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Systems: MSK AB > Orthopaedic Problems of the Hand > Flashcards

Orthopaedic Problems of the Hand Flashcards

1
Q

What elective hand conditions are there?

A
  • Dupuytren’s Disease
  • Trigger Finger
  • De Quervain’s Tenovaginitis
  • Nerve entrapments (Carpal Tunnel Syndrome, Cubital Tunnel Syndrome)
  • Ganglion
  • OA Base of Thumb
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2
Q

What is the epideminiology of Dupuytren’s?

A
  • M:F 8:1 (15-64s)
  • M:F 2:1 (75+)

Disease develops earlier in males

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3
Q

What is the aetiology of Dupuytren’s?

A

Autosomal dominant of variable penetrance

  • Sporadic in 30% of cases
  • Onset may be sex linked
  • Almost exclusively white races
  • Few sporadic reports in other races
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4
Q

What is Dupuytren’s associated with?

A
  • Diabetes
  • Alcohol
  • Tobacco
  • HIV
  • Epilepsy
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5
Q

What are the features of Dupuytren’s diatheses?

A
  • Early onset disease
  • Bilateral disease
  • Family history
  • Ectopic disease
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6
Q

What is the pathophysiology of Dupuytren’s?

A

Myofibroblast

  • Intracellular contractile elements
  • Regulated by growth factors
  • Production of collagen
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7
Q

What functional problems does Dupuytren’s present?

A
  • Usually not painful
  • Loss of finger extension (active or passive)
  • Hand in pocket
  • Gripping things
  • Washing face
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8
Q

What are the treatment option for Dupuytren’s?

A

Non-operative

  • Observe
  • Splints don’t work
  • Radiotherapy

Operative

  • Partial fasciectomy
  • Dermo-fasciectomy
  • Arthrodesis
  • Amputation
  • Percutaneous needle fasciotomy
  • Collagenase
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9
Q

What are the features of a partial fascieotomy?

A
  • Most common procedure performed in UK
  • Good correction can be achieved
  • Wounds can take 2-3 weeks to heal
  • Stiffness requires physiotherapy
  • Can’t be cured
  • Recurrence 50 % at 5 years
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10
Q

What are the features of a dermo-fasciotomy?

A
  • More radical than partial fasciotomy
  • Removal of skin may reduce recurrence rates
  • Requires intensive physiotherapy
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11
Q

What are the features of a percutaneous needle fasciotomy?

A

-Quick
-No wounds
-Return to normal activities 2-3 days
-Does not prevent traditional surgery in future
-Higher recurrence
(? 50% at 3 years)
-Can be repeated
-Risk of Nerve Injury

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12
Q

What is the anatomy behind trigger finger?

A
  • 2 tendons to each finger
  • Tendons run in sheath
  • Thickenings in the sheath are called pulleys
  • Pulleys keep tendons close to the bone
  • Swelling in tendon catches on the pulleys
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13
Q

Who gets trigger finger?

A
  • F>M
  • 40s-60s
  • Ring > Thumb > Middle
  • Repetitive use of hand ?
  • Local trauma
  • Associations: RA, DM, Gout
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14
Q

How is trigger finger diagnosed?

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’
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15
Q

What are the treatment options for trigger finger?

A

Non-operative

  • Splintage
  • Steroids

Operative

  • Percutaneous release
  • Open surgery
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16
Q

What history may a patient with de Quervain’s syndrome present with?

A
  • 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
17
Q

What is the epidemiology of de Quervain’s syndrome?

A
  • M:F 1:6
  • 50s to 60s
  • Increased in post partum and lactating females
  • Activities with frequent thumb abduction and ulnar deviation
18
Q

What is the pathophysiology of de Quervain’s syndrome?

A
  • 1st dorsal extensor compartment
  • Fibro-osseous tunnel at the distal radius
  • Thickening of localised segment
  • 30% 1st compartment divided by septum
19
Q

What examination should be done in Quervain’s syndrome?

A
  • Examine thumb joints and consider base of thumb OA
  • Finklestein’s test
  • Resisted thumb extension
20
Q

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

A

Non-operative

  • Splints
  • Steroid injection

Operative
-Decompression

21
Q

What is the anatomy of a ganglion?

A
  • A myxoid degeneration from joint synovia

- Arise from joint capsule, tendon sheath or ligament

22
Q

Who gets ganglia?

A
  • F:M 2:1
  • Peak 20-40 years
  • Account for 70% of discrete swelling of the hand and wrist
  • Dorsal> volar 3:1
23
Q

What may ganglia be associated with?

A

Recurrent injury around the wrist

24
Q

How is a diagnosis of hand/wrist ganglia made?

A
  • Present with lump
  • Firm, non-tender
  • Change in size
  • Smooth
  • Occasionally lobulated
  • Normally not fixed to underlying tissues
  • Never fixed to the skin
25
Q

What are the treatment options for ganglia?

A

Non-operative

  • Reassure and observe
  • Aspiration
  • Hit with a book

Operative
-Excision (including the root)

26
Q

How does OA of the base of the thumb present?

A
  • Pain
  • Stiffness
  • Swelling
  • Deformity
  • Loss of function
27
Q

Who is affected by base of the thumb OA?

A
  • Common condition affecting 1 in 3 women

- They have difficulty opening jars and pinching

28
Q

What should you look for in base of the thumb OA?

A

STT OA

29
Q

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

A

Non Operative

  • Life style modifications
  • NSAIDS
  • Splint
  • Steroid Injection

Operative

  • Trapeziectomy
  • Fusion
  • Replacement
30
Q

What is the gold standard treatment for base of the thumb OA?

A

Trapeziectomy as it gives good pain relief and moderate pinch grip (+/- interposition flap or ligament reconstruction)

Systems: MSK AB (43 decks)

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