Orthopaedic Hand Problems

Question 1

What kind of inherited condition is Dupuytren’s?

Answer 1

Autosomal dominant

Question 2

What kind of patient gets Dupuytren’s?

Answer 2

Female dominated
Males present earlier than females
Only in white population

Question 3

What other conditions are associated with Dupuytren’s?

Answer 3

Diabetes
Alcohol
Tobacco
HIV
Epilepsy

Question 4

What four things make up Dupuytren’s diathesis?

Answer 4

Early onset disease
Bilateral disease
Family History
Ectopic disease

Question 5

What is the disease process of Dupuytren’s?

Answer 5

Myofibroblast
Intracellular contractile elements
Regulated by growth factors
Production of collagen
Overgrowth of the tendons causing contracture of the hands (active and passive). Usually affects the little and ring finger. Usually not painful

Question 6

What is the management of Dupuytren’s?

Answer 6

Observe
Splints don’t work
Radiotherapy (not used in Scotland but can be used to slow down progression)
Partial fasciectomy
Dermo-fasciectomy
Arthrodesis
Amputation
Percutaneous Needle Fasciotomy
Collagenase

Question 7

What is trigger finger?

Answer 7

The thickenings of the sheaths that hold the tendons of the fingers act as pulleys. A swelling in the tendon causes it to catch on the pulley.
Clicking sensation with movement of digit
Lump in palm under pulley
May have to use other hand to ‘unlock’
Clicking may progress to locking

Question 8

What are associated conditions of trigger finger?

Answer 8

Rheumatoid arthritis
Diabetes Mellitus
Gout

Question 9

What is the management of trigger finger?

Answer 9

Splintage
Steroid
Percutaneous release
Open surgery

Question 10

What is the presentation of De Quervain’s tenosynovitis?

Answer 10

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

Question 11

What kind of patients get De Quervain’s?

Answer 11

Female over male
Age 50s - 60s
Increased in post partum and lactating females
Activities with frequent thumb abduction and ulnar deviation

Question 12

What is a differential diagnosis for De Quervain’s?

Answer 12

OA of thumb

Question 13

What is the management of De Quervain’s?

Answer 13

Splints
Steroid injection
Surgical Decompression

Question 14

What is a ganglion?

Answer 14

Lump that arises from joint capsule, tendon sheath or ligament

Question 15

What are the characteristics of a ganglion lump?

Answer 15

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

Question 16

What is the management of a ganglion?

Answer 16

Reassure the patient that it is self limiting and should go away
Aspirate fluid
Can operate and need to remove root of ganglion

Question 17

What are the symptoms of thumb OA?

Answer 17

Pain
Stiffness
Swelling
Deformity
Loss of function

Question 18

What is the management of thumb OA?

Answer 18

Life style modifications
NSAIDS
Splint
Steroid Injection
Trapeziectomy
Fusion
Replacement