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MSK- Spine and Upper Limb > Hand Problems > Flashcards

Hand Problems Flashcards

1
Q

What are ganglions?

A

Fluid filled cysts, found adjacent to a tendon or synovial joint (outpourings of a synovial cavity)

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2
Q

When can ganglions/mucous cysts be removed? What is the rate of recurrence?

A

If they are causing pain- 50% chance of recurrence

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3
Q

When can ganglions not be removed?

A

For cosmetic reasons

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4
Q

If a patient wants a ganglion removed for cosmetic reasons, what should you inform them?

A

It will leave a scar, which may be just as cosmetically unacceptable. It may also remain tender which can be worse than the cyst in the first place.

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5
Q

What is a mucous cyst?

A

A ganglion at the flexor tendon of the DIP joint, often associated with OA

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6
Q

What are some symptoms of a mucous cyst?

A

May be painful, produce discharge, deform the nail

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7
Q

Will the size of a mucous cyst remain constant?

A

No, it will fluctuate

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8
Q

How would you describe what a ganglion feels like?

A

Smooth, rubbery, firm and should transilluminate

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9
Q

What kind of lumps will transilluminate?

A

Fluid filled

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10
Q

What are mucous cysts filled with? What are ganglions filled with?

A

Mucus cysts = mucous, ganglions = synovial fluid

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11
Q

What side of the wrist are ganglion cysts seen at?

A

Both, can be dorsal or volar

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12
Q

Is there normally treatment for a ganglion?

A

No, they usually resolve with time and do not require treatment

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13
Q

What type of ganglion shouldn’t be excised? Why?

A

Volar wrist ganglion cysts: close association with the radial artery

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14
Q

What type of tendons can be affected by trigger finger? What tendon is mostly affected?

A

Flexor tendons, especially flexor digitorum superficialis

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15
Q

What happens in trigger finger?

A

There is swelling of the tendon and tendon sheath, until the tendon gets caught on the edge of the A1 pulley

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16
Q

Where will there be pain in trigger finger?

A

Over the A1 pulley at the metacarpal head

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17
Q

In trigger finger, the finger will be stuck in what position? Why?

A

Stuck in flexion because the nodule passes below the pulley but then can’t get back through on extension

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18
Q

How can the affected finger in trigger finger be extended?

A

Using the other hand to pull it which can be painful, or over time it will suddenly ping into extension

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19
Q

Will all patients with trigger finger be able to extend their finger?

A

No

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20
Q

Movement of the finger in trigger finger causes what? Why?

A

A clicking sensation as the nodule catches onto and then passes under the pulley

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21
Q

Who does trigger finger affect?

A

Anyone at any age, even kids

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22
Q

What is the conservative management for trigger finger?

A

It often resolves spontaneously, in the meantime you can give a splint to prevent flexion, and up to 3 tendon sheath injections which are often curative

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23
Q

What is the downside of using a splint in trigger finger?

A

Can cause stiffening

24
Q

What is the surgical management of trigger finger? When is this used?

A

Division of the A1 pulley to allow the tendon to move freely. Only used in recurrent/persistent cases.

25
Q

DeQuervain’s tenosynovitis affects where?

A

The first extensor compartment, containing abductor policies longs and extensor pollicis brevis

26
Q

What causes DeQuervain’s tenosynovitis? Where does it cause pain?

A

Usually a repetitive strain injury causing pain over the radial styloid process at the wrist

27
Q

Who does DeQuervain’s tenosynovitis occur in? What conditions is it related to?

A

Mostly women aged 30-50, associated with pregnancy and RA

28
Q

What tests and investigations are used for DeQuervain’s tenosynovitis?

A

Finklestein’s test, US, x-ray

29
Q

Describe a presentation of DeQuervain’s tenosynovitis?

A

Spontaneous and painful, red and swollen

30
Q

Describe the Fincklestein’s test?

A

Get the patient to make a fist and then press down on the base of the thumb- this will elicit a lot of pain

31
Q

What are the treatment options for DeQuervain’s tenosynovitis?

A

NSAIDs, splinting, rest, steroid injections, decompression surgery

32
Q

What is Dupuytren’s contracture?

A

Connective tissue disorder where the palmar fascia undergoes hyperplasia. Normal fascial bands then form nodules and cords.

33
Q

Dupuytren’s causes contractures where? What deformity does this result in?

A

Contractures at the MCP and PIP joints, resulting in a fixed flexion deformity

34
Q

What is the underlying pathology of Dupuytren’s contracture?

A

Proliferation of myofibroblast cells rather than fibroblasts and the production of abnormal collagen- type 3 rather than type 1

35
Q

Which fingers do contractures in Dupuytren’s most commonly affect?

A

Little and ring fingers (though can affect any)

36
Q

How common is it for Dupuytren’s to be bilateral?

A

Half of cases

37
Q

Describe the onset of Dupuytren’s?

A

Painless, gradual progression which usually begins as a palmar pit/nodule

38
Q

What are some factors which can be related to Dupuytren’s?

A

Genetics, diabetes, alcohol/cirrhosis, smoking, phenytoin therapy (epilepsy), fibromatosis

39
Q

What is a clinical sign which is a fairly strong indicator of Dupuytren’s?

A

The patient cannot put their hand flat on a table

40
Q

Who is Dupuytren’s most common in?

A

Older men (10:1)

41
Q

Diathesis is a severe type of Dupuytren’s. Who is a more severe type more common in?

A

Young people, and those with fibromatosis elsewhere

42
Q

What are some conservative management options for Dupuytren’s?

A

Stretches, activity modification, splintage

43
Q

What two surgeries are mostly used for Dupuytren’s?

A

Fasciectomy (removal of diseased fascia) or fasciotomy (division of cords)

44
Q

What are some outcomes to be aware of following surgery for Dupuytren’s?

A

A lot of therapy and rehab to get it moving again, and chance of recurrence (especially younger patients)

45
Q

If Dupuytren’s is familial, how is it inherited? Where are descendents commonly from?

A

Autosomal dominant, high prevalence in North Europe/Scandinavia

46
Q

Up to 30% of Dupuytren’s contractors at which joint can be tolerated?

A

MCP

47
Q

Dupuytren’s at which joint is usually an indicator for surgery? Why?

A

PIP- readily stiffens

48
Q

What is paronychia?

A

Infection within the nail fold

49
Q

Paronychia usually occurs in who? Why?

A

Children, due to nail biting

50
Q

What can paronychia result in?

A

Formation of pus, may affect the growth of the nail

51
Q

What are some management options for paronychia?

A

Elevation, antibiotics, incision and drainage

52
Q

Flexor tendon sheath infection is what? Is it associated with trauma or injury?

A

An emergency! Not necessarily associated with trauma or injury.

53
Q

Why is flexor tendon sheath infection an emergency?

A

It can track up the palm and arm

54
Q

What are some signs and symptoms of flexor tendon sheath infection?

A

Extreme pain, limited extension, tracking lymph node involvement

55
Q

How is a flexor tendon sheath infection treated? What can occur if not treated?

A

Make an incision at the top and bottom and wash it out. If this is not done it can cause permanent disability.

MSK- Spine and Upper Limb (13 decks)

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