Orthopaedic Conditions of the Hand Flashcards
In which sex is Dupuytren’s contracture more common?
Males, tends to occur earlier in men too
What is the aetiology of Dupuytren’s?
Exactly aetiology unknown
Genetic predisposition (penetrance unknown)
Sporadic in 30%
Onset possibly sex linked and seems to occur exclusively in white races
What is associated with Dupuytren’s?
Factors which cause injury to the palmar fascia and in a predisposed individual would contribute to dx progression
Incl. DM, alcohol, tobacco, HIV, epilepsy
What is Dupuytren’s diathesis?
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)
What is the pathology of Dupuytren’s?
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
What is a typical presentation of Dupuytren’s?
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
How do you diagnose Dupuytren’s?
Clinical
Table top test - when unable to lay hand flat on table –> suggestive of requiring Rx
How do you manage Dupuytren’s?
Incurable
Observe
RT rarely used
Partial fasciectomy (gold standard) Dermo-fasciectomy (more severe, less recurrence, req. intense physio) Arthrodesis Amputation Percutaneous needle fasciotomy Collagenase
What is involved in follow up of a partial fasciectomy?
Wounds take 2-3weeks to heal
Stiffness requires physio input
High recurrence rate
What is involved in percutaneous needle fasciotomy?
Cutting bands via a bevelled needle
Risk of nerve injury
2-3 day complete recovery
What is involved in collagenase injection?
Inject cord with collagenase but can also dissolve tendons!!
In which gender/age is trigger finger more common?
Females
40s-60s
In which finger is trigger finger more common?
Ring > thumb > middle
What is the pathology of trigger finger?
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
What conditions are associated with trigger finger?
RA, gout, DM
What is a typical history of someone with trigger finger?
Painful locking of finger in flexed position, releases suddenly with a pop on extension
Often assoc. with tenderness and lump over A1 pulley
How can you differentiate trigger finger from Dupuytren’s?
Short history and clicking sensation
How do you manage trigger finger?
Splintage
Steroid injection is mainstay
Percutaneous release
Open surgery to cut A1 pulley (only if failure of multiple steroid injections)
In what gender and age group does De Quervan’s syndrome tend to occur?
Females, 50-60s
Who is at increased risk of De Quervan’s?
Post-partum or breast feeding ladies
Bilateral wrist pain and just been pregnant should make you think of what condition?
De Quervans
What is a typical history of De quervans syndrome?
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
How do you differentiate De Quervans from base of thumb OA?
Press on base of thumb and radial styloid and see which is more painful
What tests can you do to help you diagnose De Quervan’s?
Finklestein’s test: put thumb in hand and ulnar deviation of wrist may ilict pain
Resisted thumb extension more effective
