Orthopaedic problèmes of the hand Flashcards
what proportion of dupuytrens presentations are sporadic
30%
if genetically linked, what type of inheritance is dupuytrens
autosomal dominant
name some factors (other than genetics) that have been should to contribute to the development of dupuytrens
- smoking
- alcohol
- HIV infection
- diabetes
- epilepsy
describe the pathology of dupuytrens
there is proliferations of myofibroblast and nodules (can be painful and tender - unlike ganglia) may develop, the palmar fascia thickens as a result. Digital cords form and finger extension becomes limited. These cords tighten and flexure contractors develop (usually int he 4th and 5th digits)
what fingers are usually spared in dupuytrens
the index finger and the thumb
who is affected by dupuytrens
most commonly males and limited to those of white races
what is the treatment options for dupuytrens
non-operative:
- radiotherapy
- observation
operative:
- partial fasciectomy
- dermofascientomy
- collagenase
- amputation
- anthrodesis (ossifying 2 bones across a joint via surgery)
- percutaneous needle fasciotomy
what is the most common procedure done to treat dupuytrens
partial fasciectomy
describe the collagenase treatment
an injection is given into the thickened cords that weakens them - after 24 hours the patient returns to have their finger straightened out that breaks the cord
what is trigger finger
when the tendons in the fingers becomes inflamed and catch in the tendon sheath - it is difficult to move the finger and there may be a clicking/locking of the finger
who suffers from trigger finger
it is more common in women, those with gout, thematic arthritis and diabetes
what are the signs/symptoms of trigger finger
- lump in the palm at the pully of the tendon
- clicking or locking of the finger
- pain at the bottom of the finger affected (on the palmar side)
what is the treatment of trigger finger
non-operative = splint or steroids operative = percutaneous release or open surgery
what is de quervain’s syndrome
inflammation of the sheath that the APL and EPL run through on the way to the thumb - there is pain at the radial side of the wrist that is aggravated by movement of the thumb
who is affected by de quervain’s syndrome
also known as texter’s/gamer’s thumb so those who use their thumbs a lot
what sign can be elicited to diagnose de quervain’s syndrome
Finklestein’s test can be done - thumb under the other fingers making a fist and tilt the fist forwards
what tendons are affected in de quervain’s
APL and EPB
where do ganglia usually occur
on the dorsal aspect of the hand in those between 20-40
where do ganglia arise from
joint cavities, tendons or ligaments
what is different about the nodules in ganglia and the nodules in trigger and dupuytrens
they are firm, not painful or tender and not fixed to underlying tissues or the skin
what is the treatment of ganglia
non-operative = observation, aspiration operative = excision +/- root
who is affected by OA base of the thumb
1 in 3 women
give some symptoms of OA base of the thumb
pain, stiffness, swelling, difficulty opening jars
what is the treatment of OA base of the thumb
non-operative:
- splint
- life style modifications
- NSAIDS
- steroid injections
operative:
- trapeziectomy (this is the gold standard treatment - involves the surgical removal of the trapezium bone
