Nontraumatic Disorders Of The Hand

Question 1

flexor tenosynovitis can cause?

Answer 1

Surgical emergency
- adhesions
- tendon vascular compromise and necrosis
- extension into adjoining deep spaces
- loss of function of entire hand

Question 2

Clinical presentation of flexor tenosynovitis?

Answer 2

Penetrating trauma 2-5 days prior to presntation

Kanavels sign

Question 3

Bacterium that cause flexor tenosynovitis?

Answer 3

Staphylococcus is MC
Often harbor anaerobes
Sometimes are polymicrobial

Question 4

What are the kanavel signs?

Answer 4

• 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)

Question 5

What causes paronychia and felons

Answer 5

Minor trauma, chewing finger nails, or exposing minor trauma to saliva

Question 6

Common bacterium for paronychia and felons?

Answer 6

Most are polymicrobial
include
- S. Aureus (MC)
- anaerobic bacteria

Question 7

What are the steps to managing paronychia and felon’s?

Answer 7

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

Question 8

What is a “position of function” for a hand

Answer 8

• Wrist at 15-30 degrees extension
• Metacarpophalangeal joints at 50-90 degrees of flexion
• Interphalangeal joints at 5-15 degrees of flexion

Question 9

Describe paronychia

Answer 9

Induration, progressing to eponychial swelling, tenderness, erythema and drainage

Question 10

Management of paronychia that is absent fluctuance

Answer 10

Warm soaks, elevation, abx

Question 11

Management of paronychia with suppuration leading to fluctuance

Answer 11

Drain
- nerve block
- avoid incising across the eponychial fold (prevents nail deformity)
- warm soaks for aftercare

Elevate, immobilize and abx

Question 12

What is a felon?

Answer 12

Subcutaneous pyogenic infection of the pulp space of the distal finger or thumb
- red, tense, markedly painful distal pulp spce

Question 13

Why do felons hurt so much?

Answer 13

The septa of the finger pad produce multiple compartments
-infection is confined and under pressure

Question 14

Felons can spread and become?

Answer 14

Flexor tenosynovitis or osteomyelitis

Question 15

How to manage felons?

Answer 15

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

Question 16

When draining a felon?

Answer 16

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

Question 17

After draining a felon?

Answer 17

Irrigate
Dry sterile dressing
Elevate
Reeval in 48hrs
Oral abx

Question 18

What causes herpetic whitlow?

Answer 18

Classically
- HSV1 in kids
- HSV2 in adults

Question 19

Symptoms of herpetic whitlow?

Answer 19

Burning, pruritic sesation

Lesion is erythematous and tender with vesicular bullae

Begin 2-14 days after exposure

Question 20

What if you drain herpetic whitlow?

Answer 20

Do not mistake herpetic whitlow for a felon because incising and drainaing may result in a secondary bacterial infection and prolong healing time

Question 21

Treatment for herpetic whitlow

Answer 21

Immobilize, elevate, pain management
Antivirals (herp meds)
Clean dressing to avoid auto innoculation or transmission

Question 22

causes/associations of deQuervain’s tenosynovitis

Answer 22

• 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

Question 23

Presentation of deQuervains tensynovitis

Answer 23

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

Question 24

Diagnosis of dequervains tenosynovitis

Answer 24

• Painful ROM of thumb
• local tenderness over distal portion of the raidal styloid
• pos finkelstein test

Question 25

Treatment of dequarvains

Answer 25

• Immobilize thumb spika spint
• Remove splint daily for ROM exercises and to avoid stiffness
• anti-inflammatory meds for 10-14 days

Corticosteroid injections or surgical decompression for persistent cases