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
What is looked for in examination of De Quervain's syndrome?
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
What is the non-operative treatment for De Quervain's syndrome?
Splints and steroid injection
27
What is the operative treatment for De Quervain's syndrome?
Decompression - decompress tendon by opening retinaculum that is holding it down
28
What are 2 nerve entrapment conditions?
Carpal tunnel syndrome Cubital tunnel syndrome
29
Describe ganglion anatomy
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
Who gets ganglia?
More common in females Wide age distribution - peak 20-40 More dorsal than volar May be associated with recurrent injury around the wrist
31
How does the patient present with ganglia?
Presents with lump, firm, non-tender, change in size, smooth, occasionally lobulated, normally not fixed and never fixed to skin
32
What is the non-operative treatment for ganglia?
Reassure and observe Aspiration
33
What is the operative treatment for ganglia?
Excision including the root
34
What is the commonest OA of the body?
Base of thumb
35
What is the symptoms of OA base of thumb?
Pain, stiffness, swelling, deformity and loss of function pain worse on activity and at night after a busy day
36
Describe base of thumb OA
Common, 1 in 3 women, pain opening jars/ pinching Dorsal subluxation, metacarpal adduction and MCPJ hyperextension Look for SST OA
37
What is the non-operative treatment of OA base of thumb?
Life style modification, NSAIDS, splint and steroid injection
38
What is the operative treatment for OA base of thumb?
Trapeziectomy - take away part of joint (trapezium) leaving fibrous space, fusion and replacement
39
Describe trapeziectomy
Gold standard for OA base of thumb Good pain relief Moderate pinch grip Possible interposition flap or ligament reconstruction