Lecture 8 Orthopaedic Problems of the Hand

Question 1

What demographic is Dupuytren’s disease commonly seen in

Answer 1

Male
15-64s
White

Question 2

What pattern of inheritance is Dupuytren’s disease

Answer 2

Autosomal dominant

30%

Question 3

What diseases have association with Dupuytren’s disease

Answer 3

o	Diabetes
o	Alcohol
o	Tobacco
o	HIV
o	Epilepsy

Question 4

Describe the pathology of Dupuytren’s disease

Answer 4

Contraction of peritendinous bands
Palmar aponeurosis
Production of excess collagen

Question 5

What are the functional problems of Dupuytren’s disease

Answer 5

Loss of finger extension
Fingers pulled into flexion into the palm
Difficulty putting hand in pocket
Problems gripping and washing face

Question 6

What is the non-operative treatment for dupuytren’s disease

Answer 6

Observe
Radiotherapy
Splints don’t work

Question 7

What is the operative treatment for dupuytren’s disease

Answer 7

o	Partial fasciectomy
o	Dermo-fasciectomy
o	Arthrodesis (excise joint and correct finger position)
o	Amputation
o	Percutaneous needle fasciotomy 
o	Collagenase

Question 8

What is “trigger finger”

Answer 8

Abnormality in flexor tendon
Thickening of sheath around finger
Swelling in tendon catches on pulley

Question 9

What is the common demographic for trigger finger

Answer 9

Women
40-60s
Ring>thumb>middle

Question 10

What causes trigger finger

Answer 10

Repetitive use of hand
Local trauma
RA, BM, Gout

Question 11

How is trigger finger diagnosed

Answer 11

Patient history
Clicking sensation with movement
Lump in palm over A1 pulley

Question 12

How is trigger finger treated (non-operative)

Answer 12

Splintage

Steroid

Question 13

How is trigger finger treated (operative)

Answer 13

o Percutaneous release- knife used to release A1 pulley

o Open surgery

Question 14

What is De Quervains Tenovaginitis

Answer 14

Thickening of 1st dorsal extensor compartment

Question 15

What are the clinical presentation history of De Quervains Tenovaginitis

Answer 15

• Several weeks pain
• Localised
• Radial side of wrist
• Aggravated by movement of the thumb
• Localised swelling
• Localised tenderness over tunnel

Question 16

What demographic normally gets De Quervains Tenovaginitis

Answer 16

F>M
50-60s
Postpartum and lactating females

Question 17

How is De Quervains Tenovaginitis diagnosed

Answer 17

Examine thumb joints

Finklestein’s test

Question 18

How is De Quervains Tenovaginitis treated (non-operatively)

Answer 18

Splints

Steroid injection

Question 19

How is De Quervains Tenovaginitis treated (operatively)

Answer 19

Decompression

Question 20

What is Ganglion

Answer 20

A myxoid degeneration from point synovial (lump)

Swelling on dorsal of wrist

Question 21

What demographic normally get ganglion

Answer 21

F>M
peak 20-40 years
Dorsal>Volar

Question 22

How is ganglion diagnosed

Answer 22

Present with lump
Firm, non-tender
Change in size
Smooth
occasionally lobulated
Not fixed to underlying tissues
Never fixed to skin

Question 23

How is ganglion treated (non-operative)

Answer 23

o Reassure & Observe
o Aspiration and steroid
o Rupture them with trauma

Question 24

How is ganglion treated (operative)

Answer 24

Excision

Question 25

What is the clinical presentation of OA base of thumb

Answer 25

Pain
Stiffness
Swelling at base of thumb
Deformity
LOF
Reduced thumb movement

Question 26

OA of base of thumb is common in men or women

Answer 26

Women

Question 27

How is OA base of thumb treated non operatively

Answer 27

Lifestyle modification
NSAIDS
Splint
Steroid injection

Question 28

How is OA tase thumb treated operatively

Answer 28

o Trapeziectomy- take away part of joint that leaves fibrous joint that doesn’t cause pain
- The gold standard
o Fusion
o Replacement