O: Hand Conditions Flashcards
what is a mucous cyst?
outpouching of synovial fluid from DIP jt affected by OA
mx of mucous cyst?
leave alone or surgically excise
what is a ganglion?
out pouching filled with mucin of synovial cavity occurring over synovial jts
where is the most common hand ganglion?
mainly dorsal carpal
aetiology of ganglions?
trauma, mucoid degeneration, synovial herniation
s/s of ganglion?
discreet, non tender bump, skin is mobile over top but tethered to underlying structures
ix for ganglions?
transilluminate test +ve, Allen’s test, USS to differentiate between cyst and aneurysm
mx of ganglions?
go away with time, or closed rupture or surgically remove if painful
what is trigger finger?
tendons run within flexor tendon sheath, this has small nodule in it causing fixed flexed finger that can be released
epi of trigger finger
more common in diabetics and females, ring and long finger mainly affected
aetiology of trigger finger
idiopathic, carpal tunnel, diabetes
pathophysiology of trigger finger?
swelling usually at flexor digitorum profundus tendon leads to irritation and tendon gets caught on edge of A1 pulley
s/s of trigger finger?
pain at A1 pulley, fixed flexed finger at PIP jt, clicking
mx for trigger finger?
conservative: splint, NSAIDs, tendon sheath corticosteroids
surgery- A1 pulley release
what is duputryene’s contracture?
pathology of palmar fascia which causes a progressive disease of digital flexure contractures
which sites are more predisposed to duputryene’s contracture?
ring finger> small finger> middle> index
epi of duputryene’s?
northern countries
pathophysiology of duputryene’s?
excessive myofibroblast proliferation and altered collagen matrix leads to thickened palmar fascia
disease progression of DC?
tarts in palm as nodule > pitting > full cord contracture develops & flexed finger
aetiology of duputryene’s?
strong genetic component, alcohol, diabetes, smoking, epilepsy, trauma
s/s of duputryenes?
nodules, pits, cord develops, contracture, painless
ix of dupuytrene;s
Houston’s table top test
mx of duputryene’s?
conservative: stretches, xiaflex injections, needle aponeurotomy
surgery: fasciotomy/ fasciectomy/ dermofasciectomy
main complication of duputryene’s?
duputryene’s diathesis: genetic, young male, bilateral involvement
what is giant cell tumour of tendon sheath?
regenerative hyperplasia with inflammatory process resulting in benign tumour found on tendon sheath of hands/feet
T/F: giant cell tumours of tendon sheath are most common soft tissue disorder after ganglion cysts
true
s/s of giant cell tumour of tendon sheath?
firm, discreet nodule at volar aspect of digits, may be tender, worse on activity
ix for giant cell tumour of tendon sheath?
doesn’t trans-illuminate
mx of giant cell tumour?
leave alone or excise
what are 3 types of nail injuries
sublingual haematoma, nail bed laceration, nails bed avulsion
mx of nail injuries in A&E?
try and maintain nail as splint.
L1&2= dressing only
L3: repair nail bed and stabilise bone
L4= <5mm nail bed then ablate nail
what is paronychia?
infection of nail fold where pus often collects
aetiology of paronychia?
young women, nail filing/ biting
organisms of paronychia?
acute= staphA chronic= Candida albicans
class of paronychia?
acute or chronic (diabetes, HIV)
s/s of acute paronychia vs chronic?
acute= pain, erythematous, hot chronic= recurrent bouts of low grade inflammation
mx for acute apronychia?
warm soaks, elevate, topical abx, incise and drain pus/ total nail bed removal followed by oral abx
what is flexor tendon sheath infection (FTSI)?
infection of tendon sheath which tracks up palm and arm and surrounds flexor tendon
aetiology of FTSI?
penetrating injury to tendon sheath, direct spread from septic jt, deep space infection
organisms responsible for FTSI?
staph A*, MRSA, staph epidermidis, Group B cocci
s/s of FTSI?
painful, swollen, hot, erythema, can’t move, usually localised to palmar aspect of 1 digit
ix for FTSI?
Kanavel’s Score: fixed flexion, fusiform swelling over finger, painful to percuss over swelling, painful on passive extension
mx for FTSI?
non-op: wash out tendon sheath, IB abx, hand immobilisation
op: incise and drain + culture-specific abx
