Non-arthritic hand conditions Flashcards
what is a mucous cyst
out pouching of synovial fluid from DIPjt in OA
How do mucous cysts present
painful blister/cyst
often in the corner of the nail
may deform the nail/ cause ridging
how to you manage a mucous cyst
may be left alone or can have excision (only way to get it to go)
what is a ganglion
outpouchings of synovial cavity so common in wrist (high conc of synovial joints)
how to ganglions present
large round swelling filled with synovial fluid
can fluctuate
usually painless but can feel tight
how to treat ganglion
leave it alone it will resolve with time or sometimes you can aspirate them
can also sometimes excise them
how to test for dominant artery (radial or ulnar)
Alan’s test
get patient to make a fist, press down on both radial and ulnar arteries
then when they relax they’re fist release one artery
do it with both arteries and see which one brings colour back to the palm the quickest
what is trigger finger
nodule/swelling on the tendon which catches as it passes through the edge of the tendon sheath
as it keeps getting stuck it gets more damaged so the swelling gets worse and its even more likely to get stuck
gets stuck in flexion
where do the tendons run in the hand
within the flexor tendon sheath - holds the tendon onto the bone
usual site of trigger finger
A1 sully (MC head)
how do you treat trigger finger
conservative - often resolves spontaneously, splint to prevent flexion
tendon sheath injection
- steroid + local anaesthetic
- often curative
- may be repeated up to 3x
surgery
- under GA or LA
- divide A1 pulley
how does trigger finger present
finger stuck in flexion
tender over A1 pulley
feel nodule pass beneath pulley
what is DeQueverain’s tenosynovitis
painful inflammation of tendons in wrist and at base of thumb
how does DeQueverain’s present
pain at the base of the thumb
spontaneous, painful, swollen/red
how do you treat DeQueverain’s
NSAIDS splint rest steroid injection surgery - decompression
what is Dupuytrens contractor
thickening and contracture of subnormal fascial leading to fixed flexion and deformity of fingers
often affects men but when it does affect women its worse
what is the main issue in Dupuytrens contractor
aponeurosis
metaplasia of the fibroblasts into myofibroblasts forming fabulous cord
how does dupuytrens contractor present
usually painless with gradual progression
what are some risk factors/causes for dupuytrens contractor
genetics alcohol/cirrhosis smoking epilepsy/anti-eleptic medication trauma dupuytrens diathesis
what is the test for Dupuytren’s contractor
table top test (can u put hand flat on table top)
measure angles
how does the site of dupuytrens affect management
MCP joint involvement is pretty much harmless, won’t progress and can be fixed at any time
PIP involvement will progress and can become unfixable
how do you manage dupuytrens
conservative - stretches (not much evidence for it) activity modification
surgery
- segmental fascieotomy
- fasciotomy
- dermofasciectomy
- percutaneous needle fasciotomy (recurrence common but a safe easy procedure good for younger people who will need another one when they’re older)
- amputation
why don’t you cut perpendicular to the skin creases
because the scar will give contractor
what is paronychia
infection in the nail fold- often in children
what is a risk factor for paronchia
nail biting
how do you manage paronychia
elevate
antibiotics
incise and drain collection
what is a flexor tendon sheath infection
rare but important- surgical emergency
infection within sheath which travels along the line up the palm and arm
how can flexor tendon sheath infection cause permanent contractor
the sheath gets scarred
how does flexor tenon sheath infection present
extremely painful
limited extension (including passive) due to pain
may have tracking lymphangitis
how to manage flexor tendon sheath infection
wash out tendon sheath
elevate
