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MSK > Orthopaedic Problems of the Hand > Flashcards

Orthopaedic Problems of the Hand Flashcards

1
Q

Who gets Duputytren’s?

A

More males in 15-64 - 8:1
Then 2:1 when over 75
Disease develops earlier in males

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2
Q

What are factors which contribute to Dupuytren’s?

A

Autosomal dominant - variable penetrance
Sporadic in 30%
Onset may be sex linked
Almost exclusively white races

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3
Q

What diseases are associated to Dupuytren’s?

A

Diabetes, alcohol, tobacco, HIV and Epilepsy

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4
Q

What is dupuytren’s diathesis?

A

Early onset
Bilateral disease
FH
Ectopic disease

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5
Q

Describe the pathology of Dupuytren’s

A

Myofibroblasts
Intracellular contractile elements - peritendinous bands an palmar aponeurosis
Regulated by growth factors
Production of collagen

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6
Q

What are the functional problems caused by Dupuytren’s disease?

A

Usually not painful
Loss of finger extension - active or passive
Difficulties in hand in pocket
Gripping problems
Washing face

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7
Q

What is non-operative treatment for Dupuytren’s?

A

Observe, splints and RT

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8
Q

What are the operative treatment for Dupuytren’s/

A

Partial and Dermo-fasciectomy
Arthrodesis
Amputation
Percutaneous needle fasciotomy and collagenase

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9
Q

Describe partial fasciectomy

A

Excise the thickened bands causing problems - most common procedure in UK
Good correction achieved
Wound 2-3 weeks to heal
Stiffness require physio
Can’t be cured

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10
Q

What is the recurrence rate after partial fasciectomy?

A

50% at 5 years

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11
Q

Describe dermo-fasciectomy

A

More radical procedure
Early more progressive disease
Remove skin and underlying fascia - removing recurrence
Needs intensive physio after

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12
Q

What are the positives and negatives for percutaneous needle fasciotomy?

A

Quick, no wounds, return to normal activities after 2-3days, can be repeated
Risk of nerve injury and can have higher recurrence
Does not prevent traditional surgery in future

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13
Q

Describe collagenase for treatment of Dupuytren’s

A

Injected into band and dissolves collagen
Recurrence rate is 34% in 3 years
Risk of 3 flexor tendon rupture
Cost

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14
Q

What is trigger finger?

A

Sensation a patient feels due to abnormality in flexor tendon

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15
Q

Describe the anatomy of trigger finger anatomy

A

2 tendons to each finger
Tendon run in sheath - thickening in sheath are called pulleys
Keep tendon close to bone
Swelling in tendon catches on pulley

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16
Q

Who gets trigger finger?

A

Women are more frequent - 40-60 year age group
Common in ring finger > thumb > middle
Can be from repetitive use of hand and local trauma

17
Q

What diseases are associated to trigger finger?

A

Rheumatoid arthritis, DM and gout

18
Q

How is trigger finger diagnosed?

A

Patient history
Clicking sensation when moving digit, lump in palm under pulley, may need other hand to unlock and clicking can go to locking

19
Q

What can be felt in examination of trigger finger?

A

Palpable lump in palm over A1 pulley
Feel the triggering around the A1 pulley

20
Q

What is the non-operative treatment for trigger finger?

A

Splint age and steroids injections around A1 pulley

21
Q

What is the operative treatment for trigger finger?

A

Percutaneous release (A1 pulley released) and open surgery

22
Q

Describe De Quervain’s syndrome

A

Occurs in 1st dorsal extensor compartment
Fibro-osseous tunnel at distal radius
Thickening of localised segment
30% of patients - 1st compartment divided by septum

23
Q

What is the patient history for De Quervain’s syndrome?

A

Several weeks pain localised to radial side of wrist
Aggravated by movement of thumb
May seen a localised swelling
Localised tenderness over tunnel

24
Q

Who gets De Quervain’s syndrome?

A

Male : Female 1:6
Age 50-60
Increased in post partum and lactating females
Activities with frequent thumb abduction and ulnar deviation
Washerwomen’s sprain

25
Q

What is looked for in examination of De Quervain’s syndrome?

A

Examine thumb joints - consider base of thumb tenderness for OA
Finklestein’s test (fold thumb into palm, close finger over and ulnar deviate wrist and produces pain) and resisted thumb extension - provide resistance with finger onto patient thumb and pain will be localised over radial styloid

26
Q

What is the non-operative treatment for De Quervain’s syndrome?

A

Splints and steroid injection

27
Q

What is the operative treatment for De Quervain’s syndrome?

A

Decompression - decompress tendon by opening retinaculum that is holding it down

28
Q

What are 2 nerve entrapment conditions?

A

Carpal tunnel syndrome
Cubital tunnel syndrome

29
Q

Describe ganglion anatomy

A

A myxoid degeneration from joint synovia - lump
Arise from joint capsule, tendon sheath or ligament as outpouchings - fluid within is concentrated making it firm

30
Q

Who gets ganglia?

A

More common in females
Wide age distribution - peak 20-40
More dorsal than volar
May be associated with recurrent injury around the wrist

31
Q

How does the patient present with ganglia?

A

Presents with lump, firm, non-tender, change in size, smooth, occasionally lobulated, normally not fixed and never fixed to skin

32
Q

What is the non-operative treatment for ganglia?

A

Reassure and observe
Aspiration

33
Q

What is the operative treatment for ganglia?

A

Excision including the root

34
Q

What is the commonest OA of the body?

A

Base of thumb

35
Q

What is the symptoms of OA base of thumb?

A

Pain, stiffness, swelling, deformity and loss of function
pain worse on activity and at night after a busy day

36
Q

Describe base of thumb OA

A

Common, 1 in 3 women, pain opening jars/ pinching
Dorsal subluxation, metacarpal adduction and MCPJ hyperextension
Look for SST OA

37
Q

What is the non-operative treatment of OA base of thumb?

A

Life style modification, NSAIDS, splint and steroid injection

38
Q

What is the operative treatment for OA base of thumb?

A

Trapeziectomy - take away part of joint (trapezium) leaving fibrous space, fusion and replacement

39
Q

Describe trapeziectomy

A

Gold standard for OA base of thumb
Good pain relief
Moderate pinch grip
Possible interposition flap or ligament reconstruction

MSK (39 decks)

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