Lecture 8 Orthopaedic Problems of the Hand Flashcards
What demographic is Dupuytren’s disease commonly seen in
Male
15-64s
White
What pattern of inheritance is Dupuytren’s disease
Autosomal dominant
30%
What diseases have association with Dupuytren’s disease
o Diabetes o Alcohol o Tobacco o HIV o Epilepsy
Describe the pathology of Dupuytren’s disease
Contraction of peritendinous bands
Palmar aponeurosis
Production of excess collagen
What are the functional problems of Dupuytren’s disease
Loss of finger extension
Fingers pulled into flexion into the palm
Difficulty putting hand in pocket
Problems gripping and washing face
What is the non-operative treatment for dupuytren’s disease
Observe
Radiotherapy
Splints don’t work
What is the operative treatment for dupuytren’s disease
o Partial fasciectomy o Dermo-fasciectomy o Arthrodesis (excise joint and correct finger position) o Amputation o Percutaneous needle fasciotomy o Collagenase
What is “trigger finger”
Abnormality in flexor tendon
Thickening of sheath around finger
Swelling in tendon catches on pulley
What is the common demographic for trigger finger
Women
40-60s
Ring>thumb>middle
What causes trigger finger
Repetitive use of hand
Local trauma
RA, BM, Gout
How is trigger finger diagnosed
Patient history
Clicking sensation with movement
Lump in palm over A1 pulley
How is trigger finger treated (non-operative)
Splintage
Steroid
How is trigger finger treated (operative)
o Percutaneous release- knife used to release A1 pulley
o Open surgery
What is De Quervains Tenovaginitis
Thickening of 1st dorsal extensor compartment
What are the clinical presentation history of De Quervains Tenovaginitis
- Several weeks pain
- Localised
- Radial side of wrist
- Aggravated by movement of the thumb
- Localised swelling
- Localised tenderness over tunnel
What demographic normally gets De Quervains Tenovaginitis
F>M
50-60s
Postpartum and lactating females
How is De Quervains Tenovaginitis diagnosed
Examine thumb joints
Finklestein’s test
How is De Quervains Tenovaginitis treated (non-operatively)
Splints
Steroid injection
How is De Quervains Tenovaginitis treated (operatively)
Decompression
What is Ganglion
A myxoid degeneration from point synovial (lump)
Swelling on dorsal of wrist
What demographic normally get ganglion
F>M
peak 20-40 years
Dorsal>Volar
How is ganglion diagnosed
Present with lump Firm, non-tender Change in size Smooth occasionally lobulated Not fixed to underlying tissues Never fixed to skin
How is ganglion treated (non-operative)
o Reassure & Observe
o Aspiration and steroid
o Rupture them with trauma
How is ganglion treated (operative)
Excision
