Minor hand conditions

Question 1

Define Dupuytren’s contracture

Answer 1

Progressive, painless fibrotic thickening of palmar

fascia.

Question 2

What are the features of Dupuytren’s contracture?

Answer 2

Middle aged/elderly patients
Skin puckering/tethering
Fixed flexion contracture of ring/little finger
Often bilateral
MCP/IP joint flexion
Associated with ALD, DM, Smoking, epilepsy+meds

Question 3

What is the management of Dupuytren’s contracture?

Answer 3

Conservative - physio/exercise
Fasiectomy - used when hand cannot be placed flat on surface, z scars to try and prevent contracture, but usually recurs. Ulnar nerve may be damaged

Question 4

What are the differentials for a Dupuytren’s contracture?

Answer 4

Skin contracture due to old injury/burn
Tendon fibrosis/Trigger finger
Ulnar nerve palsy

Question 5

Define Trigger finger

Answer 5

Tendon nodule which catches on tendon sheath. Triggering on forced extension → Fixed flexion deformity

Question 6

What fingers are usually effected by Trigger finger?

Answer 6

Ring/Middle finger

Associated with RA

Question 7

What is the treatment for Trigger finger?

Answer 7

Steroid injection - High recurrence

Surgery

Question 8

Define Ganglion

Answer 8

Smooth, multilocular cystic swellings

May become in communication with joint capsules/tendons

Question 9

What are the features of a Ganglion?

Answer 9

90% on dorsum of hand
Subdermal, fixed to deeper structures so limits movement
Can cause pain or nerve pressure symptoms

Question 10

What is the management of a Ganglion?

Answer 10

50% go spontaneously
Aspiration ± steroid and hyaluronidase injection
Surgical excision
Differentials - lipoma, sebaceous cyst, fibroma

Question 11

What is Volkmann’s contracture?

Answer 11

Ischaemia usually due to brachial artery damage causes muscle death in the forearm leading to contraction of the muscles and Volkmann’s contracture in the hand