Hand Problems Flashcards

1
Q

This Deck Covers:

A
  • Dupuytren’s
  • Trigger Finger
  • De-Quervain’s Tenovaginitis
  • Ganglia
  • Base of Thumb OA
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2
Q

Who gets Dupuytren’s Disease?

A

Mostly Men (8M>1F), men present younger too.

White people

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3
Q

Explain the genetic component of Dupuytren’s Disease?

A

Autosomal dominant with variable penetrance

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4
Q

What conditions are associated with Dupuytren’s?

A
Diabetes
Alcohol
Tobacco
HIV
Epilepsy
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5
Q

Describe the pathology behind Dupuytren’s?

A

Myofibroblasts make collagen which forms hard nodules along the palmar tendons of the fingers, pulling the finger into flexion

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6
Q

How does Dupuytren’s Present?

A

First hard nodules under palmar skin

Then the fingers become permanently flexed (lose passive/active extension)

Its not painful but they do get functional issues like problems washing their face or gripping things

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7
Q

Which fingers are effected by Dupuytren’s?

A

Mostly Ring Finger

Followed by Pinkie & Middle

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8
Q

How do we treat Dupuytren’s?

A

Radiotherapy

Fasciectomy

Percutaneous needle fasciotomy (Early)

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9
Q

What are the pros/cons of the major treatments for Dupuytren’s?

A

Partial Fasciectomy followed by physio

Percutaneous Needle Fasciotomy is good cos it recovers within 2/3days rather than weeks, has high recurrence but can be repeated

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10
Q

Who gets Trigger Finger and which fingers does it affect?

A

F>M in 40-60s

Affects Ring > Thumb > Middle

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11
Q

What is Trigger Finger?

A

Swollen flexor tendon catches the sheath it passes through making it difficult to flex

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12
Q

What conditions are associated with trigger finger?

A

RA
Diabetes
Gout

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13
Q

How does Trigger Finger present?

A

Clicking sensation on movement of the digit than can progress to “locking”

They may need the other hand to unlock the digit

May be a palpable lump under the sheath in the palm

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14
Q

How can we treat Trigger Finger?

A

Splintage
Steroid Injection

Operatively:
- Percutaneous release or open surgery

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15
Q

Define De-quervain’s Tenovaginitis?

A

Non-inflammatory thickening of the EPB & APL tendons along with their sheaths that causes:

  • radial wrist pain aggravated by thumb movement
  • +/- a localised swelling
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16
Q

who gets Dequervain’s Tenovaginitis?

A

Mostly women in 50-60s

Also Post-partum or lactating women

17
Q

What tests can be used for De Quervain’s Tenovaginitis?

A

Finklestein’s Test - Grasp the patients thumb and sharply ulnar deviate the hand looking for sharp pain along the distal radius

18
Q

How do we treat De Quervain’s Tenovaginitis?

A

Splintage
Steroid Injection

Operative Decompression

19
Q

What is ganglion?

A

Cyst arising from a joint capsule, tendon sheath or ligament

20
Q

Who gets ganglia?

A

More common females

Wide age ranges but peaks at 20-40yrs

21
Q

Where are most ganglia found on the hands?

A

Dorsal Surface

22
Q

How does a ganglia appear?

A

As a smooth, firm, non-tender lump that changes in size

Its never fixed to skin and rarely to underlying structures

23
Q

How do we treat ganglia?

A
  • Aspiration
  • “Family Bible” Technique

Operative Excision

24
Q

Who gets Osteoarthritis in the thumb?

A

1 in 3 women

25
Q

How does OA present in the thumb?

A
Pain
Stiffness
Swelling
Deformity
Loss of function
26
Q

What else should we check for in a patient with base of thumb OA?

A

Scapho-Trapezoid-Trapezium (STT) OA

27
Q

How can we treat base of thumb OA non-operatively?

A
  • Steroid injection
  • Splint
  • NSAIDs
  • Lifestyle modifications
28
Q

What surgery can we offer for OA?

A

Gold standard is Trapeziectomy

Also Joint Fusion or replacement