Orthopaedic conditions of the hand Flashcards
Who gets Dupuytren’s Disease
mainly in men 15-64 (8:1)
Dupuytren’s Disease is?
Autosomal dominant – variable penetrance
Sporadic in 30% of cases
Dupuytren’s Disease = Associations have been made t0?
Diabetes Alcohol Tobacco HIV Epilepsy
Dupuytrens Diathesis (4)
Early onset disease
Bilateral disease
Family History
Ectopic disease
pathology of Dupuytrens
The contraction of precendinous bands - thickened - CONTRACT AND PULL FINGERS INTO FLEXION - palmar aponeurosis (continuation of palmar aponeurosis)
pathology of Dupuytrens is regulated by? (2)
Regulated by growth factors
Production of collagen
Dupuytrens functional problems (6)
Usually not painful Loss of finger extension – active or passive Hand in pocket Gripping things Washing face
Curse of the MacCrimmons
Dupuytren’s Disease Treatment non - operative (3)
Observe
Splints don’t work
Radiotherapy
Dupuytren’s Disease Treatment - operative (6)
Partial fasciectomy
Dermo-fasciectomy
Arthrodesis
Amputation
Percutaneous Needle Fasciotomy
Collagenase
Partial Fasciectomy - what do you do?
open skin- find thickened band and excise them
- Stiffness requires physiotherapy
- Most common procedure performed in UK
RECURRENCE is common
Dermo-Fasciectomy - what do you do?
skin is removed from the palm and underlying fascia
need extensive physiotherapy
Percutaneous Needle Fasciotomy for Dupuytren’s - features
- 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
Collagenase
injected into the band - dissolves the collagen in the band and finger straightens
very expensive
- 3 Flexor Tendon Ruptures
What is trigger finger ?
sensation due to abnormality in finger flexor tendon
How many tendons to each finger
2
- run in a sheath
Thickenings in sheath called?
pulley - hold tendons close to the bone
A Swelling in tendon ?
catches each time it passes through a pulley
Trigger FingerWho gets it?
what fingers?
can be due to what?
Women more frequent than men
Ring > Thumb > Middle
Repetitive use of hand ?
Local trauma
Associations of trigger finger
RA, DM, Gout
Trigger Finger Diagnosis (5)
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’
Diagnosis of TF - 2 features on CE you will feel ?
Palpable lump in palm over A1 pulley
Feel the triggering around the A1-pulley
Trigger Finger - non-operative
Splintage
Steroid
Trigger finger - operative
Percutaneous release
Open surgery
De Quervain’s Syndrome - Where is it seen
1st dorsal extensor compartment
- fibro osseous tunnel
-Thickening of local segment
SWELLING AND PAIN
De Quervain’s Syndrome - diagnosis (4)
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
De Quervain’s Syndrome mainly affects? (3)
older ladies
increased in Post P and lactating females
Activities with frequent thumb abduction and ulnar deviation
De Quervain’s Syndrome - CE look for ? (2)
tenderness over base of thumb
- Examine all of the joints
De Quervain’s Syndrome - what test? (2)
Finklestein’s Test
Resisted thumb extension
De Quervain’s Syndrome - non operative
Splints
Steroid injection
De Quervain’s Syndrome - operative
Decompression
Common nerve conditions
Carpal Tunnel Syndrome
Cubital Tunnel Syndrome
What is a ganglion
A myxoid degeneration from joint synovia…‘Doctor, I have a lump’
Ganglion Anatomy
Arise from joint capsule, tendon sheath or ligament
as OUTPUCHING’S - fluid pumped - water is pulled out
Ganglion lumps are ?
fairly firm
70% of all discrete swellings in the hand and wrist are?
Ganglia
Peak age for ganglia
More common in females (2:1)
Wide age distribution (peak 20-40yrs)
Ganglia are more?
Dorsal > Volar
Ganglia Diagnosis (7)
Present with lump Firm, non-tender Change in size Smooth Occasionally lobulated Normally not fixed to underlying tissues Never fixed to the skin
Ganglia Treatment? - non - operative
Benign swellings
Reassure & Observe
Aspiration
Ganglia Treatment? - operative
Excision
Including ‘the root’
OA Base of Thumb?
most common OA in human body
OA Base of Thumb presents with (5)
Pain Stiffness Swelling Deformity Loss of function
OA pain at base of thumb- describe?
- worse on activity and present at night
- thumb movement reduced and stiffer
- swelling at base of thumb
Base of Thumb OA features
Common
1 in 3 women
Pain opening jars / pinching
Base of Thumb OA - anatomical features (3)
Dorsal subuxation, metacarpal adduction, MCPJ hyperextension
OA Base of Thumb - non operative (4)
Life style modifications
NSAIDS
Splint
Steroid Injection
OA Base of Thumb - operative (3)
Trapeziectomy
Fusion
Replacement
Trapeziectomy is the gold standard for what condition
The “gold standard”
Good pain relief
Moderate pinch grip
+/- interposition flap or ligament reconstruction
takes away part of the joint - leaves a fibrous space
