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MSK > MSK: hand, wrist, arm > Flashcards

MSK: hand, wrist, arm Flashcards

1
Q

Is Dupuytrens more likely to occur in males or females?

A

Males

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2
Q

What is the genetics of Dupuytrens?

A

Autosomal dominant

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3
Q

What race typically gets Dupuytrens?

A

White

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4
Q

What are the risk factors for Dupuytrens?

A 
Diabetes
Alcohol
Tobacco
HIV
Epilepsy
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5
Q

What is the pathology of Dupuytrens?

A

Myofibroblast proliferation which results in altered collagen matrix, causing contracture and sickening of the palmar fascia

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6
Q

What are the functional problems of Dupuytrens?

A

Loss of finger extension - active or passive
Hand in pocket
Gripping things
Washing

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7
Q

What are the non-operative options for Dupuytrens?

A

Observe

Radiotherapy

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8
Q

What are the operative options for Dupuytrens?

A 
Partial fasciectomy
Dermo-fasciectomy 
Arthrodesis
Amputation
Percutaneous needle fasciotomy
Injectable collagenase
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9
Q

What finger does Dupuytrens most commonly affect?

A

4th (ring) finger

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10
Q

How long does it usually take for a partial fasciectomy to heal?

A

2-3wks

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11
Q

What is the recurrence of Dupuytrens with partial fasciectomy?

A

50% at 5yrs

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12
Q

Which treatment for Dupuytrens requires intensive physio?

A

Dermo-fasciectomy

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13
Q

What are the benefits of percutaneous needle fasciotomy for Dupuytrens?

A

Quick
No wounds
Return to normal fast
Can be repeated

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14
Q

What are the disadvantages of percutaneous needle fasciotomy for Dupuytrens?

A

Does not prevent traditional surgery in future
Higher recurrance
Risk of nerve injury

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15
Q

What is the pathology of trigger finger?

A

Swelling, which leads to the formation of hard nodules in the tendons. These hard nodules and then unable to freely slide through the normal fibrosseous tunnels (“pulleys”) that hold tendons down against the bones in the hand.

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16
Q

Which sex is affected more by trigger finger?

A

Women

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17
Q

What age group is most affected by trigger finger?

A

40-60

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18
Q

What is the most common finger to get trigger finger?

A

Ring>thumb>middle

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19
Q

What are the predisposing factors for trigger finger?

A

RA
Type I diabetes
Gout

20
Q

What is the diagnosis for trigger finger?

A 
Patient history
Clicking sensation with movement of digit
Lump in palm under pulley
May have to unlock
Clicking -> locking
21
Q

Where is the lump in palm for trigger finger diagnosis?

A

Over A1 pulley

22
Q

What are the non-operative options for trigger finger?

A

Splintage

Steroid

23
Q

What are the operative options for trigger finger?

A

Percutaneous release

Open surgery

24
Q

What is the typical presentation of De Quervain’s syndrome?

A

Several weeks pain localised to radial side of wrist
Aggravated by movement of the thumb
Localised swelling
Localised tenderness over tunnel

25
Q

Which sex does De Quervain’s usually affect?

A

Females

26
Q

Which group does De Quervain’s usually affect?

A

50-60

Post-partum and lactating females

27
Q

What hand motions usually lead to De Quervain’s syndrome?

A

Frequent thumb abduction

Ulnar deviation

28
Q

Which compartment does De Quervain’s syndrome affect?

A

1st dorsal extensor compartment

29
Q

Which tendons does De Quervain’s affect?

A

Extensor pollicis brevis

Abductor pollicis longus

30
Q

What is a differential diagnosis of De Quervain’s syndrome?

A

Base of thumb OA

31
Q

What would you exam for suspected De Quervain’s?

A

Thumb joints

32
Q

What are the tests for De Quervain’s?

A

Finklestein’s test

Resisted thumb extension

33
Q

What is Finklestein’s test?

A

The thumb in placed in the palm, with the fingers folded over – to make a fist
Wrist is adducted (toward the ulnar side)
A positive test is where pain is felt in the radial side of the wrist during this adduction

34
Q

What is a positive Finklestein’s test?

A

Where pain is felt in the radial side of the wrist during this adduction

35
Q

What is the non-operative management for De Quervain’s?

A

Splints

Steroid injection

36
Q

What is the operative management for De Quervain’s?

A

Decompression

37
Q

What is a ganglion?

A

A myxoid degeneration from joint synovial which arises from joint capsule, tendon sheath or ligament

38
Q

Which sex is more likely to get a ganglion?

A

Female

39
Q

Which type of ganglion is more common: dorsal or volar?

A

Dorsal

40
Q

What are ganglions sometimes associated with?

A

Recurrent injury around the wrist

41
Q

What are the signs of a ganglion?

A 
Present with lump
Firm, non-tender
Change in size
Smooth
Occasionally lobulated
Normally not fixed to underlying tissues
Never fixed to skin
42
Q

What is the management of a ganglion?

A

Reassure and observe
Aspiration
Operative: excision

43
Q

What are the signs/symptoms of OA at the base of thumb?

A 
Pain
Stiffness
Swelling
Deformity
Loss of function
44
Q

What is the STT joint?

A

Scaphotrapeziotrapezoidal (STT)

45
Q

What is the non-operative management of OA base of thumb?

A

Life style modification
NSAIDs
Splint
Steroid injection

46
Q

What is the operative management of OA base of thumb?

A

Trapeziectomy
Fusion
Replacement

47
Q

What is the gold standard operative management of OA base of thumb?

A

Trapeziectomy

MSK (17 decks)

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