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MSK > Hand Problems > Flashcards

Hand Problems Flashcards

1
Q

Who gets Dupuytren’s Disease?

A

Mostly Men (8M>1F), men present younger too.

White people

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2
Q

Explain the genetic component of Dupuytren’s Disease?

A

Autosomal dominant with variable penetrance

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3
Q

What conditions are associated with Dupuytren’s?

A 
Diabetes
Alcohol
Tobacco
HIV
Epilepsy
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4
Q

Describe the pathology behind Dupuytren’s?

A

Thickening of the Palmar fascia- found in the elastic layer of the skin.
The fascia contain cords which cause the fingers too curl.
In Dupuytrens excess of myofibroblasts which are the intracellular components which cause XS contracture.

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5
Q

How does Dupuytren’s Present?

A
  • First hard nodules under palmar skin
  • Then the fingers become permanently flexed (lose passive/active extension)
  • Not painful
  • Get functional issues like problems washing their face or gripping things
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6
Q

Which fingers are effected by Dupuytren’s?

A

Mostly Ring Finger

Followed by Pinkie & Middle

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7
Q

How do we treat Dupuytren’s ( Non- operative and operative)

A

Non operative:

  • Radiotherapy
  • Observation
  • Splints do not work

Operative:

  • Fasciectomy
  • Percutaneous needle fasciotomy (Early)
  • Amputation
  • Collagenase
  • Arthrodesis
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8
Q

What are the pros/cons of the major treatments for Dupuytren’s?

A

Partial Fasciectomy followed by physio

Percutaneous Needle Fasciotomy is good cos it recovers within 2/3days rather than weeks, has high recurrence but can be repeated

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9
Q

Who gets Trigger Finger and which fingers does it affect?

A

F>M in 40-60s

Affects Ring > Thumb > Middle

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10
Q

What is Trigger Finger?

A

Swollen flexor tendon catches the sheath it passes through making it difficult to flex

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11
Q

What conditions are associated with trigger finger?

A

RA
Diabetes
Gout

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12
Q

How does Trigger Finger present?

A

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 (a1 pulley)

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13
Q

How can we treat Trigger Finger?

A

Splintage
Steroid Injection

Operatively:
- Percutaneous release or open surgery

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14
Q

Define De-quervain’s Tenovaginitis?

A

Non-inflammatory thickening of the EPB & APL tendons along with their sheaths that causes:

  • radial wrist pain aggravated by thumb movement
  • Fibro-osseus tunnel at distal radius
  • +/- a localised swelling/tenderness
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15
Q

who gets Dequervain’s Tenovaginitis?

A
  • Mostly women in 50-60s

- Also Post-partum or lactating women

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16
Q

What tests can be used for De Quervain’s Tenovaginitis?

A

Finklestein’s Test - Grasp the patients thumb and sharply ulnar deviate the hand looking for sharp pain along the distal radius

17
Q

How do we treat De Quervain’s Tenovaginitis?

A

Splintage
Steroid Injection

Operative Decompression

18
Q

What is ganglion?

A

Cyst arising from a joint capsule, tendon sheath or ligament

19
Q

Who gets ganglia?

A
  • More common females

- Wide age ranges but peaks at 20-40yrs

20
Q

Where are most ganglia found on the hands?

A

Dorsal Surface

21
Q

How does a ganglia appear?

A
  • As a smooth, firm, non-tender lump that changes in size

- Its never fixed to skin and rarely to underlying structures

22
Q

How do we treat ganglia?

A 
Do not need treatment unless they are causing pain or applying pressure
Non-operative: 
- Aspiration
- "Family Bible" Technique
Operative: 
Operative Excision
23
Q

Who gets Osteoarthritis in the thumb?

A

1 in 3 women

24
Q

How does OA present in the thumb?

A 
Pain
Stiffness
Swelling
Deformity
Loss of function
25
Q

What else should we check for in a patient with base of thumb OA?

A

Scapho-Trapezoid-Trapezium (STT) OA

26
Q

How can we treat base of thumb OA non-operatively?

A
  • Steroid injection
  • Splint
  • NSAIDs
  • Lifestyle modifications
  • Surgery : trapeziectomy, based thumb replacement
27
Q

What surgery can we offer for OA?

A

Gold standard is Trapeziectomy

Also Joint Fusion or replacement

28
Q

Pros of a Fasciectomy vs percutaneous needle fasciectomy

A

Fasciectomy: aims at removing damaged areas of fascia- cuts them out
• Wounds take 2-3 weeks to repair
• 50% of reoccurance after 5 years
• Needs physiotherapy afterwards

Pecutaneous fasciotomy:
•	No wounds 
•	Return to activity in 2-3 days 
•	Higher re-occurance 
•	Risk of nerve injury
29
Q

Explain the differences between main types of Fasciectomy?

A

Aims at removing areas of fascia which have been affected.

1-	Partial 
• Most common
• Wounds take 2-3 weeks to repair 
• Stiffness required physiotherapy afterwards 
• 50% of reccurence after 5 years

2- Dermo
•More radical
•removing skin may prevent reoccurence

3-	Percutaneous needle fasciotomy:
•No wounds 
•Return to activity in 2-3 days 
•Higher reccurance (50% in 3 years)
•Can be repeated 
•Does not prevent more traditional surgery in the future 
•Risk of nerve injury

MSK (40 decks)

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