Localised Hand Pain: De Quervains tenosynovitis; Trigger finger; Carpal tunnel syndrome; Duputren’s contracture Flashcards
Describe what is meant by De Quervain’s tenosynovitis [1]
Which tendons does it most commonly affect? [2]
De Quervain’s tenosynovitis is a condition where there is swelling and inflammation of the tendon sheaths in the wrist. It is a type of repetitive strain injury
It primarily affects two tendons:
Abductor pollicis longus (APL) tendon
Extensor pollicis brevis (EPB) tendon
Describe the presentation of DQT [3]
Pain in radial aspect of the wrist
Aching
Burning
Weakness
Numbness
Tenderness
What is meant by mummy thumb in DQT? [1]
One notable cause of bilateral De Quervain’s tenosynovitis is in new parents repetitively lifting newborn babies in a way that stresses the tendons of the thumb. For this reason, it is sometimes referred to as “mummy thumb”.
Name and describe the test used for DQT [1]
Finkelstein’s test:
- Finkelstein’s test involves the patient making a fist with their thumb inside their fingers.
- Then, the wrist is adducted (ulnar deviation), causing strain on the APL and EPB tendons.
- If this movement causes pain at the radial aspect of the wrist, the test is positive, indicating De Quervain’s tenosynovitis.
Mangement for DQT?
Non-operative:
First line:
- NSAIDS, rest and immobilisation
Second line:
- steroid injection
Operative:
- surgical release of 1st dorsal compartment (radial based incision proximal to the wrist)
Define trigger finger [1]
What is trigger finger AKA? [1]
It is also known as stenosing tenosynovitis.
Describe the pathophysiology of trigger finger [2]
Normal physiology:
- Flexor tendons of fingers pass through sheaths along the length of the fingers
Trigger finger:
- Get thickening of tendon or tightening of the sheath
- Means when flexed / extended it causes pain, stiffness or catching
- This spefically happens at the first annular pulley (A1) at the metacarpophalangeal (MCP) joint.
Clinical presentation of trigger finger? [3]
Presentation:
- Is painful and tender (usually around the MCP joint on the palm-side of the hand)
- swelling around MCP joint
* Does not move smoothly
* Makes a popping or clicking sound - hallmark feature
* Gets stuck in a flexed position
Which patient populations have a higher chance of getting trigger finger? [4]
DMT1
RA
gout
carpal tunnel syndrome
Non-operative and operative treatment of trigger finger?
Non-operative:
First line:
- splinting, activity modification, NSAIDs
Second line:
- Steroid injections
Operative:
- Surgery to release the A1 pulley - either percutaneous release or open release
Define Dupuytren’s contracture [1]
Describe the pathophysiology [2]
Dupuytren’s contracture is a condition where the fascia of the hand becomes thickened and tight, leading to finger contractures.
Pathophysiology:
* The palmar fascia of the hand forms a triangle of strong connective tissue on the palm.
- the fascia of the hands becomes thicker and tighter and develops nodules as a result of excessive collagen deposition
- Cords of dense connective tissue can extend into the fingers, pulling the fingers into flexion and restricting their ability to extend (contracture).
Describe the presentation of Dupuytren’s contracture [3]
- First sign: hard nodules on the palm.
- Skin thickening and pitting
- Finger pulled into flexion
- Most commonly the ring finger affected
Describe a test used to assess for DC [1]
Table-top test:
- The patient tries to position their hands flat on a table. If the hand cannot rest completely flat, the test is positive,
At what stage do you consider surgical treatment for DC? [1]
consider surgical treatment of Dupuytren’s contracture:
- metacarpophalangeal joints cannot be straightened and thus the hand cannot be placed flat on the table (positive table top test)
What are the three options for surgery for DC? [3]
Needle fasciotomy
- (also known as needle aponeurotomy) involves inserting a needle through the skin to divide and loosen the cord that is causing the contracture.
Limited fasciectomy:
- involves removing the abnormal fascia and cord to release the contracture.
Dermofasciectomy:
- involves removing the abnormal fascia and cord, as well as the associated skin. A skin graft is used to replace the removed skin.