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Year 3 > Orthopaedic Problems of the Hand > Flashcards

Orthopaedic Problems of the Hand Flashcards

1
Q

who does dupuytrens disease affect?

A

white races
M:F 8:1 15-64
M:F 2:1 > 75

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2
Q

dupuytrens disease inheritance

A

autosomal dominant

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3
Q

what has been associated with dupuytrens disease ?

A 
diabetes
alcohol
tobacco
HIV
epilepsy
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4
Q

what is dupuytens diathesis

A

early onset disease
bilateral disease
family Hx
ectopic disease

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5
Q

pathology causing dupuytrens disease

A

myofibroblast:
intracellular contractile elements
regulated by growth factors
production of collagen

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6
Q

functional problems associated with dupuytrens disease

A 
usally not painful
loss of finger extenson - active/passive
hand in pocket
gripping things
washing face
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7
Q

treatment of dupuytrens disease: non-operative

A

observe
splints don’t work
radiotherapy

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8
Q

treatment of dupuytrens disease: operative

A

partial fasciectomy
dermo-fasciectomy
arthrodesis
amputation

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9
Q

partial fasciectomy vs dermo-fasciectomy

A 
§ Partial fasciectomy
• Good correction
• Wounds can take 2-3 weeks to heal
• Stiffness requires physiotherapy
• Can’t be cured
• Recurrence 50% at 5 years
§ Dermo-fasciectomy
• More radical procedure
• Removal skin may reduce recurrence rates
• Requires intensive physiotherapy
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10
Q

treatment of dupuytrens disease: percutaneous needle fasciotomy

A 
quick
no wounds
return to normal in 2-3 days
50% recurrence
can be repeated
risk of nerve injury
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11
Q

treatment of dupuytrens disease: collagenase

A

recurrence 34.8%
3 flexor tendon rupture
cost
await longer term recurrence

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12
Q

describe trigger finger

A
  • 2 tendons to each finger
  • Tendons run in sheath
  • Thickenings in sheath = pulley
  • Keep tendon close to bone
  • Swelling in tendon catches on pulley
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13
Q

who gets trigger finger?

A

women
40-60
repetivie use of hand
local trauma

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14
Q

where is trigger finger most common?

A

ring > thumb > middle

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15
Q

what is trigger finger associated with?

A

RA
DM
gout

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16
Q

diagnosis of trigger finger

A

palpable lump in palm over A1 pulley

feel the triggering around the A1 pulley

17
Q

mangement of trigger finger

A

non-operative: splint, steroid

operative: percutaneous release, open

18
Q

typical hx of De Quervain’s tenovaginitis

A

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

19
Q

who gets De Quervain’s tenovaginitis?

A
  • M:F 1:6
  • 50-60 years
  • Increased in post-partum and lactating females
  • Activities with frequent thumb abduction and ulnar deviation
  • Washerwoman’s sprain
20
Q

where does De Quervain’s tenovaginitis affect?

A
  • 1st dorsal extensor compartment
  • Fibro-osseous tunnel at the distal radius
  • Thickening of localized segment
  • 30% 1st compartment divided by septum
  • Consider base of thumb OA
21
Q

how to assess De Quervain’s tenovaginitis

A

finklestein’s test

resisted thumb extension

22
Q

management of De Quervain’s tenovaginitis

A 
o Non-operative
§ Splint
§ Steroid injection
o Operative
§ Decompression
23
Q

what is a ganglion cyst?

A
  • A myxoid degeneration from joint synovia
  • Arise from joint capsule, tendon sheath or ligament
  • 70% of all discrete swellings in the hand and wrist
24
Q

who gets ganglion cysts?

A
  • M:F 1:2

* Wide age distribution (peak 20-40yrs)

25
Q

diagnosis of ganglion cysts

A 
o Present with lump
o Firm, non-tender
o Change in size
o Smooth
o Occasionally lobulated
o Normally not fixed to underlying tissues
o Never fixed to the skin
26
Q

treatment of ganglion cysts

A 
o Non-operative
§ Reassure and observe
§ Aspiration
§ Hit it with a bible?
o Operative
§ Excision – including the root
27
Q

presentation of OA of the base of the thumb

A
  • Pain
  • Stiffness
  • Swelling
  • Deformity
  • Loss of function
  • Common
  • 1 in 3 women
  • Pain opening jars/pinching
  • Dorsal subluxation, metacarpal adduction, MCPJ hyperextension
  • Loos for STT OA
28
Q

treatment of OA of the base of the thumb

A 
o Non-operative
§ Life-style modifications
§ NSAIDS
§ Splint
§ Steroid injection
o Operative
§ Trapeziectomy
• Gold standard
• Good pain relief
• Moderate pinch grip (+/- interposition flap or ligament
reconstruction)
§ Fusion
§ Replacement

Year 3 (164 decks)

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