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Year 3: Block 1: MSK system > Orthopaedic conditions of the hand > Flashcards

Orthopaedic conditions of the hand Flashcards

1
Q

Who gets Dupuytren’s Disease

A

mainly in men 15-64 (8:1)

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2
Q

Dupuytren’s Disease is?

A

Autosomal dominant – variable penetrance

Sporadic in 30% of cases

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3
Q

Dupuytren’s Disease = Associations have been made t0?

A 
Diabetes
Alcohol
Tobacco
HIV
Epilepsy
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4
Q

Dupuytrens Diathesis (4)

A

Early onset disease
Bilateral disease
Family History
Ectopic disease

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5
Q

pathology of Dupuytrens

A

The contraction of precendinous bands - thickened - CONTRACT AND PULL FINGERS INTO FLEXION - palmar aponeurosis (continuation of palmar aponeurosis)

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6
Q

pathology of Dupuytrens is regulated by? (2)

A

Regulated by growth factors

Production of collagen

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7
Q

Dupuytrens functional problems (6)

A 
Usually not painful
Loss of finger extension – active or passive
Hand in pocket
Gripping things
Washing face

Curse of the MacCrimmons

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8
Q

Dupuytren’s Disease Treatment non - operative (3)

A

Observe
Splints don’t work
Radiotherapy

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9
Q

Dupuytren’s Disease Treatment - operative (6)

A

Partial fasciectomy
Dermo-fasciectomy
Arthrodesis
Amputation

Percutaneous Needle Fasciotomy
Collagenase

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10
Q

Partial Fasciectomy - what do you do?

A

open skin- find thickened band and excise them

  • Stiffness requires physiotherapy
  • Most common procedure performed in UK

RECURRENCE is common

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11
Q

Dermo-Fasciectomy - what do you do?

A

skin is removed from the palm and underlying fascia

need extensive physiotherapy

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12
Q

Percutaneous Needle Fasciotomy for Dupuytren’s - features

A
  • Quick
  • No wounds
  • Return to normal activities 2-3 days
  • skin over band and is cut across - allows the finger to be straightened
  • risk of nerve injury
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13
Q

Collagenase

A

injected into the band - dissolves the collagen in the band and finger straightens

very expensive
- 3 Flexor Tendon Ruptures

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14
Q

What is trigger finger ?

A

sensation due to abnormality in finger flexor tendon

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15
Q

How many tendons to each finger

A

2

- run in a sheath

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16
Q

Thickenings in sheath called?

A

pulley - hold tendons close to the bone

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17
Q

A Swelling in tendon ?

A

catches each time it passes through a pulley

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18
Q

Trigger FingerWho gets it?
what fingers?
can be due to what?

A

Women more frequent than men
Ring > Thumb > Middle

Repetitive use of hand ?
Local trauma

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19
Q

Associations of trigger finger

A

RA, DM, Gout

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20
Q

Trigger Finger Diagnosis (5)

A

Pain in palm of hand at level of distal palmar crease - kicking sensation when bend and straighten fingerers

Clicking sensation with movement of digit

Lump in palm under pulley (metacarpal head)

May have to use other hand to ‘unlock’
‘Clicking’ may progress to ‘locking’

21
Q

Diagnosis of TF - 2 features on CE you will feel ?

A

Palpable lump in palm over A1 pulley

Feel the triggering around the A1-pulley

22
Q

Trigger Finger - non-operative

A

Splintage

Steroid

23
Q

Trigger finger - operative

A

Percutaneous release

Open surgery

24
Q

De Quervain’s Syndrome - Where is it seen

A

1st dorsal extensor compartment
- fibro osseous tunnel

-Thickening of local segment

SWELLING AND PAIN

25
Q

De Quervain’s Syndrome - diagnosis (4)

A 
Patient History
Several weeks pain localised to radial side of wrist
Aggravated by movement of the thumb
May have seen a localised swelling
Localised tenderness over tunnel
26
Q

De Quervain’s Syndrome mainly affects? (3)

A

older ladies
increased in Post P and lactating females
Activities with frequent thumb abduction and ulnar deviation

27
Q

De Quervain’s Syndrome - CE look for ? (2)

A

tenderness over base of thumb

- Examine all of the joints

28
Q

De Quervain’s Syndrome - what test? (2)

A

Finklestein’s Test

Resisted thumb extension

29
Q

De Quervain’s Syndrome - non operative

A

Splints

Steroid injection

30
Q

De Quervain’s Syndrome - operative

A

Decompression

31
Q

Common nerve conditions

A

Carpal Tunnel Syndrome

Cubital Tunnel Syndrome

32
Q

What is a ganglion

A

A myxoid degeneration from joint synovia…‘Doctor, I have a lump’

33
Q

Ganglion Anatomy

A

Arise from joint capsule, tendon sheath or ligament

as OUTPUCHING’S - fluid pumped - water is pulled out

34
Q

Ganglion lumps are ?

A

fairly firm

35
Q

70% of all discrete swellings in the hand and wrist are?

A

Ganglia

36
Q

Peak age for ganglia

A

More common in females (2:1)

Wide age distribution (peak 20-40yrs)

37
Q

Ganglia are more?

A

Dorsal > Volar

38
Q

Ganglia Diagnosis (7)

A 
Present with lump
Firm, non-tender
Change in size
Smooth
Occasionally lobulated
Normally not fixed to underlying tissues
Never fixed to the skin
39
Q

Ganglia Treatment? - non - operative

A

Benign swellings
Reassure & Observe
Aspiration

40
Q

Ganglia Treatment? - operative

A

Excision

Including ‘the root’

41
Q

OA Base of Thumb?

A

most common OA in human body

42
Q

OA Base of Thumb presents with (5)

A 
Pain
Stiffness
Swelling
Deformity
Loss of function
43
Q

OA pain at base of thumb- describe?

A
  • worse on activity and present at night
  • thumb movement reduced and stiffer
  • swelling at base of thumb
44
Q

Base of Thumb OA features

A

Common
1 in 3 women
Pain opening jars / pinching

45
Q

Base of Thumb OA - anatomical features (3)

A

Dorsal subuxation, metacarpal adduction, MCPJ hyperextension

46
Q

OA Base of Thumb - non operative (4)

A

Life style modifications
NSAIDS
Splint
Steroid Injection

47
Q

OA Base of Thumb - operative (3)

A

Trapeziectomy
Fusion
Replacement

48
Q

Trapeziectomy is the gold standard for what condition

A

The “gold standard”
Good pain relief
Moderate pinch grip
+/- interposition flap or ligament reconstruction

takes away part of the joint - leaves a fibrous space

Year 3: Block 1: MSK system (22 decks)

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