Orthopaedic Problems of the Hand

Question 1

What is the genetic classification of duputren’s disease?

Answer 1

Autosomal dominant

Question 2

What risk factors are associated with dupuytren’s?

Answer 2

Diabetes 
Smoking
Alcohol 
HIV 
Epilepsy

Question 3

What is the pathology of dupuytren’s?

Answer 3

Myofibroblasts proliferate, nodule develops in palmar fascia
Spread along the fascia and into the fingers resulting in the development of a cord
Disease continues to spread into fingers, cord tightens creating a contracture

Question 4

What are the functional problems associated with dupuytren’s?

Answer 4

Usually not painful 
Loss of finger extension - active or passive 
Hand in pocket 
Gipping things 
Washing face

Question 5

What are operative treatment options for dupuytren’s?

Answer 5

Partial fasciectomy
Dermo-fasciectomy
Arthrodesis
Amputation

Question 6

What are the non-operative treatment options for dupuytren’s?

Answer 6

Percutaneous needle fasciotomy

Collagenase

Question 7

What is the pathology of trigger finger?

Answer 7

Thickenings in tendon sheath creates pulley
Keeps tendon close to bone
Swelling in tendon caches on pulley

Question 8

Who gets trigger finger?

Answer 8

Women more frequent than men 
40-60s 
Ring>thumb>middle 
Local trauma 
Diabetes 
Gout 
Rheumatoid arthritis

Question 9

What are the clinical features used to diagnose trigger finger?

Answer 9

Clicking sensation with movement of digit 
Lump in palm under pulley
Use of other hand to unlock things 
Clicking may progress to locking 
Palpable lump in palm over A1 pulley 
Triggering felt around A1 pulley

Question 10

What are the non-operative treatment options for trigger finger?

Answer 10

Splintage

Steroid

Question 11

What are the operative treatment options for trigger finger?

Answer 11

Percutaneous release

Open surgery

Question 12

What is the presentation of De Quervain’s syndrome?

Answer 12

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

Question 13

Who gets De Quervain’s syndrome?

Answer 13

More prominent in females
50-60s
Increased in post partum and lactating females
Activities with frequent thumb abduction and ulnar deviation

Question 14

What is the pathology of De Quervain’s syndrome?

Answer 14

1st dorsal extensor compartment
Fibro-osseus tunnel at the distal radius
Thickening of localised segment

Question 15

What examination should be used to diagnose De Quervain’s syndrome?

Answer 15

Finklestein’s test

Resisted thumb extension

Question 16

What are the treatment options for De Quervain’s syndrome?

Answer 16

Splints, steroid injection (non-operative)

Decompression (operative)

Question 17

What is a ganglion?

Answer 17

Myxoid degeneration from joint synovia, arising from joint capsule, tendon sheath or ligament

Question 18

What are the clinical features of ganglion?

Answer 18

Present with lump 
Firm, non-tender 
Change in size 
Smooth
Occasionally lobulated 
Normally not fixed to underlying tissues 
Never fixed to skin

Question 19

What are the treatment options for ganglion?

Answer 19

Reassure and observe, aspiration (non operative)

Excision including the root (operative)

Question 20

What are the symptoms of osteoarthritis of the thumb base?

Answer 20

Pain 
Stiffness 
Swelling 
Deformity 
Loss of function

Question 21

What are the non operative treatment options for OA of thumb base?

Answer 21

Lifestyle modifications
NSAIDs
Splint
Steroid injections

Question 22

What are the operative treatment options for OA of thumb base?

Answer 22

Trapeziectomy
Fusion
Replacement