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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?

A

Women

23
Q

Epidemiology of trigger finger - Age?

A

40-60s

24
Q

Epidemiology of trigger finger - associations?

A

RA, DM, Gout

25
Q

Diagnosis of trigger finger?

A 
> 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
Q

Where is a lump palpable in trigger finger?

A

In the palm over A1 pulley

27
Q

Where is the triggering palpable in trigger finger?

A

Around the A1 pulley

28
Q

Trigger finger - treatment?

A

Non-operative
> Splintage
> Steroid

Operative
> Percutaneous release
> Open surgery

29
Q

De Quervain’s syndrome - patient history?

A

> 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
Q

De Quervain’s syndrome - epidemiology?

A

> 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
Q

De Quervain’s syndrome - epidemiology, sex?

A

Female

> M:F = 1:6

32
Q

De Quervain’s syndrome - epidemiology, when increased in women?

A

> Increased in post partum and lactating females

33
Q

De Quervain’s syndrome - epidemiology, which activities?

A

> Activities with frequent thumb abduction and ulnar deviation

34
Q

De Quervain’s syndrome - diagnosis?

A

> Examine thumb joint = Consider base of thumb OA
Finklestein’s Test
Resisted thumb extension

35
Q

De Quervain’s syndrome - management?

A

Non-operative:
> Splints
> Steroid injection

Operative:
> Decompression

36
Q

What is a ganglion?

A

> A myxoid degeneration from join synovial joint, “A lump”

> Arise from joint capsule, tendon sheath or ligament

37
Q

Ganglion - epidemiology?

A

> 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
Q

Ganglion - epidemiology,, sex?

A

Females (2:1)

39
Q

Ganglion - epidemiology, age?

A

Age 20-40 yrs peak

40
Q

Ganglion - epidemiology, site (Dorsal vs. Volvar)?

A

Dorsal > Volvar (3:1)

41
Q

Ganglion - Diagnosis?

A

Present with lump:
> Firm, non-tender

> Change in size

> Smooth

> Occasionally lobulated

> Normally not fixed to underlying tissues

> Never fixed to the skin

42
Q

Ganglion - treatment?

A

Non-operative
> Reassure & Observe
> Aspiration
> Hit it with a bible!? Old-school

Operative
> Excision
> Including ‘the root’

43
Q

OA base of thumb - Clinical presentation?

A 
> Pain (Opening jars)
> Stiffness
> Swelling
> Deformity
> Loss of function
44
Q

Issues surrounding OA base of thumb?

A

Dorsal subuxation, metacarpal adduction, MCPJ hyperextension

45
Q

How many woman affected by OA base of thumb?

A

1 in 3

46
Q

OA base of thumb - treatment?

A 
Non Operative
> Life style modifications
> NSAIDS
> Splint
> Steroid Injection

Operative
> Trapeziectomy
> Fusion
> Replacement

47
Q

OA base of thumb - treatment, non-operative?

A 
Non Operative
> Life style modifications
> NSAIDS
> Splint
> Steroid Injection
48
Q

OA base of thumb - treatment, operative?

A

Operative
> Trapeziectomy = “Gold standard”
> Fusion
> Replacement

49
Q

OA base of thumb - treatment, gold standard operative?

A

Trapeziectomy

50
Q

Trapeziectomy?

A

> 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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