Hand Problems Flashcards
- Dupuytren's - Trigger Finger - De-Quervain's Tenovaginitis - Ganglia - Base of Thumb OA
Who gets Dupuytren’s Disease?
8M>1F
White people
Explain the inheritance pattern of Dupuytren’s Disease? [2]
Autosomal dominant with variable penetrance
What conditions are associated with Dupuytren’s? [4]
Diabetes
Alcohol n Tobacco
HIV
Epilepsy - phenytoin rx
Describe the pathology behind Dupuytren’s? [3]
Myofibroblasts make collagen which forms hard nodules along the palmar tendons of the fingers, pulling the finger into flexion
How does Dupuytren’s present? [5]
First: hard nodules under palmar skin, bilateral
Then the fingers become permanently flexed (lose passive/active extension)
Usually not painful
Functional issues like problems washing their face or gripping things
Ectopic lesion on plantar fascia
Which fingers are effected by Dupuytren’s? [3]
Which clinical test is used to investigate [1]
Mostly Ring Finger
Followed by Pinkie & Middle
Houston’s table top test
How do we treat Dupuytren’s?
Non-operative [3]
Operative means [6]
Non-operative:
Watch and wait, splints but ineffective, radiotherapy
Partial Fasciectomy Dermo-Fasciectomy Arthrodesis Amputation - Percutaneous Needle Fasciotomy - Collagenase
Partial vs demo fasciectomy Both followed by physiotherapy Recurrence rate in partial? Percutaneous needle fasciotomy vs fasciectomy - 2 cons? - recovery time? Collagenese recurrence rate, 2 cons
Dermo fasciectomy - more radical than partial as overlying skin is removed too
Recurrence rate in partial is 50% in 5 years
Percutaneous needle fasciotomy - quick recovery within 2-3 days but higher recurrence and risk of nerve injury
Collagenase - 3 year recurrence 35%, $ and no control over where collagenase goes
Who gets Trigger Finger and which fingers does it affect? [2]
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? [5]
RA Diabetes Gout CTS De Quervain's tenosynovitis
How does Trigger Finger present? [3]
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?
2 non-operative
2 operative
Splintage
Steroid Injection
Operatively:
- Percutaneous release
- 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
Epidemiology Dequervain’s Tenovaginitis? [2]
Causes [3]
Mostly women in 50-60s
Also Post-partum or lactating women
Causes:
Caused by repetitive overuse in activities with frequent thumb abduction and ulnar deviation
RA
Trauma - direct blow to thumb
What tests can be used for De Quervain’s Tenosynovitis? [2]
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? [4]
Splintage
Steroid Injection
Immobilisation with thumb splint (spica)
Operative Decompression
What is ganglion?
Cyst arising from a joint capsule, tendon sheath or ligament
Who gets ganglia? [2]
Where are most ganglia found on the hands?
More common females
Wide age ranges but peaks at 20-40yrs
Dorsal Surface
How does a ganglia appear? [5]
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? [3]
- Aspiration
- “Family Bible” Technique
Operative Excision including root
Epidemiology OA - common
1 in 3 women
How does OA present in the thumb? [5]
One clinical finding on examination
Pain - pinching, night, use-related Stiffness Swelling Deformity Loss of function
- Crepitus
What else should we check for in a patient with base of thumb OA? [1]
Scapho-Trapezoid-Trapezium (STT) OA
How can we treat base of thumb OA non-operatively?
Non-Operative [4]
- Steroid injection
- Splint
- NSAIDs
- Lifestyle modifications eg exercise, weight loss
What surgery can we offer for OA? [3]
Gold standard is Trapeziectomy
Joint Fusion
Joint replacement
Metacarpal fracture
Ax
Presentation of rotational type # [3]
Ax: usually punch
Rotational # cause:
- rotation of fingers
- if cannot extend fingers, get them to flex
- rotation has occurred if all not pointing to scaphoid
Metacarpal fracture Mx
Stable closed fracture [2]
Rotational or >2MCs
Stable closed #:
- splint or cast
- with wrist in partial extension, MCP in flexion and fingers in extension
Rotational or >2MCs:
- ORIF with plates or screws
Infective flexor tenosynovitis
Ax [3]
Ax:
- staph aureus (although can incl. strep and gram -ves)
- causes infection of flexor tendon sheath
- which has spread from paronychia or felon
What is paronychia or felon?
Infective flexor tenosynovitis Mx [3]
Paronychia - cellulitis around nail bed
Felon - abscess of pulp of distal finger
Mx:
- IV Abx
- Wash out in theatre
- Repeated washouts with post-op indwelling catheter
Kanavel’s 4 signs
Characteristic of infective flexor tenovsynovitis
- Symmetrical swollen fingers
- Tenderness over flexor sheath
- Pain on passive exetension of fingers
- Neutral position in slight flexion
