Hand Problems Flashcards
What is a mucous cyst
Outpouching of synovial fluid from the DIP joint
Seen in OA
How will a mucous cyst present
May be painful
May fluctuate in size and discharge
May lead to nail deformity or ridging
How do you manage a mucous cyst
May be left alone
Can excise if causing issue
What is a ganglion
Outpouching of the synovial cavity
Filled with synovial fluid
May feel tight but normally painless
How do you manage a ganglion
Usually resolves with time - leave alone
Can aspirate or excise if causing trouble - not common
How do tendons lie in the hand
Run within the flexor tendon sheath
Enters this around the level of palmar crease
A series of pulleys hold them to the bone
What is trigger finger
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
Which pulley is the most common site of trigger finger
A1 pulley
Who is at higher risk of trigger finger
Diabetics
More likely to end up with fixed flexion
How do you differentiate trigger finger from Dupuytren’s
In Dupuytren’s the finger will never release – unlike trigger finger
How do you treat trigger finger
Often resolves itself - observe
Can splint to prevent flexion
Inject tendon sheath
Surgery - divide the pulley
Describe the tendon sheath injections used in trigger finger
Combination of steroid and local anaesthetic
Often curative
Can repeat 3x (if doesn’t work refer for surgery)
What is DeQuervain’s tenosynovitis
Inflammation of the extensor tendons of thumb (1st compartment)
How does DeQuervain’s tenosynovitis present
Pain - in thumb
Swelling and redness
Positive Finklestein’s test
What is Finklestein’s test
Tuck thumb into fist then deviate ulna (tilt hand forward)
If painful it is positive
How do you manage DeQuervain’s tenosynovitis
NSAID Splint Rest Steroid injection - usually works Surgery - decompression
What is Dupuytren’s contracture
Thickening and contracture of subdermal fascia leading to fixed flexion deformity of fingers
There is metaplasia of the fibroblasts into myofibroblasts which then contract
What are some potential causes of Dupuytren’s contracture
Exact 'cause' unknown Genetics - Vikings Alcohol Smoking Anti-epilepsy meds Trauma?
Which sex is more likely to get Dupuytren’s
Men
But will be more aggressive in women
How do you treat Dupuytren’s
Stretching, activity modification
Surgery - fasciectomy
What is paronychia
Infection within the nail fold
May involve pus collection
What increases risk of paronychia
Nail biting
Common in children
How do you manage paronychia
Elevate
Antibiotics
Incise and drain pus
Infection of the tendon sheath is an emergency - true or false
True
Must operate immediately and wash out the tendon sheath
What are signs of flexor tendon sheath
The infection can track up arm
Extremely painful
Limited extension due to pain
May have tracking lymphangitis
What is a degloving injury
Separation of skin from the underlying surface
Where would a scaphoid fracture cause tenderness
Anatomical snuffbox
What is a subungual haematoma
A bleed under the nail
Often a result of blunt force trauma
How do you treat a subungual haematoma
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
You need to repair the nail bed in order for nail injuries to heal - true or false
TRUE
The condition of the nail bed determines how the nail grows back
What do joint fractures increase risk of
post-traumatic arthritis
What is a boxers fracture
Break in the neck of finger - usually little
Often occurs after punching someone/something
How would you treat a boxer’s fracture
Buddy strap = secure to neighbouring finger
Early mobilisation
What is mallet finger
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
How do you manage mallet finger
Splint straight for 6 weeks
Occasionally fix avulsion fracture with wire if displaced
How do you treat a PIP joint dislocation
Has to be treated urgently
Pull to reduce and then buddy strap
Will be very stiff
What type of injury tends to cause PIP joint dislocation
Twisting
What is a Bennett’s fracture
Fracture at base of thumb that goes into joint alongside dislocation
How do you examine the FDP
Hold the PIP joint straight and bend the tip of the finger
How do you examine the FDS
Hold index, ring and pinkie fingers straight and get patient to bend middle finger up
What are the principles of treatment for mutilating injuries
Preserve amputed parts on ice Early debridement Establish bony support and vascularity Repair tissues Establish skin cover Prevent/treat infection Mobilise
What is Eschar
Thick, leathery, inelastic skin which can form after burns
May need to be surgically released
Describe the standard treatment for burns
Pain relief Rehydrate - fluid loss is a big issue
Prevent/treat infection
Describe how RA can affect the extensor tendon
Autoimmune attacks leads to tendon degeneration and rupture
Leads to weakness or dropped finger
Can only treat with tendon transfer
What is the most common hand tendon rupture
EPL
What causes an EPL rupture
Often occurs a few weeks after an undisplaced radial fracture
May be caused by ischaemia
How does EPL rupture present
Loss of function of thumb extension
What makes up the extensor mechanism of the knee
Quadriceps muscle
Quadriceps tendon
Patella
Patellar tendon
What are the signs of damage to the quads or patellar tendon
Palpable gap Unable to do straight leg raise
Patella may sit high or low on X-ray
How do you diagnose quad or patellar tendon rupture
Imaging - x-ray, US or MRI
How do you treat quad or patellar tendon rupture
Surgical repair
What is Osgood-Schlatter’s disease
Pain at insertion of patellar tendon
Leaves a prominent bony lump below knee
Who gets Osgood-Schlatter’s disease
Active, adolescent boys
What are the clinical findings of an Achilles tendon rupture
Palpable gap
Unable to stand on tiptoes
Simmonds test positive
Who commonly presents with Achilles tendon rupture
Middle aged
During sudden acceleration/deceleration
How do you treat an Achilles tendon rupture
Serial casts to bring foot to neutral position
Surgical repair
Both work and have equal outcomes
What is Simmonds Test
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
