Non Arthritic Hand Conditions

Question 1

what is a mucous cyst

Answer 1

outpouching of synovial fluid from DIPjt OA

Question 2

what are the features of a mucous cyst

Answer 2

can be painful, may fluctuate/ discharge, may deform nail, cause ridge

Question 3

what is the treatment for a mucous cyst

Answer 3

can be left alone

excision (take down to bone as there may be a small osteophyte)

Question 4

what can happen if an excised mucous cyst recurs

Answer 4

can damage nail bed

Question 5

what are ganglions

Answer 5

outpouching of synovial cavity

Question 6

what are the features of ganglions

Answer 6

more common where high concentration of synovial joints,
filled with synovial fluid,
fluctuate,
usually painless, 
may feel tight,
resolve with time

Question 7

how can you treat ganglions

Answer 7

most resolve with time but can aspirate with large bore (thick fluid) needle, or excision

Question 8

what are the risks of treating ganglion

Answer 8

50% recurrence rate

volar wrist ganglion on radial artery so not safe to aspirate

Question 9

what do the flexor tendons in the hand run in

Answer 9

the flexor tendon sheath

Question 10

what causes trigger finger

Answer 10

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)

Question 11

what is the purpose of the flexor tendon sheath

Answer 11

holds the tendons to the bone

Question 12

who is at higher risk of trigger finger

Answer 12

diabetics

Question 13

what are the examination findings of trigger finger

Answer 13

demonstrate triggering, tender over A1 pulley, feel nodule pass beneath pulley

important to distinguish form dupuytrens

Question 14

how do you manage trigger finger

Answer 14

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

Question 15

what is dequervains tenosynovitis

Answer 15

irritation of the tendon sheath holding the radial tendons

Question 16

what are the features of dequervains

Answer 16

spontaneous, painful (on thumb extension), swollen/red, locally tender, finklesteins test (grab thumb with folded fingers then ulnar deviate)

Question 17

what is the management for DeQuervains

Answer 17

NSAIDs, splint, rest, steroid injection, surgery (decompression- open tendon sheath)

Question 18

what is dupuytrens contracture

Answer 18

thickening and contractuyre of subdermal fascia leading to fixed flexion deformity of fingers

Question 19

what are the features of dupuytrens

Answer 19

painless, gradual progression, usually starts as palmar pit/ nodule, more common in men- more aggressive in women

Question 20

what is the cause of dupuytrens

Answer 20

unknown, associated with;

• genetics
• diabetes
• alcohol/ cirrhosis
• smoking
• injury
• peyronies (penis)

Question 21

what is seen on examination of dupuytrens

Answer 21

feel cords, MCP/PIP involvement (MCP corrects easily), table top test) hand flat on table)

Question 22

what is the treatment for dupuytrens

Answer 22

conservative- stretches, activity modification

surgery- segmental fasciectomy, dermofasciectomy, amputation

new treatments- collagenase injection, percutaneous needle fasciotomy

Question 23

what is paronychia

Answer 23

infection within the nail fold, may result in pus collection

Question 24

who gets paronychia

Answer 24

often children- nail biting is a risk for it

Question 25

how do you manage paronychia

Answer 25

elevate, antibiotics, incise and drain pus collection

Question 26

is flexor tendon sheath infection self limiting

Answer 26

no surgical emergency- if dont treat quickly will get permanent contracture

Question 27

what are the features of flexor tendon sheath infectino

Answer 27

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

Question 28

how do you treat flexor tendon sheath infection

Answer 28

wash out the tendon