Hand Problems Flashcards
This Deck Covers:
- Dupuytren’s
- Trigger Finger
- De-Quervain’s Tenovaginitis
- Ganglia
- Base of Thumb OA
Who gets Dupuytren’s Disease?
Mostly Men (8M>1F), men present younger too.
White people
Explain the genetic component of Dupuytren’s Disease?
Autosomal dominant with variable penetrance
What conditions are associated with Dupuytren’s?
Diabetes Alcohol Tobacco HIV Epilepsy
Describe the pathology behind Dupuytren’s?
Myofibroblasts make collagen which forms hard nodules along the palmar tendons of the fingers, pulling the finger into flexion
How does Dupuytren’s Present?
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
Which fingers are effected by Dupuytren’s?
Mostly Ring Finger
Followed by Pinkie & Middle
How do we treat Dupuytren’s?
Radiotherapy
Fasciectomy
Percutaneous needle fasciotomy (Early)
What are the pros/cons of the major treatments for Dupuytren’s?
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
Who gets Trigger Finger and which fingers does it affect?
F>M in 40-60s
Affects Ring > Thumb > Middle
What is Trigger Finger?
Swollen flexor tendon catches the sheath it passes through making it difficult to flex
What conditions are associated with trigger finger?
RA
Diabetes
Gout
How does Trigger Finger present?
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
How can we treat Trigger Finger?
Splintage
Steroid Injection
Operatively:
- Percutaneous release or open surgery
Define De-quervain’s Tenovaginitis?
Non-inflammatory thickening of the EPB & APL tendons along with their sheaths that causes:
- radial wrist pain aggravated by thumb movement
- +/- a localised swelling
who gets Dequervain’s Tenovaginitis?
Mostly women in 50-60s
Also Post-partum or lactating women
What tests can be used for De Quervain’s Tenovaginitis?
Finklestein’s Test - Grasp the patients thumb and sharply ulnar deviate the hand looking for sharp pain along the distal radius
How do we treat De Quervain’s Tenovaginitis?
Splintage
Steroid Injection
Operative Decompression
What is ganglion?
Cyst arising from a joint capsule, tendon sheath or ligament
Who gets ganglia?
More common females
Wide age ranges but peaks at 20-40yrs
Where are most ganglia found on the hands?
Dorsal Surface
How does a ganglia appear?
As a smooth, firm, non-tender lump that changes in size
Its never fixed to skin and rarely to underlying structures
How do we treat ganglia?
- Aspiration
- “Family Bible” Technique
Operative Excision
Who gets Osteoarthritis in the thumb?
1 in 3 women
How does OA present in the thumb?
Pain Stiffness Swelling Deformity Loss of function
What else should we check for in a patient with base of thumb OA?
Scapho-Trapezoid-Trapezium (STT) OA
How can we treat base of thumb OA non-operatively?
- Steroid injection
- Splint
- NSAIDs
- Lifestyle modifications
What surgery can we offer for OA?
Gold standard is Trapeziectomy
Also Joint Fusion or replacement
