes of Dupuytren’s
DM
Alcohol/cirrhosis
smoking
Ex of Dupuytren’s
Feel cords
MCP/PIP joint involvement - measure angles
Table-top tests
Tx of Dupuytren’s
Conservative - stretches
Surgery
- segmental fasciectomy
- fasciectomy
- dermofasciectomy
- amputation
what are newer treatment options for Dupuytrens
- collagenase injection
- percutaneous needle fasciotomy
what is paronychia
infection within the nail fold
often in children - nail biting!
may result in pus collection
Mx of paronychia
elevate
antibiotics
incise and drain collection
surgical emergency in the hand
flexor tendon sheath infection
how does a flexor tendon sheath infection present
infection within sheath, tracking up the palm and arm
extremely painful
limited extension, including passive
Mx of tendon sheath infection
wash out tendon sheath
