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MSK > O: Hand Conditions > Flashcards

O: Hand Conditions Flashcards

1
Q

what is a mucous cyst?

A

outpouching of synovial fluid from DIP jt affected by OA

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2
Q

mx of mucous cyst?

A

leave alone or surgically excise

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3
Q

what is a ganglion?

A

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

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4
Q

where is the most common hand ganglion?

A

mainly dorsal carpal

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5
Q

aetiology of ganglions?

A

trauma, mucoid degeneration, synovial herniation

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6
Q

s/s of ganglion?

A

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

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7
Q

ix for ganglions?

A

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

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8
Q

mx of ganglions?

A

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

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9
Q

what is trigger finger?

A

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

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10
Q

epi of trigger finger

A

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

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11
Q

aetiology of trigger finger

A

idiopathic, carpal tunnel, diabetes

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12
Q

pathophysiology of trigger finger?

A

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

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13
Q

s/s of trigger finger?

A

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

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14
Q

mx for trigger finger?

A

conservative: splint, NSAIDs, tendon sheath corticosteroids

surgery- A1 pulley release

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15
Q

what is duputryene’s contracture?

A

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

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16
Q

which sites are more predisposed to duputryene’s contracture?

A

ring finger> small finger> middle> index

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17
Q

epi of duputryene’s?

A

northern countries

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18
Q

pathophysiology of duputryene’s?

A

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

19
Q

disease progression of DC?

A

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

20
Q

aetiology of duputryene’s?

A

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

21
Q

s/s of duputryenes?

A

nodules, pits, cord develops, contracture, painless

22
Q

ix of dupuytrene;s

A

Houston’s table top test

23
Q

mx of duputryene’s?

A

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

24
Q

main complication of duputryene’s?

A

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

25
Q

what is giant cell tumour of tendon sheath?

A

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

26
Q

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

A

true

27
Q

s/s of giant cell tumour of tendon sheath?

A

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

28
Q

ix for giant cell tumour of tendon sheath?

A

doesn’t trans-illuminate

29
Q

mx of giant cell tumour?

A

leave alone or excise

30
Q

what are 3 types of nail injuries

A

sublingual haematoma, nail bed laceration, nails bed avulsion

31
Q

mx of nail injuries in A&E?

A

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

32
Q

what is paronychia?

A

infection of nail fold where pus often collects

33
Q

aetiology of paronychia?

A

young women, nail filing/ biting

34
Q

organisms of paronychia?

A 
acute= staphA
chronic= Candida albicans
35
Q

class of paronychia?

A

acute or chronic (diabetes, HIV)

36
Q

s/s of acute paronychia vs chronic?

A 
acute= pain, erythematous, hot
chronic= recurrent bouts of low grade inflammation
37
Q

mx for acute apronychia?

A

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

38
Q

what is flexor tendon sheath infection (FTSI)?

A

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

39
Q

aetiology of FTSI?

A

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

40
Q

organisms responsible for FTSI?

A

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

41
Q

s/s of FTSI?

A

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

42
Q

ix for FTSI?

A

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

43
Q

mx for FTSI?

A

non-op: wash out tendon sheath, IB abx, hand immobilisation

op: incise and drain + culture-specific abx

MSK (26 decks)

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