Orthopaedic Problems of the Hand Flashcards
What happens in Dupuytren’s?
Abnormal thickening of tissues of the palm and causes one or more finger to be flexed towards the palm
Who is more likely to develop Dupuytrens?
Males, especially when younger but more women get it with age
Genetic link
Pretty much only seen in Caucasians, very very rare in Asia
Dupuytrens has a genetic link in some cases, not all. Some are sporadic. What kind of genetic condition is Dupuytrens?
Autosomal dominant
Which factors can be associated with developing Dupuytrens?
Diabetes
Alcohol
Tobacco
HIV
Epilepsy
Dupuytrens is not usually painful but can a pain from day to day life. Which functional problems may a patient with Dupuytrens experience?
Struggles putting hands in pockets
Grapping things
Washing face (would poke eye)
What is the test for Dupuytrens which determines if a patient needs an operation?
Table Top Test
If patient is able to fully flatten their hand down on a table, they do not need surgery
The only real treatment for Dupuytrens is surgery- non-operative measures don’t really work.
There are a couple of surgery options. List some of them.
Partial fasciectomy
Dermo-fasciectomy
Arthrodesis
Percutaneous Needle Fasciectomy
What is the most common operation for Dupuytrens?
Partial fasciectomy
Pros and cons of partial fasciectomy for Dupuytrens?
Good correction
Wound heals 2-3 weeks
50% reoccurrence
Requires physio after for finger stiffness
Which operation for Dupuytrens may be more suitable for a a younger patient, especially if they have a more hands on job?
Dermo Fasciectomy
Pros and cons of Dermo Fasciectomy for Dupuytrens?
Reduced reoccurrence rates
Requires intense physio
Percutaneous Needle Fasciectomy is a procedure which can be carried out in clinics under local anaesthetic.
It involves a needle scratching the bands that are contracting and causing the issue.
Pros and cons?
Quick, no wounds
Can be repeated and doesn’t prevent surgery in future
Higher reoccurrence
Risk of nerve injury
What happens in trigger finger?
Swelling of tendons of the hand catches on the pulleys (thickening of sheath) causing difficulties in extending their finger
->patients are able to make a fist and bend fingers but struggle to straighten fingers out again after
Who is more likely to get trigger finger?
Women > men
40-60
Which fingers tend to be more commonly affected by trigger finger?
Ring > thumb > middle
What can trigger finger be associated with?
Potentially repetitive use of hand
Local trauma
Certain conditions: rheumatoid arthritis. diabetes, gout
Trigger finger diagnosis is made based on history and examination. What may the patient describe and what may be found?
Patient will mention clicking sensation during movement of the digit, may even lock in position
Have to actively use other hand to unlock hand
Can feel small lump at base of finger on the palmar aspect
Non-operative treatment options for trigger finger?
Splints
Steroid injection
->steroid injection reduces collagen strength and allows pulley to stretch more. Injection give about 70% cure rate and if not, second one gives 90%
Operative treatment for trigger finger?
->e.g. if steroid injection doesn’t work in the 10%
Percutaneous release
Open surgery
What would a patient with De Quervain’s Syndrome present with?
Several weeks of pain localised to radial side of wrist
Pain aggravated by movement of thumb
May be localised swelling
->if put stethoscope over, may hear a creaking noise
Who is more likely to get De Quervain’s Syndrome?
Females
50-60
Increased in postpartum and lactating females- perhaps due to picking baby up a lot?
How is De Quervain’s Syndrome diagnosed?
Examination of base of thumb
Considering the fact that De Quervain’s Syndrome needs to be diagnosed by examination of thumb base, which differential needs to be excluded?
Osteoarthritis as most commonly occurs at the base of the thumb
Which test confirms De Quervain’s Syndrome?
Finklesteins test
->hehe love it, put thumb in palm and move sharply to other side and will cause agonising pain if have De Quervain’s Syndrome
Non-operative treatment of De Quervain’s Syndrome?
Splints
Steroid injection
->physio does not help as movement elicits more pain
Operative treatment of De Quervain’s Syndrome?
Decompression
Ganglion?
Lump on hand, mostly dorsum but some palmar
Who is more likely to get a ganglia?
More common in females
Peak 20-40yrs
->pretty common condition, lecturer said in the lecture he can almost guarantee someone in the lecture theatre has one
In examination of a ganglion, what would be seen?
Firm, non-tender lump
Can change is size, patient may say after a bath it’s bigger and in the cold it’s disappeared
ALWAYS smooth
Hard to move as fixed to underlying tissues
->if unsure of diagnosis, can aspirate it and see a viscous fluid
Treatment of ganglia?
Reassurance and observation
Can be excised but rarely done
->majority of patients are young and don’t like the look of them so will want it removed but by removing them, they will be left with a scar which they probably won’t like either
Which joint is most commonly affected by osteoarthritis?
Base of thumb
What are the symptoms of OA at the base of thumb>?
Pain
Stiffness
Swelling
Deformity
Loss of function
Who is more likely to get base of thumb OA?
Women, 1 in 3 :) fab
No-operative treatment of OA of base of thumb?
Lifestyle modifications
NSAIDs
Splints
Steroid injections
Operative treatment for OA base of thumb?
Trapeziectomy - gold standard
Fusion
Replacement
What happens in a trpaeziectomy?
Type of excision arthroplasty- removal of bone and it forms scar tissue in the gap
When would a trapeziectomy not be the operation of choice of OA of base of thumb?
If a person requires a good pinch grip and downside of the surgery is that pinch grip is fine but not amazing
->however, much better grip than they’re had before
If someone needs to have a strong pinch grip, maybe for their job, what can be done?
->lecturer gave examples he carried out of professional horse rider and a man on Orkney who fixes shoes :)
