Orthopaedic problèmes of the hand

Question 1

what proportion of dupuytrens presentations are sporadic

Answer 1

30%

Question 2

if genetically linked, what type of inheritance is dupuytrens

Answer 2

autosomal dominant

Question 3

name some factors (other than genetics) that have been should to contribute to the development of dupuytrens

Answer 3

• smoking
• alcohol
• HIV infection
• diabetes
• epilepsy

Question 4

describe the pathology of dupuytrens

Answer 4

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)

Question 5

what fingers are usually spared in dupuytrens

Answer 5

the index finger and the thumb

Question 6

who is affected by dupuytrens

Answer 6

most commonly males and limited to those of white races

Question 7

what is the treatment options for dupuytrens

Answer 7

non-operative:

• radiotherapy
• observation

operative:

• partial fasciectomy
• dermofascientomy
• collagenase
• amputation
• anthrodesis (ossifying 2 bones across a joint via surgery)
• percutaneous needle fasciotomy

Question 8

what is the most common procedure done to treat dupuytrens

Answer 8

partial fasciectomy

Question 9

describe the collagenase treatment

Answer 9

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

Question 10

what is trigger finger

Answer 10

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

Question 11

who suffers from trigger finger

Answer 11

it is more common in women, those with gout, thematic arthritis and diabetes

Question 12

what are the signs/symptoms of trigger finger

Answer 12

• 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)

Question 13

what is the treatment of trigger finger

Answer 13

non-operative = splint or steroids 
operative = percutaneous release or open surgery

Question 14

what is de quervain’s syndrome

Answer 14

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

Question 15

who is affected by de quervain’s syndrome

Answer 15

also known as texter’s/gamer’s thumb so those who use their thumbs a lot

Question 16

what sign can be elicited to diagnose de quervain’s syndrome

Answer 16

Finklestein’s test can be done - thumb under the other fingers making a fist and tilt the fist forwards

Question 17

what tendons are affected in de quervain’s

Answer 17

APL and EPB

Question 18

where do ganglia usually occur

Answer 18

on the dorsal aspect of the hand in those between 20-40

Question 19

where do ganglia arise from

Answer 19

joint cavities, tendons or ligaments

Question 20

what is different about the nodules in ganglia and the nodules in trigger and dupuytrens

Answer 20

they are firm, not painful or tender and not fixed to underlying tissues or the skin

Question 21

what is the treatment of ganglia

Answer 21

non-operative = observation, aspiration 
operative = excision +/- root

Question 22

who is affected by OA base of the thumb

Answer 22

1 in 3 women

Question 23

give some symptoms of OA base of the thumb

Answer 23

pain, stiffness, swelling, difficulty opening jars

Question 24

what is the treatment of OA base of the thumb

Answer 24

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