Orthopaedic Porblems of the Hand

Question 1

6 hand conditions

Answer 1

• Dupuytren’s disease
• Trigger finger
• De Quervain’s Tenovaginitis
• Nerve entrapments (carpal/cubital tunnel syndrome)
• Ganglion
• OA base of thumb

Question 2

Who gets dupuytren’s disease

Answer 2

Almost exclusively white males

Question 3

Pathology of dupuytren’s

Answer 3

• Myofibroblast
• Intracellular contractile elements
• Regulated by growth factors
• Production of collagen

Question 4

Functional problems of dupuytren’s

Answer 4

• Usually not painful
• Loss of finger extension (active or passive)
• Trouble gripping things + washing face

Question 5

Treatment of dupuytren’s disease

Answer 5

-Non-operative 
Collagenase
-Operative 
Partial fasciectomy 
Dermo-fasciectomy 
-Percutaneous Needle fasciotomy

Question 6

Most common treatment of dupuytren’s in UK

Answer 6

• Partial fasciectomy

- Wounds take 2-3 weeks to heal

Question 7

Describe percutaneous needle fasciotomy

Answer 7

• Quick + no wounds
• Return to normal activities 2-3 days
• Risk of nerve injury
• Can be repeated

Question 8

Describe collagenase

Answer 8

• Breaks down the peptide bonds in collagen
• Risk of tendon rupture
• Cost

Question 9

Describe trigger finger

Answer 9

• Finger’s tendon gets inflamed and “catches” on tendon sheath
• Pain at base of the affected finger moved or pressed on
• Stiffness/clicking when moved (particularly first thing in the morning)

Question 10

Risk factors of trigger finger

Answer 10

• Diabetes mellitus
• Gout
• Rheumatoid arthritis

Question 11

How to diagnose trigger finger

Answer 11

• Hx
• Clicking sensation with movement of digit
• Lump in palm under pulley
• “Clicking” may progress to “locking”
• May have to use other hand to “unlock”

Question 12

Non operative and operative treatment of trigger finger

Answer 12

• Non-operative = splintage or steroid

- Operative = open surgery or percutaneous release

Question 13

HxPC of de quervain’s syndrome

Answer 13

• Pain localised to radial side of wrist (several weeks)
• Aggravated by movement of the thumb
• May have seen localised swelling
• Localised tenderness over tunnel

Question 14

Whose likely to get de quervain’s syndrome

Answer 14

• Women

- Especially postpartum + lactating women

Question 15

What is de quervain’s syndrome

Answer 15

Tenosynovitis of the sheath or tunnel that surrounds the two tendons that control the movement of the thumb

Question 16

Non-operative and operative treatment of de quervain’s syndrome

Answer 16

• Non-operative = Splints + steroid injection

- Operative = Decompression

Question 17

What is a ganglion cyst

Answer 17

• A fluid-filled swelling that usually develops near a joint or tendon
• Dorsal or volar

Question 18

What’s more common dorsal or volar ganglion cysts

Answer 18

Dorsal > volar (3:1)

Question 19

Risk factor of ganglion cysts

Answer 19

• Females (2:1)

- Recurrent injury around wrist

Question 20

How to diagnose a ganglion cyst

Answer 20

• Present with a firm, non-tender, smooth lump that’s changed in size
• Normally not fixed to underlying tissues
• NEVER fixed to skin
• Occasionally lobulated

Question 21

Non-operative and operative treatment of ganglion cysts

Answer 21

-Non-operative
Aspiration
Reassure & observe 
"Hit it with a bible"
-Operative 
Excision 
Including "the root"

Question 22

Osteoarthritis base of thumb symptoms

Answer 22

• Pain + stiffness
• Swelling
• Deformity
• Loss of function

Question 23

Non-operative and operative treatment of OA base of thumb

Answer 23

Non-operative

• NSAIDs
• Splint
• Steroid injection
• Life style modification

Operative

• Trapeziectomy
• Fusion
• Replacement