Orthopaedic Porblems of the Hand Flashcards
6 hand conditions
- Dupuytren’s disease
- Trigger finger
- De Quervain’s Tenovaginitis
- Nerve entrapments (carpal/cubital tunnel syndrome)
- Ganglion
- OA base of thumb
Who gets dupuytren’s disease
Almost exclusively white males
Pathology of dupuytren’s
- Myofibroblast
- Intracellular contractile elements
- Regulated by growth factors
- Production of collagen
Functional problems of dupuytren’s
- Usually not painful
- Loss of finger extension (active or passive)
- Trouble gripping things + washing face
Treatment of dupuytren’s disease
-Non-operative Collagenase -Operative Partial fasciectomy Dermo-fasciectomy -Percutaneous Needle fasciotomy
Most common treatment of dupuytren’s in UK
- Partial fasciectomy
- Wounds take 2-3 weeks to heal
Describe percutaneous needle fasciotomy
- Quick + no wounds
- Return to normal activities 2-3 days
- Risk of nerve injury
- Can be repeated
Describe collagenase
- Breaks down the peptide bonds in collagen
- Risk of tendon rupture
- Cost
Describe trigger finger
- 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)
Risk factors of trigger finger
- Diabetes mellitus
- Gout
- Rheumatoid arthritis
How to diagnose trigger finger
- 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”
Non operative and operative treatment of trigger finger
- Non-operative = splintage or steroid
- Operative = open surgery or percutaneous release
HxPC of de quervain’s syndrome
- Pain localised to radial side of wrist (several weeks)
- Aggravated by movement of the thumb
- May have seen localised swelling
- Localised tenderness over tunnel
Whose likely to get de quervain’s syndrome
- Women
- Especially postpartum + lactating women
What is de quervain’s syndrome
Tenosynovitis of the sheath or tunnel that surrounds the two tendons that control the movement of the thumb
Non-operative and operative treatment of de quervain’s syndrome
- Non-operative = Splints + steroid injection
- Operative = Decompression
What is a ganglion cyst
- A fluid-filled swelling that usually develops near a joint or tendon
- Dorsal or volar
What’s more common dorsal or volar ganglion cysts
Dorsal > volar (3:1)
Risk factor of ganglion cysts
- Females (2:1)
- Recurrent injury around wrist
How to diagnose a ganglion cyst
- 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
Non-operative and operative treatment of ganglion cysts
-Non-operative Aspiration Reassure & observe "Hit it with a bible" -Operative Excision Including "the root"
Osteoarthritis base of thumb symptoms
- Pain + stiffness
- Swelling
- Deformity
- Loss of function
Non-operative and operative treatment of OA base of thumb
Non-operative
- NSAIDs
- Splint
- Steroid injection
- Life style modification
Operative
- Trapeziectomy
- Fusion
- Replacement
