Hand problems Flashcards
What is Dupuytrens?
- An inherited disease of progressive fibrous tissue contracture of the palmar fascia.
- Condition in which one or more fingers become permanently bent in a flexed position
Epidemiology of Dupuytrens?
- M : F = 8 : 1 in 15 – 64’s
- M : F = 2 : 1 in over 75’s
- Autosomal dominant – variable penetrance
- Almost always white race
- Onset may be sex linked
What is the pathology of dupuytrens?
- Myofribroblast
- Intracellular contractile elements
- Regulated by growth factors
- Production of collagen
What functional issues arrise with Dupuytrens?
- Usually not painful
- Loss of finger extension – active or passive
- Hand in pocket
- Gripping things
- Washing face
Non-operative treatment for Dupuytrens?
- Observe
- Splints don’t work
- Radiotherapy
Operative treatment for Dupuytrens?
- Partial fasciectomy
- Dermo-fasciectomy
- Arthrodesis
- Amputation
- Percutaneous Needle Fasciotomy
- Collagenase
Please explain pros/cons partial fasciectomy.
This procedure involves the excision of diseased Dupuytren’s tissue with the use of multiple 1 cm transverse incisions
- Most common procedure performed in UK
- Good correction can be achieved
- Wounds can take 2-3 weeks to heal
- Stiffness requires physiotherapy
- Can’t be cured
- Recurrence 50 % at 5 years
Please explain pros/cons of dermo fasciectomy.
- More radical procedure
- Removal skin may reduce recurrence rates
- Requires intensive physiotherapy
Elaborate on the pros and cons of Percutaneous Needle Fasciotomy.
- Quick
- No wounds
- Return to normal activities 2-3 days
- Does not prevent traditional surgery in future
- Higher recurrence (? 50% at 3 years)
- Can be repeated
- Risk of Nerve Injury
What is trigger finger?
Trigger fingers is a common disorder characterized by catching, snapping or locking of the involved finger flexor tendon, associated with dysfunction and pain
Pathogenesis of trigger finger?
- 2 tendons to each finger
- Tendons run in sheath
- Thickenings in sheath = pulley
- Keep tendon close to bone
- Swelling in tendon catches on pulley
Who is likely to get trigger finger?
- 40-60s
- Women more than men
- Repetitive use of hand
- Trauma
What are some diagnostic factors for trigger finger?
- Patient history
- Clicking sensation with movement of digit
- Lump in palm under pulley
- Clicking may progress to locking
Tx for trigger finger?
Non-operative
- Splintage
- Steroids
Operative
- Percutaneous release
- Open surgery
What is De Quervain’s Syndrome?
Tenosynovitis of the sheath or tunnel that surrounds two tendons that control movement of the thumb
How is De Quervains diagnosed?
- Patient history
- Several weeks pain localised to radial side of wrist
- Aggravated by movement of the thumb
- May have seen a localised swelling
- Localised tenderness over tunnel
Who get’s de querveins?
- M:F 1:6
- Age 50s - 60s
- Increased in post partum and lactating females
- Activities with frequent thumb abduction and ulnar deviation
What do we need to examine when suspected de quervains?
- Examine thumb joints
- Consider base of thumb OA
Tx for de quervains?
Non-operative
- Splints
- Steroid injection
Operative
- Decompression
What is a ganglion? Where do they arrise?
A myxoid degeneration from joint synovia…‘Doctor, I have a lump’
Arise from joint capsule, tendon sheath or ligament
Who gets ganglions?
- 70% of all discrete swellings in the hand and wrist
- More common in females (2:1)
- Wide age distribution (peak 20-40yrs)
- Dorsal > Volar (3:1)
- May be associated with recurrent injury around the wrist
How do ganglions present?
- Present with lump
- Firm, non-tender
- Change in size
- Smooth
- Occasionally lobulated
- Normally not fixed to underlying tissues
- Never fixed to the skin
Tx for ganglion?
Non-operative
- Reassure and observe
- Aspiration
- Hit it with a bible?
Operative
- Excision
- Including the root
