Nontraumatic Disorders Of The Hand Flashcards
flexor tenosynovitis can cause?
Surgical emergency
- adhesions
- tendon vascular compromise and necrosis
- extension into adjoining deep spaces
- loss of function of entire hand
Clinical presentation of flexor tenosynovitis?
Penetrating trauma 2-5 days prior to presntation
Kanavels sign
Bacterium that cause flexor tenosynovitis?
Staphylococcus is MC
Often harbor anaerobes
Sometimes are polymicrobial
What are the kanavel signs?
- Percussive tenderness: tenderniss along the entire length of the flexor tendon sheath
- uniform swelling: symmetric finger swelling along entire tendon sheath
- intense pain: with passive extension
- flexion posture: flexed posture at rest (to minimize pain)
What causes paronychia and felons
Minor trauma, chewing finger nails, or exposing minor trauma to saliva
Common bacterium for paronychia and felons?
Most are polymicrobial
include
- S. Aureus (MC)
- anaerobic bacteria
What are the steps to managing paronychia and felon’s?
First: drain in the ED
Second: immobilize extremity
- reduces inflammation and secondary injury
- limits extension of the infection
Third: BS abx, alter after culture
Fourth: admit or reeval in 48hrs
What is a “position of function” for a hand
- Wrist at 15-30 degrees extension
- Metacarpophalangeal joints at 50-90 degrees of flexion
- Interphalangeal joints at 5-15 degrees of flexion
Describe paronychia
Induration, progressing to eponychial swelling, tenderness, erythema and drainage
Management of paronychia that is absent fluctuance
Warm soaks, elevation, abx
Management of paronychia with suppuration leading to fluctuance
Drain
- nerve block
- avoid incising across the eponychial fold (prevents nail deformity)
- warm soaks for aftercare
Elevate, immobilize and abx
What is a felon?
Subcutaneous pyogenic infection of the pulp space of the distal finger or thumb
- red, tense, markedly painful distal pulp spce
Why do felons hurt so much?
The septa of the finger pad produce multiple compartments
-infection is confined and under pressure
Felons can spread and become?
Flexor tenosynovitis or osteomyelitis
How to manage felons?
Drain using digital block, get cultures
- unilateral longitudinal approach: spares teh sensate volar pad and drains
- Longitudinal approach: if pointing toward the volar fat pad
When draining a felon?
Dissect the septa to ensure drainage
Avoid excision to the flexor crease of the DIP
More extensive incisions such as fish-mouth, hockey stick, and through and through are not indicated
After draining a felon?
Irrigate
Dry sterile dressing
Elevate
Reeval in 48hrs
Oral abx
What causes herpetic whitlow?
Classically
- HSV1 in kids
- HSV2 in adults
Symptoms of herpetic whitlow?
Burning, pruritic sesation
Lesion is erythematous and tender with vesicular bullae
Begin 2-14 days after exposure
What if you drain herpetic whitlow?
Do not mistake herpetic whitlow for a felon because incising and drainaing may result in a secondary bacterial infection and prolong healing time
Treatment for herpetic whitlow
Immobilize, elevate, pain management
Antivirals (herp meds)
Clean dressing to avoid auto innoculation or transmission
causes/associations of deQuervain’s tenosynovitis
- caused by excessive use of thumb and wrist
- associated with pregnancy and postpartem
- activities of repeated radioulnar deviation
- hammering, cross country skiing, lifting a child
Presentation of deQuervains tensynovitis
Pain in the extensor pollicis brevis and abductor pollicis tendons
- along the radial aspect of the wrist that radiates to the thumb or into the forearm
Diagnosis of dequervains tenosynovitis
- Painful ROM of thumb
- local tenderness over distal portion of the raidal styloid
- pos finkelstein test
