Non-arthritic hand conditions

Question 1

what is a mucous cyst

Answer 1

out pouching of synovial fluid from DIPjt in OA

Question 2

How do mucous cysts present

Answer 2

painful blister/cyst
often in the corner of the nail
may deform the nail/ cause ridging

Question 3

how to you manage a mucous cyst

Answer 3

may be left alone or can have excision (only way to get it to go)

Question 4

what is a ganglion

Answer 4

outpouchings of synovial cavity so common in wrist (high conc of synovial joints)

Question 5

how to ganglions present

Answer 5

large round swelling filled with synovial fluid
can fluctuate
usually painless but can feel tight

Question 6

how to treat ganglion

Answer 6

leave it alone it will resolve with time or sometimes you can aspirate them

can also sometimes excise them

Question 7

how to test for dominant artery (radial or ulnar)

Answer 7

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

Question 8

what is trigger finger

Answer 8

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

Question 9

where do the tendons run in the hand

Answer 9

within the flexor tendon sheath - holds the tendon onto the bone

Question 10

usual site of trigger finger

Answer 10

A1 sully (MC head)

Question 11

how do you treat trigger finger

Answer 11

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

Question 12

how does trigger finger present

Answer 12

finger stuck in flexion
tender over A1 pulley
feel nodule pass beneath pulley

Question 13

what is DeQueverain’s tenosynovitis

Answer 13

painful inflammation of tendons in wrist and at base of thumb

Question 14

how does DeQueverain’s present

Answer 14

pain at the base of the thumb

spontaneous, painful, swollen/red

Question 15

how do you treat DeQueverain’s

Answer 15

NSAIDS 
splint 
rest 
steroid injection 
surgery - decompression

Question 16

what is Dupuytrens contractor

Answer 16

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

Question 17

what is the main issue in Dupuytrens contractor

Answer 17

aponeurosis

metaplasia of the fibroblasts into myofibroblasts forming fabulous cord

Question 18

how does dupuytrens contractor present

Answer 18

usually painless with gradual progression

Question 19

what are some risk factors/causes for dupuytrens contractor

Answer 19

genetics 
alcohol/cirrhosis 
smoking 
epilepsy/anti-eleptic medication 
trauma 
dupuytrens diathesis

Question 20

what is the test for Dupuytren’s contractor

Answer 20

table top test (can u put hand flat on table top)

measure angles

Question 21

how does the site of dupuytrens affect management

Answer 21

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

Question 22

how do you manage dupuytrens

Answer 22

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

Question 23

why don’t you cut perpendicular to the skin creases

Answer 23

because the scar will give contractor

Question 24

what is paronychia

Answer 24

infection in the nail fold- often in children

Question 25

what is a risk factor for paronchia

Answer 25

nail biting

Question 26

how do you manage paronychia

Answer 26

elevate
antibiotics
incise and drain collection

Question 27

what is a flexor tendon sheath infection

Answer 27

rare but important- surgical emergency

infection within sheath which travels along the line up the palm and arm

Question 28

how can flexor tendon sheath infection cause permanent contractor

Answer 28

the sheath gets scarred

Question 29

how does flexor tenon sheath infection present

Answer 29

extremely painful
limited extension (including passive) due to pain
may have tracking lymphangitis

Question 30

how to manage flexor tendon sheath infection

Answer 30

wash out tendon sheath

elevate