Non-Arthritic Hand Conditions Flashcards
What are mucous cysts?
Outpouching of the synovial fluid from DIP joint due to osteoarthritis
What are some presentations of mucous cysts?
May be painful, fluctuate/discharge, may deform nail and cause ridge
How are mucous cysts treated?
Do nothing
Excision = often needs advancement/rotation flap
What are ganglions?
Outpouching of synovial cavity = more common, often synovial joints (e.g wrist)
Where is the most common site for ganglions?
Next to site of palpation of radial pulse = often stuck to artery
What are some features of ganglions?
Filled with synovial fluid, fluctuate/transilluminate, usually painless but may feel tight, usually resolve with time
How are ganglions treated?
Do nothing, aspirate, excision
What is the pathogenesis of trigger finger?
Tendons run within flexor tendon sheath, any swelling of tendon leads to irritation = more swelling, tendon gets caught on edge of A1 pulley
What are some symptoms of trigger finger?
Pain over A1 pulley (MC head), sticking of finger in flexion, may need other hand to extend finger or may not be able to extend finger at all
What are some examination features of a patient with trigger finger?
Demonstrate triggering, tender over A1 pulley, feel nodule pass beneath pulley, may affect thumb
What is the conservative treatment for trigger finger?
Often resolves spontaneously = splint to prevent flexion
How are tendon sheath injections given for trigger finger?
Steroid and local anaesthetic, often curative, may be repeated up to two time
What surgery can be done for trigger finger?
Offered after failure to resolve after two tendon sheath injections, given under local or general anaesthetic, divide A1 pulley
What are the contents of the carpal tunnel?
4 x FDP tendons, 4 x FDS tendons, 1 x FPL tendon, median nerve
Where does the median nerve innervate?
Motor to LOAF muscles
Sensory to palmar hand, thumb, index and middle finger and radial half of ring finger
What are the LOAF muscles?
Lumbricals I and II, opponens pollicis, abductor pollicis brevis, flexor pollicis brevis
What are the symptoms of carpal tunnel syndrome?
Often sensory involvement to radial 3 and a half fingers, often worse at night, relieved by shaking the hand, palmar sensation often spared
What are some associations of carpal tunnel syndrome?
Diabetes, pregnancy, hypothyroidism, fluid overload, acromegaly, rheumatoid arthritis, most commonly idiopathic, more common in women
What are some investigations for carpal tunnel syndrome?
Phalen’s test and Tinnel’s test
Compressive neuropathy = increased latency, decreased amplitude
Kamath and Stothard carpal tunnel questionnaire
How is carpal tunnel syndrome treated?
Splintage, diagnostic steroid injection, surgery
What is DeQuervain’s tenosynovitis?
Inflammation of the tendon sheath = affects the back of the thumb
How does DeQuervain’s tenosynovitis present?
Spontaneous, painful, swollen/red, positive Finklestein’s test
What are the treatment options for DeQuervain’s tenosynovitis?
NSAIDs, splint, rest
Steroid injection
Surgery = decompression
What is Dupuytren’s contracture?
Thickening and shortening of the subdermal fascia = causes fixed flexion deformity of fingers
What is the initial presentation of Dupuytren’s contracture?
Painless gradual progression = usually starts as palmar pit/nodule
What are some associations of Dupuytren’s contracture?
Genetics (Northern European), diabetes, alcohol/cirrhosis, smoking, epilepsy/anti-epileptic medicine, Dupuytren’s diathesis (Lederhosen’s = foot, Peyronnie’s = penis)
What should be done in an examination of a patient with suspected Dupuytren’s contracture?
Feel cords, establish involvement of MCP/PIP joints by measuring angles, table-top test
What are the conservative treatments for Dupuytren’s contracture?
Stretches and activity modification
What are some surgical options for Dupuytren’s contracture?
Segmental fasciectomy, fasciectomy, dermofasciectomy, amputation
What are some newer treatment options for Dupuytren’s contracture?
Collagenase injection, percutaneous needle fasciotomy
What is paronychia?
Infection of the nail fold = common in children and nail biters, may result in pus collection
What is the management for paronychia?
Elevate, antibiotics, incise and drain collection
What is flexor tendon sheath infection?
Rare surgical emergency = infection within the sheath, tracking up palm and arm
What may a patient with flexor tendon sheath infection complain of?
Extreme pain, limited extension (including passive) due to pain
What are Kanavel’s cardinal signs of flexor tendon sheath infection?
Affected finger held in fixed flexion
Fusiform swelling over finger
Painful to percuss over sheath
Painful on passive extension
How is flexor tendon sheath infections treated?
Wash out tendon sheath (A1 and A5 pulleys)
