Minor hand conditions

Question 1

What’s Dupuytren’s Contracture?

Answer 1

Dupuytren’s Contracture

• Progressive, painless fibrotic thickening of palmar

fascia.

Question 2

Features and presentations of Dupuytren’s contracture

Answer 2

• M>F
• Middle age / elderly
• Skin puckering and tethering
• Fixed flexion contracture of ring and little fingers
• Often bilateral and symmetrical
• MCP and IP joint flexion

Question 3

Associations with Dupuytren’s Contracture

Answer 3

BAD FIBERS

• Bent penis: Peyronies (3%)
• AIDS
• DM
• FH: AD
• Idiopathic: commonest
• Booze: alcoholic liver disease
• Epilepsy and epilepsy meds (phenytoin)
• Reidel’s thyroiditis and other fibromatoses
• Smoking

Question 4

Treatment of Dupuytren’s Contracture

Answer 4

Conservative: e.g. physio / exercises

Fasciectomy

• e.g. when hand can’t be placed flat on the table
• Z-shaped scars: prevent contracture
• Can damage ulnar nerve
• Usually recurs

Question 5

What’s Trigger finger

- what happens

• presentation
• association
• management

Answer 5

Tendon nodule which catches on proximal side of

tendon sheath → triggering on forced extension→ fixed flexion deformity

• Usually ring and middle fingers
• Associated with RA
• Rx: steroid injection (high recurrence) or surgery

Question 6

Mallet’s Finger

possible cause

management

Answer 6

• direct blow to the extended finger
• Mallet deformity → it’s at the tip of the finger (caused by rupture or avulsion of the extensor tendon of distal phalanx

Management:

• mallet splint → holds the pharynx in full extension for 6 weeks at all times (even during washing); tendon will usually reunite