orthopaedic problems hand

Question 1

associations to dupuytren’s disease

Answer 1

diabetes
alcohol 
tobacco 
HIV 
epilepsy

Question 2

pathology of Duputreyn’s disease

Answer 2

palmar aponeurosis extends as pretendinous bands into fingers

thickened bands contract and pull fingers into flexion

regulated by growth factors and excessive production of collagen

Question 3

functional problems assoc with Duputreyn’s disease

Answer 3

loss of finger extension

hard to - grip things, wash face

Question 4

non-operative treatment of DUputreyn’s disease

Answer 4

observation

radiotherapy to slow down collagen production

(splints don’t work)

Question 5

operative treatment of Duputreyn’s

Answer 5

partial fasciectomy - excise thickened bands

dermo-fasciectomy - remove skin from palm and underlying fascia

arthrodesis
amputation
percutaneous needle fasciotomy: cut bands with needle

collagensase: injected into band to dissolve collagen

Question 6

what is trigger finger

Answer 6

sensation patient experiences due to flexor tendon

swelling in tendon catches on the sheath they run in (pulley)

Question 7

who gets trigger ifnger

Answer 7

women more than men
40-60
ring>thumb?middle
trauma of tendon at pulley

associations: DM, RA, gour

Question 8

diagnosis of trigger finger

Answer 8

patient history: clicking sensation with movement of digit, may have to use other hand to ‘unlock’ (finger jams)

palpable lump over A1 pulley

Question 9

treatment of trigger finger: non-operative

Answer 9

splintage

steroid injection

Question 10

treatment of trigger finger: operative

Answer 10

percutaneous release

open surgery

Question 11

de Quervain’s tenovaginitis

Answer 11

retinaculum thickened, swells and compresses tendon causing pain

Question 12

de Q tenovaginitis patient Hx

Answer 12

several weeks pain radial side wrist

pain worse when move thumb

maybe localised swelling

localised tenderness over tunnel

Question 13

who gens de Q’s tenovaginitis

Answer 13

females more than men
50-60yrs
post-partum + lactating women

activities with thumb abduction and ulnar deviation

Question 14

treamtent of de Q’s tenovaginitis

Answer 14

splint
steroid injection

operative: decompression

Question 15

what is a ganglion cyst

Answer 15

a myxoid degeneration from joint synovia

arise from joint capsule, tendon sheath ligament

Question 16

who gets ganglion cysts

Answer 16

females
peak 20-40yrs
may be assoc with recurrent injury arounf wrist

Question 17

gnaglion cyst characteristics

Answer 17

pt presents with lump

firm, non-tender
change in size
smooth, occasionally lobulated
normally not fixed to underlying tissues 
never fixed to skin

Question 18

treatment of ganglion cyst

Answer 18

reassure and observe
aspiration

operative: excision

Question 19

clinical presentation osteoarthritis at base of thumb

Answer 19

pain: worse activity + night 
stiff
swelling 
deformity 
loss function: movement reduced, difficulty grippng

Question 20

treatment of base thumb OA: non-operative

Answer 20

lifestyle
NSAIDs
splint
steroid injection

Question 21

treatment of base thumb OA: operative

Answer 21

trapeziectomy (best) - take away trapaezium part joint

fusion
replacement