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Musculoskeletal > Orthopaedic Problems of The Hand > Flashcards

Orthopaedic Problems of The Hand Flashcards

1
Q

Who is dupuytrens most common in?

A

Men

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2
Q

What is the aetiology for dupuytrens disease?

A
  • Autosomal dominant – variable penetrance
  • Sporadic in 30% of cases
  • Onset may be sex linked
  • Almost exclusively white races
  • Few sporadic reports in other races

Associations with diabetes, alcohol, tobacco, HIV, epilepsey

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3
Q

What is the pathology and clinical presentation of dupuytrens contracture?

A

Fibrosis and contracture of the palmar fascia

Inability to extend fingers fully (test is to put hand flat on the table)

Assoicated with puckering of the skin and palpable nodules.

Little and ring fingers are usually worst affected.

Very slowly progressive - Painless - main symptoms are associated with catching the affected finger becoming snagged in posckets or poking the eye during face washing.

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4
Q

Are you able to flex the finger in dupuytrens contracture?

A

Yes

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5
Q

What are the non-operative treatments for dupuytrens disease?

A

Observe (until the condition progresses to the point that they need an operation)

Radiotherapy

Splints do not work

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6
Q

What are the operative treatments for dupuytrens disease?

A

Partial fasciectomy - main treatment

Dermo-fasciectomy

Arthrodesis

Amputation

Percutaneous needle fasciectomy

Collagenase

Dupuytrens will eventually come back after treatment

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7
Q

What is recurrence rate of dupuytrens contracture at 5 years?

A

50%

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8
Q

What are the benefits of percutaneous needle fasciectomy?

A

Quick

No wounds

Return to normal activities in 2-3 days

Does not prevent traditional surgery in the future

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9
Q

What are the limitations of percutaneous needle fasciectomy?

A

HIgher recurrence (although the procedure can be repeated)

Risk of nerve injury

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10
Q

What is the risk of using collagenase?

A

RIsk of tendon rupture

(since collagen is everywhere)

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11
Q

What is the pathophysiology of trigger finger?

A

Swelling in tendon catches on pulley

(stenosing tenosynovitis in flexor tendon sheath)

Intermittent locking of the finger in flexion

The pulleys are like the hoops on a fishing rod (they keep the tendon close to the bone)

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12
Q

Who does trigger finger commonly affect?

A
  • Women more frequent than men
  • 40s-60s
  • Ring > Thumb > Middle
  • Repetitive use of hand ?
  • Local trauma
  • Associations
  • RA, DM, Gout
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13
Q

What is the diagnosis of trigger finger?

A
  • Patient History
  • Clicking sensation with movement of digit
  • Lump in palm under pulley
  • May have to use other hand to ‘unlock’
  • ‘Clicking’ may progress to ‘locking’

Palpable lump in the palm over A1 pulley

Feel the triggering around the A1 - pulley

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14
Q

What is non-operative treatment of trigger finger?

A

Splintage

Steroid

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15
Q

What is operative treatmetn of trigger finger?

A

Percutaneous release

Open surgery

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16
Q

What rendon sheaths are involved in de quervain’s syndrome?

A

Abductor pollicis longus

Extensor pollicis brevis

17
Q

Where is the pain in de quervain’s tenovangitis syndrome?

A

radial aspect of the distal forearm and wrist.

Marked pain on ulnar deviation with the thumb held in the patients hand (finkelsteins sign)

Localised tenderness over tunnel - may have warmth, linear swelling or crepitus

18
Q

What is the pathological process of de quervain’s tenosynovitis?

A

Inflammation of the sheath that surrounds the APL and the EPB

19
Q

Who is de quervain’s common in?

A

Common in females

Age 50-60

Increased in post partum and lactating females

Activites with frequent thumb abduction and ulnar deviation

20
Q
A
21
Q

What is a differential for de Quervain’s tenovangitis?

A

Base of the thumb OA

22
Q

What is non-operative and operative treatment of de Quervain’s syndrome?

A

Non-operative = splints and steroid injection

Operative = Decompression

23
Q

What is a ganglion?

A

Myxoid degeneration from joint synovia

  • Arises from joint capsule, tendon sheath or ligament

A ganglion cyst is a tumor or swelling on top of a joint or the covering of a tendon (tissue that connects muscle to bone). It looks like a sac of liquid (cyst). Inside the cyst is a thick, sticky, clear, colorless, jellylike material.

24
Q

Who gets ganglia?

A

More common in females

more common on the back of the hand than the front of the hand

May be associated with recurrent injury around the wrist

25
Q

What is the clincal presentation of ganglia?

A

Lump

Firm

Non-tneder

Change in size (classic sign is that it changes in size to become bigger or smaller)

Smooth

Occasionally lobulated

Normally not fixed to underlying tissues

Never fixed to the skin

26
Q

What is ganglia treatment?

A

Non-operative:

Reassure and observe

Aspiration - you need a thick needle because the fluid is so thick

Hit with a bible

(it will spontaneously go away in many cases)

Operative:

Excision including the root

Recurrence rate is very high after surgery

27
Q

What are the clinical features of OA of the base of the thumb?

A

Pain

Stiffness

Swelling

Deformity

Loss of function

28
Q

How common is OA in the base of the thumb?

A

Common - 1 in 3 women get OA in the base of the thumb

29
Q

What are the changes in the thumb when there is base of thumb OA present?

A

Dorsal subluxation

Metacarpal adduction

MCPJ hyperextension

30
Q

What are the non-operative treatments for OA base of thumb?

A
  • Life style modifications
  • NSAIDS
  • Splint
  • Steroid Injection
31
Q

What are the operative treatments for OA base of thumb?

A

Trapeziectomy - gold standard, good pain releif.

The space where the trapezium was fills in with scar tissue. There is loss in strength of the thumb. Pinch strength may feel like it is improving because there is less pain after operation (but this will occur about 3-6 months after the operation).

Fusion (only works if one joint is affected) - young people with heavy handling job - fusing is better for maintaining strength than a trapeziectomy.

Replacement

Musculoskeletal (28 decks)

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