Hand Problems

Question 1

This Deck Covers:

Answer 1

• Dupuytren’s
• Trigger Finger
• De-Quervain’s Tenovaginitis
• Ganglia
• Base of Thumb OA

Question 2

Who gets Dupuytren’s Disease?

Answer 2

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

White people

Question 3

Explain the genetic component of Dupuytren’s Disease?

Answer 3

Autosomal dominant with variable penetrance

Question 4

What are the risk factors for Dupuytren’s?

Answer 4

Diabetes
Alcohol
Tobacco
HIV
Epilepsy (phenytoin treatment)

Question 5

Describe the pathology behind Dupuytren’s?

Answer 5

Myofibroblasts make collagen which forms hard nodules along the palmar tendons of the fingers, pulling the finger into flexion

Question 6

How does Dupuytren’s Present?

Answer 6

First hard nodules under palmar skin

Then the fingers become permanently flexed (lose passive/active extension)

Its not painful but they do get functional issues like problems washing their face or gripping things

Question 7

Which fingers are effected by Dupuytren’s?

Answer 7

Mostly Ring Finger

Followed by Pinkie & Middle

Question 8

How do we treat Dupuytren’s?

Answer 8

Radiotherapy

Fasciectomy

Percutaneous needle fasciotomy (Early)

Question 9

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

Answer 9

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

Question 10

Who gets Trigger Finger and which fingers does it affect?

Answer 10

F>M in 40-60s

Affects Ring > Thumb > Middle

Question 11

What is Trigger Finger?

Answer 11

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

Question 12

What conditions are associated with trigger finger?

Answer 12

RA
Diabetes
Gout

Question 13

How does Trigger Finger present?

Answer 13

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

Question 14

How can we treat Trigger Finger?

Answer 14

Splintage
Steroid Injection

Operatively:
- Percutaneous release or open surgery

Question 15

Define De-quervain’s Tenovaginitis?

Answer 15

Non-inflammatory thickening of the Extensor Pollicis Brevis & Abductor Pollicis Longus tendons along with their sheaths that causes:

• radial wrist pain aggravated by thumb movement
• +/- a localised swelling

Question 16

who gets Dequervain’s Tenovaginitis?

Answer 16

Mostly women in 50-60s

Also Post-partum or lactating women

Question 17

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

Answer 17

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

Question 18

How do we treat De Quervain’s Tenovaginitis?

Answer 18

Splintage
Steroid Injection
Analgesia

Operative Decompression

Question 19

What is ganglion?

Answer 19

Cyst arising from a joint capsule, tendon sheath or ligament

Question 20

Who gets ganglia?

Answer 20

More common females

Wide age ranges but peaks at 20-40yrs

Question 21

Where are most ganglia found on the hands?

Answer 21

Dorsal Surface

Question 22

How does a ganglia appear?

Answer 22

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

Its never fixed to skin and rarely to underlying structures

Question 23

How do we treat ganglia?

Answer 23

• Aspiration
• “Family Bible” Technique

Operative Excision

Question 24

Who gets Osteoarthritis in the thumb?

Answer 24

1 in 3 women

Question 25

How does OA present in the thumb?

Answer 25

Pain
Stiffness
Swelling
Deformity
Loss of function

Question 26

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

Answer 26

Scapho-Trapezoid-Trapezium (STT) OA

Question 27

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

Answer 27

• Steroid injection
• Splint
• NSAIDs
• Lifestyle modifications

Question 28

What surgery can we offer for OA?

Answer 28

Gold standard is Trapeziectomy

Also Joint Fusion or replacement