Non Arthritic Hand Conditions Flashcards
what is a mucous cyst
outpouching of synovial fluid from DIPjt OA
what are the features of a mucous cyst
can be painful, may fluctuate/ discharge, may deform nail, cause ridge
what is the treatment for a mucous cyst
can be left alone
excision (take down to bone as there may be a small osteophyte)
what can happen if an excised mucous cyst recurs
can damage nail bed
what are ganglions
outpouching of synovial cavity
what are the features of ganglions
more common where high concentration of synovial joints, filled with synovial fluid, fluctuate, usually painless, may feel tight, resolve with time
how can you treat ganglions
most resolve with time but can aspirate with large bore (thick fluid) needle, or excision
what are the risks of treating ganglion
50% recurrence rate
volar wrist ganglion on radial artery so not safe to aspirate
what do the flexor tendons in the hand run in
the flexor tendon sheath
what causes trigger finger
any swelling on a tendon leads to irritation (e.g nodule due to microtrauma) = more swelling= tendon gets caught on edge on A1 pulley= pain over A1 pulley (MC head)= sticking of finger (usually in flexion)
what is the purpose of the flexor tendon sheath
holds the tendons to the bone
who is at higher risk of trigger finger
diabetics
what are the examination findings of trigger finger
demonstrate triggering, tender over A1 pulley, feel nodule pass beneath pulley
important to distinguish form dupuytrens
how do you manage trigger finger
conservative- often resolves spontaneously, splint to prevent flexion
tendon sheath injection- steroid + LA, often curative, done up to 3 times
surgery- under GA/ LA, divide A1 pulley
what is dequervains tenosynovitis
irritation of the tendon sheath holding the radial tendons
what are the features of dequervains
spontaneous, painful (on thumb extension), swollen/red, locally tender, finklesteins test (grab thumb with folded fingers then ulnar deviate)
what is the management for DeQuervains
NSAIDs, splint, rest, steroid injection, surgery (decompression- open tendon sheath)
what is dupuytrens contracture
thickening and contractuyre of subdermal fascia leading to fixed flexion deformity of fingers
what are the features of dupuytrens
painless, gradual progression, usually starts as palmar pit/ nodule, more common in men- more aggressive in women
what is the cause of dupuytrens
unknown, associated with;
- genetics
- diabetes
- alcohol/ cirrhosis
- smoking
- injury
- peyronies (penis)
what is seen on examination of dupuytrens
feel cords, MCP/PIP involvement (MCP corrects easily), table top test) hand flat on table)
what is the treatment for dupuytrens
conservative- stretches, activity modification
surgery- segmental fasciectomy, dermofasciectomy, amputation
new treatments- collagenase injection, percutaneous needle fasciotomy
what is paronychia
infection within the nail fold, may result in pus collection
who gets paronychia
often children- nail biting is a risk for it
how do you manage paronychia
elevate, antibiotics, incise and drain pus collection
is flexor tendon sheath infection self limiting
no surgical emergency- if dont treat quickly will get permanent contracture
what are the features of flexor tendon sheath infectino
rare, infection within sheath + tracking up palm arm, extremely painful, limited extension (including passive) due to pain, may have tracking lymphangitis, usually unwellm erythema tracks
how do you treat flexor tendon sheath infection
wash out the tendon
