Orthopaedic Problems of the Hand Flashcards
Associations with Dupuytren’s
Diabetes Alcohol Tobacco HIV Epilepsy
Pathophysiology of Dupuytren’s
Myofibroblast =>
Intracellular contractile elements
Regulated by growth factors
Production of collagen
Dupuytren’s functional problems
Usually not painful Loss of finger extension - active or passive Hand in pocket Gripping things Washing face
Dupuytren’s non-operative treatment
Observe
Splints don’t work
Radiotherapy
Dupuytren’s operative treatment
Partial fasciectomy
Dermo-fasciectomy
Arthrodesis
Amputation
Trigger finger non-operative treatment
Splintage
Steroids
Trigger finger operative treatment
Percutaneous release
Open surgery
What is de Quervain’s syndrome?
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
Consider base of thumb OA
De Quervain’s non-operative treatment
Splints
Steroid injection
De Quervain’s operative treatment
Decompression
What is a ganglion?
A myxoid degeneration from joint synovia
Arise from joint capsule, tendon sheath or ligament
May be associated with recurrent injury
Ganglia presentation
Present with lump Firm, non-tender Change in size Smooth Occasionally lobulated Normally not fixed to underlying tissues Never fixed to the skin
Ganglia non-operative treatment
Reassure & Observe
Aspiration
Ganglia operative treatment
Excision including ‘the root’
OA base of thumb presentation
Pain (eg opening jars) Stiffness Swelling Deformity Loss of function
