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Musculoskeletal System > Orthopaedic Problems of the Hand > Flashcards

Orthopaedic Problems of the Hand Flashcards

1
Q

What is the M:F incidence of Dupuytren’s disease in 15-64s?

A

M:F
8:1

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2
Q

What is the M:F incidence of Dupuytren’s disease in over 75s?

A

M:F
2:1

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3
Q

What are the genetic features of Dupuytren’s disease?

A

Disease develops earlier in males
Autosomal dominant with variable penetrance
Sporadic in 30% of cases
Onset may be sex-linked

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4
Q

What races are affected by Dupuytren’s disease?

A

Almost exclusively white races

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5
Q

What are some of the conditions/causes linked to Dupuytren’s disease?

A 
Diabetes mellitus
Excess alcohol
Tobacco smoking 
HIV 
Epilepsy
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6
Q

What is the presentation of Dupuytren’s diathesis?

A

Early onset disease
Bilateral disease
Family history
Ectopic disease

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7
Q

What is Dupuytren’s diathesis an indication of?

A

Severity and strong genetic predisposition

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8
Q

What is the pathology of Dupuytren’s diathesis?

A

Myofibroblast
Thickening and contracture of palmar fascia
Intracellular contractile element, regulated by growth factors, produces collagen

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9
Q

What are the symptoms and signs of Dupuytren’s contracture?

A

Usually not painful
Loss of finger extension - active or passive
May see skin pits
MCP/PIP joint contracture
Table-top test - can they get their hand flat on the table, if not, this may be indicative of necessary treatment
Most commonly affects little and ring fingers
Radial disease means they are more likely to have rapid recurrence

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10
Q

What is the non-operative treatment of Dupuytren’s?

A

Observe
Splints don’t work
Radiotherapy (less common in UK)

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11
Q

What is the operative treatment of Dupuytren’s?

A

Mainstay of treatment in the UK
Partial fasciectomy - remove thickened fascia
Dermo-fasciectomy - remove fascia and skin then replace with skin graft, most extensive operation but least recurrence
Arthrodesis
Amputation
Percutaneous needle fasciotomy
Collagenase

NB - Dupuytren’s can be treated but not cured

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12
Q

What are the features of a partial fasciectomy?

A 
Most common procedure in the UK 
Good correction can be achieved
Wounds take 2-3 weeks to heal
Stiffness requires physiotherapy 
Recurrence 50% at 5 years
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13
Q

What are the features of dermo-fasciectomy?

A

More radical, generally done for recurrence
Removal of skin may reduce the recurrence rate
Requires intensive physiotherapy

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14
Q

What are the features of percutaneous needle fasciotomy?

A 
Quick 
No wounds 
Return to normal activities in 2-3 days 
Does not prevent traditional surgery in the future 
Higher recurrence - 50% at 3 years 
Can be repeated
Risk of nerve injury
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15
Q

What are the features of collagenase treatment?

A

Presented 3 year recurrence rate 34.8%
3 flexor tendon ruptures/300 patients in trials
Expensive
Longer-term recurrence rates currently unknown

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16
Q

What is trigger finger?

A

There are 2 tendons to each finger which run in sheaths
Thickenings in the sheath result in a ‘pulley’ which keeps the tendon close to bone
Swelling in tendon catches on this pulley, causing fingers to catch/lock when bent
Can usually be straightened with encouragement

17
Q

When is trigger finger more likely?

A

Women > men
40-60s
Ring > thumb > middle
Repetitive use of hand - degenerative changes
Local trauma
Association with rheumatoid arthritis, diabetes and gout

18
Q

How is trigger finger diagnosed/what are the signs and symptoms?

A

Patient history
Clicking sensation with movement of digit
Lump in palm under pulley
May have to use the other hand to unlock the stuck finger
Clicking may progress to locking
If a palpable lump is felt in palm over A1 puller, will feel triggering around this area

NB - Dupuytren’s is more slowly progressive

19
Q

What is the treatment of trigger finger?

A

Non-operative

  • splintage
  • steroid injection

Operative

  • percutaneous release
  • open surgery
20
Q

What are the signs and symptoms of De Quervain’s Tenovaginitis?

A

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

21
Q

When is De Quervain’s tenovaginitis more common?

A

M>F, M:F 1:6
Age 50-60
Increased in postpartum and lactating females
Activities with frequent thumb abduction and ulnar deviation

22
Q

What is the pathology of De Quervain’s tenovaginitis?

A

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

23
Q

What tests can be done for De Quervain’s tenovaginitis?

A

Finklestein’s test - put thumb in clenched fist then ulnar deviate the hand
Resisted thumb extension - more sensitive

24
Q

What is the treatment of De Quervain’s tenovaginitis?

A

Non-operative

  • splints
  • steroid injection, risk of depigmentation and thinning

Operative

  • decompression
  • be aware of dorsal sensory branch of radial nerve
25
Q

What are the nerve entrapments in the hand?

A

Carpal tunnel syndrome

Cubital tunnel syndrome

26
Q

What are the signs and symptoms of osteoarthritis in the base of the thumb?

A 
Pain 
Stiffness
Swelling
Deformity
Loss of function 
Pain opening jars/pinching 
Dorsal subluxation
Metacarpal adduction
ACPJ hyperextension 
Look for STT osteoarthritis
27
Q

What is the treatment of osteoarthritis of the thumb?

A

Non-operative

  • lifestyle modification
  • NSAIDs
  • splint
  • steroid injection

Operative

  • trapeziectomy
  • fusion
  • replacement
28
Q

What are the features of trapeziectomy?

A

Gold standard treatment for OA of thumb
Good pain relief
Moderate pinch grip +/- interposition flap or ligament reconstruction

29
Q

What is a ganglion?

A

Myxoid degeneration from joint synovia (cyst containing thick, clear substance) that arises from joint capsule, tendon sheath or ligament
70% of all discrete swellings in hand and wrist

30
Q

When are ganglions most common?

A

More common in females 2:1 males

Wide age distribution peak 20-40 years

31
Q

What are the signs and symptoms of a ganglion?

A

Lump - firm, non-tender, change in size, smooth, occasionally lobulated
Normally not fixed to underlying tissues and never fixed to the skin

32
Q

What is the treatment of a ganglion?

A

Non-operative

  • reassure and observe
  • aspiration, about 60% recurrence, can be repeated

Operative
- excision, including the root, 30-40% recurrence

Musculoskeletal System (40 decks)

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