Orthopaedic Problems of the Hand Flashcards
who does dupuytrens disease affect?
white races
M:F 8:1 15-64
M:F 2:1 > 75
dupuytrens disease inheritance
autosomal dominant
what has been associated with dupuytrens disease ?
diabetes alcohol tobacco HIV epilepsy
what is dupuytens diathesis
early onset disease
bilateral disease
family Hx
ectopic disease
pathology causing dupuytrens disease
myofibroblast:
intracellular contractile elements
regulated by growth factors
production of collagen
functional problems associated with dupuytrens disease
usally not painful loss of finger extenson - active/passive hand in pocket gripping things washing face
treatment of dupuytrens disease: non-operative
observe
splints don’t work
radiotherapy
treatment of dupuytrens disease: operative
partial fasciectomy
dermo-fasciectomy
arthrodesis
amputation
partial fasciectomy vs dermo-fasciectomy
§ 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
treatment of dupuytrens disease: percutaneous needle fasciotomy
quick no wounds return to normal in 2-3 days 50% recurrence can be repeated risk of nerve injury
treatment of dupuytrens disease: collagenase
recurrence 34.8%
3 flexor tendon rupture
cost
await longer term recurrence
describe trigger finger
- 2 tendons to each finger
- Tendons run in sheath
- Thickenings in sheath = pulley
- Keep tendon close to bone
- Swelling in tendon catches on pulley
who gets trigger finger?
women
40-60
repetivie use of hand
local trauma
where is trigger finger most common?
ring > thumb > middle
what is trigger finger associated with?
RA
DM
gout
diagnosis of trigger finger
palpable lump in palm over A1 pulley
feel the triggering around the A1 pulley
mangement of trigger finger
non-operative: splint, steroid
operative: percutaneous release, open
typical hx of De Quervain’s tenovaginitis
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
who gets De Quervain’s tenovaginitis?
- 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
where does De Quervain’s tenovaginitis affect?
- 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
how to assess De Quervain’s tenovaginitis
finklestein’s test
resisted thumb extension
management of De Quervain’s tenovaginitis
o Non-operative § Splint § Steroid injection o Operative § Decompression
what is a ganglion cyst?
- A myxoid degeneration from joint synovia
- Arise from joint capsule, tendon sheath or ligament
- 70% of all discrete swellings in the hand and wrist
who gets ganglion cysts?
- M:F 1:2
* Wide age distribution (peak 20-40yrs)
diagnosis of ganglion cysts
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
treatment of ganglion cysts
o Non-operative § Reassure and observe § Aspiration § Hit it with a bible? o Operative § Excision – including the root
presentation of OA of the base of the thumb
- 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
treatment of OA of the base of the thumb
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
