Hand Problems Flashcards
Who gets Dupuytrens?
15-64s M:F = 8:1
75+ M:F = 2:1
Disease develops earlier in males
Associations made to; diabetes, alcohol, tobacco, HIV, epilepsy
How is Dupuytrens inherited?
Autosomal dominant with variable penetrance
Sporadic in 30% of cases
Onset may be sex-linked, almost exclusively white races
What is the pathology of Dupuytren’s disease?
Myofibroblast; intracellular contractile elements, regulated by growth factors and produce collagen
What is the effect of Dupuytrens?
Functional problems, usually not painful
Loss of finger extension; active or passive
Hand in pocket, gripping things, washing face difficult
What is the treatment for Dupuytrens?
Non operative
- observe
- splints don’t work
- radiotherapy
Operative
- partial fasciectomy
- dermo-fasciectomy
- arthrodesis
- amputation
Percutaneous needle fasciotomy
Collagenase
Describe partial fasciectomy
Dupuytrens procedure
Most common procedure in UK
Good correction can be achieved
Wounds take 3-4weeks to heal
Stiffness requires physio, can’t be cured
Recurrence 50% at 5 years
Describe dermo-fasciectomy
Dupuytrens procedure
More radical than partia faasciectomy
Removal skin may reduce reccurence rates but requires intensive physio
Describe percutaneous needle fasciotomy
Dupuytrens procedure
Quick, no wounds
Return to normal activity 2-3 days and doesn’t prevent traditional surgery in future
Higher recurrence (?50% at 3 years)
Can be repeated but risk of nerve injury
What is the anatomy of trigger finger?
2 tendons to each finger
Tendons run in sheath
Thickening in sheath = pulley which keeps tendon close to bone
Swelling in tendon catches on pulley
Who gets trigger finger?
Women more than men
40s-60s
Ring > thumb > middle
Associated with; RA, DM, gout
How is trigger finger diagnosed?
History
Clicking sensation with movement of finger
lump in palm under pulley
may have to use other hand to ‘unlock’
Clicking may progress to ‘locking’
Describe treatment of trigger finger
Non-operative
- splintage
- steroid
Operative
- percutaenous release
- open surgery
Describe the presentation of De Quervain’s tenovaginitis
Several weeks pain localised to radial side wrist
Aggravated by thumb movement
May have (had) localised swelling
Localised tenderness over tunnel
Who gets De Quervain’s Tenovaginitis
M:F = 1:6
50s to 60s
Increased in post-partum and lactating females
Where is the problem in De Quervain’s tenovaginitis?
1st dorsal extensor compartment
Fibro-osseous tunnel at distal radius
Thickening localised segment
30% 1st compartment divided by septum
What tests can be done for De Quervain’s Tenovaginitis?
Finklestein’s test
Resisted thumb extension
Describe treatment of De Quervain’s tenovaginitis
Non-operative
- splints
- steroid injection
operative
- decompression
Describe ganglion anatomy
A myxoid degeneration from joint synovia (a lump)
Arise from joint capsule, tendon sheath or ligament
Who gets ganglia?
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
Describe the diagnosis of ganglia
Present with lump; firm, non-tender
Change in size, smooth
Occasionally lobulated, normally not fixated to underlying tissues
NEVER fixed to skin
Describe treatment of ganglia
Non-operative
- reassure and observe
- aspirate
Operative
- excision
- including “root”
How does OA of base of thumb present?
Pain Stiffness Swelling Deformity Loss of function
Who gets base of thumb OA?
Common
1 in 3 women
pain opening jars/pinching
Dorsal subuxation, metacarpal adduction, MCPJ hyperextension
Look for STT OA
How is OA base of thumb treated?
Non-operativee
- lifestyle modification
- NSAIDs
- Splint
- Steroid injection
Operative
- trapeziectomy
- fusion
- replacement
Describe trapeziectomy
Used to treat base of thumb OA
“gold standard”
Good pain relief, moderate pinch group
+/- interposition flap or ligament reconstruction
