Non-Arthritic Hand Conditions Flashcards
what is a mucous cyst?
outpouching of synovial fluid from DIP joint OA
how does a mucous cyst present?
often near bottom corner of nail blister type appearance can be painful can fluctuate/discharge can deform nail/cause ridging if close enough to the nail
how is a mucous cyst managed?
may be left alone
can be excised (only way to get rid of it?)
- risk of nail deformity and recurrence
what is a ganglion?
outpouching of synovial cavity filled with synovial fluid
- therefore more common where high concentration of synovial joints (e/g wrists)
how do ganglions present?
large round swelling
can fluctuate
usually painless but may feel tight
how is a ganglion managed?
can be left alone an should go away with time
“family bible”
aspiration (if superficial, high recurrence rate)
excision (rare, risk of damage to radial artery)
what is Alan’s test?
test to determine whether radial or ulnar is dominant arterial supply to the hand
what is trigger finger
nodule/swelling on tendon in hand which catches on the tendon sheath as it passes through and causes irritation
leads to more swelling until the tendon gets stuck on the edge of the A1 pulley
how does trigger finger present?
pain over A1 pulley (MC head)
triggering = sticking of finger in flexion
may need other hand to extend the finger or be unable to extend it at all
how is trigger finger examined?
demonstrate triggering
feel nodule pass beneath pulley
tender over A1 pulley
- distinguish from dupuytrens
how is trigger finger managed?
conservative (splint, wait to resolve spontaneously)
tendon sheath injection (steroid and local anaesthetic)
- usually curative
- may be repeated up to 3X
surgery if recurrent after injections
- divide A1 pulley (under General or local anaesthetic)
what is DeQuervain’s Tenosynovitis?
…
how does DeQuervains present?
spontaneous pain
swollen/red
finklesteins test
how is DeQuervains managed?
NSAIDs splint rest steroid injection - usually work decompression surgery - if steroids don't work
what is duputrens contracture?
thickening and contracture of subdermal palmar fascia leading to fixed flexion deformity of fingers
where is the issue in dupuytrens?
aponeurosis
metaplasia of the fibroblasts into myofibroblasts
forms fibrous cord which contracts the finger
how does dupuytrens present?
painless, gradual progression
starts as palmar pit/nodule
what are the risk factors for dupuytrens?
genetics? DM alcohol/cirrhosis smoking epilepsy/anti-epileptic medication trauma dupuytrens diathesis (lederhosens (feet))
how is dupuytrens contracture examined?
feel cords
MCP/PIP joint involvement (measure angles)
table-top test
how does site of dupuytrens affect management?
MCP joint involvement is basically harmless, wont progress and can be fixed at anytime
PIP joint involvement will progress and can become unfixable
how is dupuytrens managed?
conservative - rarely fixes problem (stretches, activity modification) surgery - segmental fasciectomy - fasciectomy - dermofasciectomy - amputation newer treatment - collagenase injection - percutaneous needle fasciotomy (recurrence common but safe, easy procedure)
what is paronychia?
infection within the nail fold
what are the risks for paronychia?
usually in children
nail biting
how does paronychia present?
puss collection
swelling
redness
at base of nail
how is paronychia managed?
elevate
antibiotics
incise and drain collection
how does flexor tendon sheath infection present?
extremely painful
limited extension (including passive) due to pain
may have tracking lymphangitis
tracking up palm and arm
how is flexor tendon sheath infection managed?
surgical emergency
wash out the tendon sheath
