O: Hand Conditions

Question 1

what is a mucous cyst?

Answer 1

outpouching of synovial fluid from DIP jt affected by OA

Question 2

mx of mucous cyst?

Answer 2

leave alone or surgically excise

Question 3

what is a ganglion?

Answer 3

out pouching filled with mucin of synovial cavity occurring over synovial jts

Question 4

where is the most common hand ganglion?

Answer 4

mainly dorsal carpal

Question 5

aetiology of ganglions?

Answer 5

trauma, mucoid degeneration, synovial herniation

Question 6

s/s of ganglion?

Answer 6

discreet, non tender bump, skin is mobile over top but tethered to underlying structures

Question 7

ix for ganglions?

Answer 7

transilluminate test +ve, Allen’s test, USS to differentiate between cyst and aneurysm

Question 8

mx of ganglions?

Answer 8

go away with time, or closed rupture or surgically remove if painful

Question 9

what is trigger finger?

Answer 9

tendons run within flexor tendon sheath, this has small nodule in it causing fixed flexed finger that can be released

Question 10

epi of trigger finger

Answer 10

more common in diabetics and females, ring and long finger mainly affected

Question 11

aetiology of trigger finger

Answer 11

idiopathic, carpal tunnel, diabetes

Question 12

pathophysiology of trigger finger?

Answer 12

swelling usually at flexor digitorum profundus tendon leads to irritation and tendon gets caught on edge of A1 pulley

Question 13

s/s of trigger finger?

Answer 13

pain at A1 pulley, fixed flexed finger at PIP jt, clicking

Question 14

mx for trigger finger?

Answer 14

conservative: splint, NSAIDs, tendon sheath corticosteroids

surgery- A1 pulley release

Question 15

what is duputryene’s contracture?

Answer 15

pathology of palmar fascia which causes a progressive disease of digital flexure contractures

Question 16

which sites are more predisposed to duputryene’s contracture?

Answer 16

ring finger> small finger> middle> index

Question 17

epi of duputryene’s?

Answer 17

northern countries

Question 18

pathophysiology of duputryene’s?

Answer 18

excessive myofibroblast proliferation and altered collagen matrix leads to thickened palmar fascia

Question 19

disease progression of DC?

Answer 19

tarts in palm as nodule > pitting > full cord contracture develops & flexed finger

Question 20

aetiology of duputryene’s?

Answer 20

strong genetic component, alcohol, diabetes, smoking, epilepsy, trauma

Question 21

s/s of duputryenes?

Answer 21

nodules, pits, cord develops, contracture, painless

Question 22

ix of dupuytrene;s

Answer 22

Houston’s table top test

Question 23

mx of duputryene’s?

Answer 23

conservative: stretches, xiaflex injections, needle aponeurotomy
surgery: fasciotomy/ fasciectomy/ dermofasciectomy

Question 24

main complication of duputryene’s?

Answer 24

duputryene’s diathesis: genetic, young male, bilateral involvement

Question 25

what is giant cell tumour of tendon sheath?

Answer 25

regenerative hyperplasia with inflammatory process resulting in benign tumour found on tendon sheath of hands/feet

Question 26

T/F: giant cell tumours of tendon sheath are most common soft tissue disorder after ganglion cysts

Answer 26

true

Question 27

s/s of giant cell tumour of tendon sheath?

Answer 27

firm, discreet nodule at volar aspect of digits, may be tender, worse on activity

Question 28

ix for giant cell tumour of tendon sheath?

Answer 28

doesn't trans-illuminate

Question 29

mx of giant cell tumour?

Answer 29

leave alone or excise

Question 30

what are 3 types of nail injuries

Answer 30

sublingual haematoma, nail bed laceration, nails bed avulsion

Question 31

mx of nail injuries in A&E?

Answer 31

try and maintain nail as splint. L1&2= dressing only L3: repair nail bed and stabilise bone L4= <5mm nail bed then ablate nail

Question 32

what is paronychia?

Answer 32

infection of nail fold where pus often collects

Question 33

aetiology of paronychia?

Answer 33

young women, nail filing/ biting

Question 34

organisms of paronychia?

Answer 34

``` acute= staphA chronic= Candida albicans ```

Question 35

class of paronychia?

Answer 35

acute or chronic (diabetes, HIV)

Question 36

s/s of acute paronychia vs chronic?

Answer 36

``` acute= pain, erythematous, hot chronic= recurrent bouts of low grade inflammation ```

Question 37

mx for acute apronychia?

Answer 37

warm soaks, elevate, topical abx, incise and drain pus/ total nail bed removal followed by oral abx

Question 38

what is flexor tendon sheath infection (FTSI)?

Answer 38

infection of tendon sheath which tracks up palm and arm and surrounds flexor tendon

Question 39

aetiology of FTSI?

Answer 39

penetrating injury to tendon sheath, direct spread from septic jt, deep space infection

Question 40

organisms responsible for FTSI?

Answer 40

staph A*, MRSA, staph epidermidis, Group B cocci

Question 41

s/s of FTSI?

Answer 41

painful, swollen, hot, erythema, can't move, usually localised to palmar aspect of 1 digit

Question 42

ix for FTSI?

Answer 42

Kanavel's Score: fixed flexion, fusiform swelling over finger, painful to percuss over swelling, painful on passive extension

Question 43

mx for FTSI?

Answer 43

non-op: wash out tendon sheath, IB abx, hand immobilisation | op: incise and drain + culture-specific abx