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MSK > Orthopaedic Conditions of the Hand > Flashcards

Orthopaedic Conditions of the Hand Flashcards

1
Q

In which sex is Dupuytren’s contracture more common?

A

Males, tends to occur earlier in men too

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2
Q

What is the aetiology of Dupuytren’s?

A

Exactly aetiology unknown
Genetic predisposition (penetrance unknown)
Sporadic in 30%
Onset possibly sex linked and seems to occur exclusively in white races

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3
Q

What is associated with Dupuytren’s?

A

Factors which cause injury to the palmar fascia and in a predisposed individual would contribute to dx progression

Incl. DM, alcohol, tobacco, HIV, epilepsy

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4
Q

What is Dupuytren’s diathesis?

A

Specific characteristics that may indicate a more aggressive course that is harder to treat
Includes early onset dx, bilateral dx, FH, ectopic dx (developing of diseases in the Dupuytren’s family - Ledderhouse (plantar fibromatosis), Peyronie’s (Dupuytren’s of the penis)

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5
Q

What is the pathology of Dupuytren’s?

A

Fibroproliferative disorder of the palmar fascia as a result of hyperactivity of myofibroblasts

Injury –> stimulates myofibroblast proliferation and collagen production –> palmar fascia thickens –> forming nodules
Nodules adhere to the skin –> puckering
Nodules developing into cords which cause flexion contractures

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6
Q

What is a typical presentation of Dupuytren’s?

A

Nodules/cords in the hand Flexion contractures (esp in 4th and 5th digit)
Inability to extend fingers
Painless
Functional consequences, e.g. unable to wash face

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7
Q

How do you diagnose Dupuytren’s?

A

Clinical

Table top test - when unable to lay hand flat on table –> suggestive of requiring Rx

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8
Q

How do you manage Dupuytren’s?

A

Incurable
Observe
RT rarely used

Partial fasciectomy (gold standard) 
Dermo-fasciectomy (more severe, less recurrence, req. intense physio) 
Arthrodesis
Amputation 
Percutaneous needle fasciotomy 
Collagenase
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9
Q

What is involved in follow up of a partial fasciectomy?

A

Wounds take 2-3weeks to heal
Stiffness requires physio input
High recurrence rate

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10
Q

What is involved in percutaneous needle fasciotomy?

A

Cutting bands via a bevelled needle
Risk of nerve injury
2-3 day complete recovery

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11
Q

What is involved in collagenase injection?

A

Inject cord with collagenase but can also dissolve tendons!!

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12
Q

In which gender/age is trigger finger more common?

A

Females

40s-60s

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13
Q

In which finger is trigger finger more common?

A

Ring > thumb > middle

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14
Q

What is the pathology of trigger finger?

A

Tendons run in sheaths held to the bone by pulleys (thickenings of the sheaths)
?Repetitive use of hand –> local trauma –> inflammation of the tendon –> unable to slide in and out of pulley –> tendon bundles into a nodule
Nodule cannot get through the pulley, so cannot extend finger

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15
Q

What conditions are associated with trigger finger?

A

RA, gout, DM

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16
Q

What is a typical history of someone with trigger finger?

A

Painful locking of finger in flexed position, releases suddenly with a pop on extension

Often assoc. with tenderness and lump over A1 pulley

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17
Q

How can you differentiate trigger finger from Dupuytren’s?

A

Short history and clicking sensation

18
Q

How do you manage trigger finger?

A

Splintage
Steroid injection is mainstay
Percutaneous release
Open surgery to cut A1 pulley (only if failure of multiple steroid injections)

19
Q

In what gender and age group does De Quervan’s syndrome tend to occur?

A

Females, 50-60s

20
Q

Who is at increased risk of De Quervan’s?

A

Post-partum or breast feeding ladies

21
Q

Bilateral wrist pain and just been pregnant should make you think of what condition?

A

De Quervans

22
Q

What is a typical history of De quervans syndrome?

A

Several weeks pain localised to the radial styloid and aggravated by thumb movement
May have localised swelling
Localised tenderness over tunnel
IN those doing frequent thumb adduction/ulnar deviation
Post-partum/breast feeding

23
Q

How do you differentiate De Quervans from base of thumb OA?

A

Press on base of thumb and radial styloid and see which is more painful

24
Q

What tests can you do to help you diagnose De Quervan’s?

A

Finklestein’s test: put thumb in hand and ulnar deviation of wrist may ilict pain
Resisted thumb extension more effective

25
Q

What is the pathology of De Quervans?

A

Stenosing tenosynovial inflammation of the 1st dorsal compartment

26
Q

What does the first dorsal compartment contain?

A

Pollicis longus and extensor pollicis brevis

27
Q

How do you manage De Quervan’s?

A 
Splints 
Steroid injections (SEs: depigmentation/defatting of skin)
Decompression: release sheath
28
Q

When doing decompression surgery for De Quervan’s what must you be careful of?

A

Injuring the dorsal root of the radial nerve

29
Q

What are ganglions?

A

Myexoid (clear, viscous fluid filled) degenerative cysts from joint synovia

30
Q

What is the most common discrete swelling of the hand/wrist?

A

Ganglion

31
Q

In which gender to ganglions tend to occur? When is the peak age of occurrence?

A

Females

20-40

32
Q

On what side of the hand do ganglion tend to occur?

A

Dorsal

33
Q

What might ganglion be associated with?

A

Recurrent injury around the wrist

34
Q

What is the typical presentation of ganglion?

A

Firm, non-tender, smooth lumps that change in size
Sometimes lobulated
Normally not fixed to underlying tissues
Never fixed to skin

35
Q

How can you manage ganglion?

A

Reassure, observe, aspiration, hit with bible

Excision (incl. the root)

36
Q

What is the presentation of OA of base of the thumb?

A 
Pain (activity related)
Stiffness
Swelling 
Deformity 
Loss of function
37
Q

How common is base of thumb OA?

A

Affects 1/3 of woman

38
Q

What is the non-operative management of base of thumb OA?

A

Lifestyle modifications
NSAIDs
Splintage
Steroid injections (under XRay)

39
Q

What is the operative management of base of thumb OA?

A

Trapeziectomy (gold standard) - takes 3-5 months to start becoming better
Fusion
Replacement

40
Q

When would you do a fusion in base of thumb OA?

A

In younger people w. heavy manual jobs

MSK (27 decks)

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