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MSK > Hand Problems > Flashcards

Hand Problems Flashcards

1
Q

What is a mucous cyst

A

Outpouching of synovial fluid from the DIP joint

Seen in OA

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2
Q

How will a mucous cyst present

A

May be painful
May fluctuate in size and discharge
May lead to nail deformity or ridging

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3
Q

How do you manage a mucous cyst

A

May be left alone

Can excise if causing issue

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4
Q

What is a ganglion

A

Outpouching of the synovial cavity
Filled with synovial fluid
May feel tight but normally painless

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5
Q

How do you manage a ganglion

A

Usually resolves with time - leave alone

Can aspirate or excise if causing trouble - not common

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6
Q

How do tendons lie in the hand

A

Run within the flexor tendon sheath
Enters this around the level of palmar crease
A series of pulleys hold them to the bone

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7
Q

What is trigger finger

A

Any swelling of tendon leads to irritation and it can get caught on one of the pulleys - gets stuck in flexed position
Get pain and clicking

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8
Q

Which pulley is the most common site of trigger finger

A

A1 pulley

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9
Q

Who is at higher risk of trigger finger

A

Diabetics

More likely to end up with fixed flexion

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10
Q

How do you differentiate trigger finger from Dupuytren’s

A

In Dupuytren’s the finger will never release – unlike trigger finger

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11
Q

How do you treat trigger finger

A

Often resolves itself - observe
Can splint to prevent flexion
Inject tendon sheath
Surgery - divide the pulley

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12
Q

Describe the tendon sheath injections used in trigger finger

A

Combination of steroid and local anaesthetic
Often curative
Can repeat 3x (if doesn’t work refer for surgery)

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13
Q

What is DeQuervain’s tenosynovitis

A

Inflammation of the extensor tendons of thumb (1st compartment)

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14
Q

How does DeQuervain’s tenosynovitis present

A

Pain - in thumb
Swelling and redness
Positive Finklestein’s test

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15
Q

What is Finklestein’s test

A

Tuck thumb into fist then deviate ulna (tilt hand forward)

If painful it is positive

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16
Q

How do you manage DeQuervain’s tenosynovitis

A 
NSAID
Splint 
Rest 
Steroid injection - usually works 
Surgery - decompression
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17
Q

What is Dupuytren’s contracture

A

Thickening and contracture of subdermal fascia leading to fixed flexion deformity of fingers
There is metaplasia of the fibroblasts into myofibroblasts which then contract

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18
Q

What are some potential causes of Dupuytren’s contracture

A 
Exact 'cause' unknown 
Genetics - Vikings 
Alcohol 
Smoking 
Anti-epilepsy meds 
Trauma?
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19
Q

Which sex is more likely to get Dupuytren’s

A

Men

But will be more aggressive in women

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20
Q

How do you treat Dupuytren’s

A

Stretching, activity modification

Surgery - fasciectomy

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21
Q

What is paronychia

A

Infection within the nail fold

May involve pus collection

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22
Q

What increases risk of paronychia

A

Nail biting

Common in children

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23
Q

How do you manage paronychia

A

Elevate
Antibiotics
Incise and drain pus

24
Q

Infection of the tendon sheath is an emergency - true or false

A

True

Must operate immediately and wash out the tendon sheath

25
Q

What are signs of flexor tendon sheath

A

The infection can track up arm
Extremely painful
Limited extension due to pain
May have tracking lymphangitis

26
Q

What is a degloving injury

A

Separation of skin from the underlying surface

27
Q

Where would a scaphoid fracture cause tenderness

A

Anatomical snuffbox

28
Q

What is a subungual haematoma

A

A bleed under the nail

Often a result of blunt force trauma

29
Q

How do you treat a subungual haematoma

A

Usually gets better on its own - nail may fall off and grow back
If pressure is causing pain you can puncture the nail to release

30
Q

You need to repair the nail bed in order for nail injuries to heal - true or false

A

TRUE

The condition of the nail bed determines how the nail grows back

31
Q

What do joint fractures increase risk of

A

post-traumatic arthritis

32
Q

What is a boxers fracture

A

Break in the neck of finger - usually little

Often occurs after punching someone/something

33
Q

How would you treat a boxer’s fracture

A

Buddy strap = secure to neighbouring finger

Early mobilisation

34
Q

What is mallet finger

A

Injury commonly caused by finger getting hit from front
Ligament is torn off finger and may cause avulsion fracture
Won’t be able to extend finger

35
Q

How do you manage mallet finger

A

Splint straight for 6 weeks

Occasionally fix avulsion fracture with wire if displaced

36
Q

How do you treat a PIP joint dislocation

A

Has to be treated urgently
Pull to reduce and then buddy strap
Will be very stiff

37
Q

What type of injury tends to cause PIP joint dislocation

A

Twisting

38
Q

What is a Bennett’s fracture

A

Fracture at base of thumb that goes into joint alongside dislocation

39
Q

How do you examine the FDP

A

Hold the PIP joint straight and bend the tip of the finger

40
Q

How do you examine the FDS

A

Hold index, ring and pinkie fingers straight and get patient to bend middle finger up

41
Q

What are the principles of treatment for mutilating injuries

A 
Preserve amputed parts on ice 
Early debridement 
Establish bony support and vascularity
Repair tissues 
Establish skin cover 
Prevent/treat infection 
Mobilise
42
Q

What is Eschar

A

Thick, leathery, inelastic skin which can form after burns

May need to be surgically released

43
Q

Describe the standard treatment for burns

A

Pain relief Rehydrate - fluid loss is a big issue

Prevent/treat infection

44
Q

Describe how RA can affect the extensor tendon

A

Autoimmune attacks leads to tendon degeneration and rupture
Leads to weakness or dropped finger
Can only treat with tendon transfer

45
Q

What is the most common hand tendon rupture

A

EPL

46
Q

What causes an EPL rupture

A

Often occurs a few weeks after an undisplaced radial fracture
May be caused by ischaemia

47
Q

How does EPL rupture present

A

Loss of function of thumb extension

48
Q

What makes up the extensor mechanism of the knee

A

Quadriceps muscle
Quadriceps tendon
Patella
Patellar tendon

49
Q

What are the signs of damage to the quads or patellar tendon

A

Palpable gap Unable to do straight leg raise

Patella may sit high or low on X-ray

50
Q

How do you diagnose quad or patellar tendon rupture

A

Imaging - x-ray, US or MRI

51
Q

How do you treat quad or patellar tendon rupture

A

Surgical repair

52
Q

What is Osgood-Schlatter’s disease

A

Pain at insertion of patellar tendon

Leaves a prominent bony lump below knee

53
Q

Who gets Osgood-Schlatter’s disease

A

Active, adolescent boys

54
Q

What are the clinical findings of an Achilles tendon rupture

A

Palpable gap
Unable to stand on tiptoes
Simmonds test positive

55
Q

Who commonly presents with Achilles tendon rupture

A

Middle aged

During sudden acceleration/deceleration

56
Q

How do you treat an Achilles tendon rupture

A

Serial casts to bring foot to neutral position
Surgical repair
Both work and have equal outcomes

57
Q

What is Simmonds Test

A

Get patient to lie on their front with feet hanging off the bed
Squeeze calf - normally foot should plantar flex, if Achilles is ruptured there will be no movement

MSK (21 decks)

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