Orthopaedic problems of the hand Flashcards
Who is dupuytrens seen in?
Males > females
What is Dupuytrens associated with?
DM Alcohol Tobacco Alcohol HIV
What is the pathology of Dupuytrens?
Palmar aponeurosis thickens and contracts
Whatvare the clinical features of Dupuytrens?
Usually not painful
Loss of finger extension
Functional problems
What is the treatment of Dupuytrens?
Non op- observe, radiotherapy Operative- partial fasciectomy Dermo-fasciectomy Arthrodesis Amputation Percutaneous needle fasciotomy Collagenase
What is the pathology of trigger finger?
Swelling of tendon catches on pulley
Who is trigger finger seen in?
Women > men
40-60 year olds
What is trigger finger associated with?
RA
DM
Gout
What are the clinical features of trigger finger?
Clicking sensation with movement of digit
Lump in palm under pulley
May have to use other hand to unlock
What is critical for diagnosis of trigger finger?
Palpable lump in palm over A1 pulley
What is the treatment of trigger finger?
Non op- splint age, steroid injection
Op- percutaneous release, open surgery
Who is De Quervain’s syndrome seen in?
Females, 50-60
What is de Quervain’s syndrome?
Thickening of localised segment of tendon running through fibrous-psseus tunnel at distal radius
What ar the clinical features of de Quervain’s syndrome?
Several weeks of pain localised to side of wrist and aggravated by thumb movement
Localised swelling and tenderness
Lump- feels like bone
How is de Quervain’s diagnosed?
Examination of thumb
Finklestein’s test
What is the treatment of de Quervain’s?
Non op- splints, steroid injection
Surgical decompression
Who are ganglia seen in?
Females 20-40
What are ganglia in the wrist associated with?
Recurrent injury
What are the clinical features of a ganglion?
Lump- firm, non tender, smooth, occasionally lobulated, never fixed to skin but can be fixed to underlying tissue
What is the treatment of a ganglion?
Non op- aspiration, “family bible”
Op- excision
What are the clinical features of OA of base of thumb?
Pain Stiffness Swelling Deformity Loss of function
Who is OA of the base of thumb seen in?
1 in 3 woemn
What are the non op treatments of OA?
Lifestyle
NSAIDs
Splints
Steroid injections
What are the operative treatment of OA of base of thumb?
Trapeziectomy
Fusion
Replacement
