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Year 3 - Musculoskeletal > Hand problems > Flashcards

Hand problems Flashcards

1
Q

Epidemiology of dupuytrens?

A

> Age 15-64 - M:F = 8:1
Age >75 - M-F = 2:1

> Disease develops earlier in men 
> Autosomal dominant, varied penetrance 
> Sporadic in 30% cases
> White race almost exclusively 
> Associative factors (Diabetes, alcohol, tobacco, HIV, Epilepsy)
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2
Q

Associations with Dupuytren’s?

A 
> Diabetes
> Alcohol
> Tobacco
> HIV
> Epilepsy
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3
Q

Which race is more likely to get Dupuytren’s?

A

White

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4
Q

Which sex is more likely to get Dupuytren’s?

A

Male
> Age 15-64 - M:F = 8:1
> Age >75 - M-F = 2:1

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5
Q

Dupuytren’s diathesis?

A

> Early onset disease
Bilateral disease
Family History
Ectopic disease

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6
Q

Dupuytren’s pathology?

A

Myofibroblast:
> Intracellular contractile elements
> Regulated by growth factors
> Production of collagen

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7
Q

Dupuytren’s - functional problems?

A 
> Usually not painful
> Loss of finger extension – active or passive
> Hand in pocket
> Gripping things
> Washing face
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8
Q

Dupuytren’s - treatment options?

A

Non-operative
> Observe
> Splints don’t work
> Radiotherapy

Operative
> Partial fasciectomy
> Dermo-fasciectomy
> Arthrodesis
> Amputation

> Percutaneous Needle Fasciotomy
Collagenase

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9
Q

Dupuytren’s - non-operative treatment options?

A

Non-operative
> Observe
> Splints don’t work
> Radiotherapy

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10
Q

Dupuytren’s - operative treatment options?

A 
Operative
> Partial fasciectomy
> Dermo-fasciectomy
> Arthrodesis
> Amputation

> Percutaneous Needle Fasciotomy
Collagenase

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11
Q

What is the most common procedure performed in the UK?

A

Partial fasciectomy

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12
Q

How long does it take for the wound to heal in partial fasciotomy?

A

2-3 weeks

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13
Q

Why is physiotherapy required in Dupuytren’s?

A

For stiffness

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14
Q

Can Dupuytren’s be cured?

A

No

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15
Q

What is the reoccurrence rates of Dupuytren’s after partial fasciectomy?

A

50% at 5 years

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16
Q

What is the advantage and disadvantages of dermo-fasciotomy in Dupuytrens?

A

Advantage:
> Removal skin may reduce reoccurrence

Disadvantages:
>More radical procedure
> Requires intensive physiotherapy

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17
Q

What is the advantage and disadvantages of percutaneous needle fasciotomy in Dupuytrens?

A 
Advantages:
> Quick
> No wounds
> Return to normal activities 2-3 days
> Can be repeated
> Does not prevent traditional surgery in future

Disadvantages:
> Higher recurrence
(? 50% at 3 years)
> Risk of Nerve Injury

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18
Q

What is the advantage and disadvantages collagenase in Dupuytrens?

A

> Presented 3 year recurrence rate 34.8%
3 Flexor Tendon Ruptures!
Cost
Await longer term recurrence rates

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19
Q

How many tendons to each finger?

A

Two tendons to each finger

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20
Q

What is the significance of the tendons of the fingers running within a sheath

A

> Keep tendon close to bone
Thickens in sheath = pulley
Swelling in tendon catches on pulley

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21
Q

Epidemiology of trigger finger?

A 
> Women more frequent than men
> 40s-60s
> Ring > Thumb > Middle
> Repetitive use of hand 
> Local trauma
> Associations (RA, DM, Gout)
22
Q

Epidemiology of trigger finger - sex?

23
Q

Epidemiology of trigger finger - Age?

24
Q

Epidemiology of trigger finger - associations?

A

RA, DM, Gout

25
Diagnosis of trigger finger?
``` > Patient History > Clicking sensation with movement of digit > Lump in palm under pulley > May have to use other hand to ‘unlock’ > ‘Clicking’ may progress to ‘locking’ ```
26
Where is a lump palpable in trigger finger?
In the palm over A1 pulley
27
Where is the triggering palpable in trigger finger?
Around the A1 pulley
28
Trigger finger - treatment?
Non-operative > Splintage > Steroid Operative > Percutaneous release > Open surgery
29
De Quervain's syndrome - 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
30
De Quervain's syndrome - epidemiology?
> M:F 1:6 > Age 50s - 60s > Increased in post partum and lactating females > Activities with frequent thumb abduction and ulnar deviation > Washerwoman’s sprain – Gray’s anatomy
31
De Quervain's syndrome - epidemiology, sex?
Female | > M:F = 1:6
32
De Quervain's syndrome - epidemiology, when increased in women?
> Increased in post partum and lactating females
33
De Quervain's syndrome - epidemiology, which activities?
> Activities with frequent thumb abduction and ulnar deviation
34
De Quervain's syndrome - diagnosis?
> Examine thumb joint = Consider base of thumb OA > Finklestein's Test > Resisted thumb extension
35
De Quervain's syndrome - management?
Non-operative: > Splints > Steroid injection Operative: > Decompression
36
What is a ganglion?
> A myxoid degeneration from join synovial joint, "A lump" > Arise from joint capsule, tendon sheath or ligament
37
Ganglion - epidemiology?
> 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
38
Ganglion - epidemiology,, sex?
Females (2:1)
39
Ganglion - epidemiology, age?
Age 20-40 yrs peak
40
Ganglion - epidemiology, site (Dorsal vs. Volvar)?
Dorsal > Volvar (3:1)
41
Ganglion - Diagnosis?
Present with lump: > Firm, non-tender > Change in size > Smooth > Occasionally lobulated > Normally not fixed to underlying tissues > Never fixed to the skin
42
Ganglion - treatment?
Non-operative > Reassure & Observe > Aspiration > Hit it with a bible!? Old-school Operative > Excision > Including ‘the root’
43
OA base of thumb - Clinical presentation?
``` > Pain (Opening jars) > Stiffness > Swelling > Deformity > Loss of function ```
44
Issues surrounding OA base of thumb?
Dorsal subuxation, metacarpal adduction, MCPJ hyperextension
45
How many woman affected by OA base of thumb?
1 in 3
46
OA base of thumb - treatment?
``` Non Operative > Life style modifications > NSAIDS > Splint > Steroid Injection ``` Operative > Trapeziectomy > Fusion > Replacement
47
OA base of thumb - treatment, non-operative?
``` Non Operative > Life style modifications > NSAIDS > Splint > Steroid Injection ```
48
OA base of thumb - treatment, operative?
Operative > Trapeziectomy = "Gold standard" > Fusion > Replacement
49
OA base of thumb - treatment, gold standard operative?
Trapeziectomy
50
Trapeziectomy?
> Gold standard surgical treatment of OA base of thumb > Good pain relied > Moderate pinch grip: - +/- interposition flap or - ligament reconstruction

Year 3 - Musculoskeletal (30 decks)

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