Orthopaedic Problems Of The Hand

Question 1

What is Dupuytrens?

Answer 1

An inherited disease of progressive fibrous tissue contracture of the palmar fascia

Question 2

Who gets Dupuytrens?

Answer 2

Predominantly affects men of Northern European descent >40 years old who smoke, drink alcohol, or have diabetes

Question 3

Dupuytrens Diathesis

Answer 3

• Early onset disease
• Bilateral disease
• Family History
• Ectopic disease

Question 4

Dupuytrens diagnostic factors

Answer 4

• difficulties with manual activities
• palmar nodule
• palmar skin changes
• pretendinous cords
• MCP joint contracture
• proximal interpharyngeal (PIP) joint contracture
• positive Hueston tabletop test

Question 5

Dupuytren’s Disease Treatment when no MCP joint or PIP joint contracture

Answer 5

• observe
• corticosteroid injections

Question 6

Surgical treatment of Dupuytrens

Answer 6

• partial fasciectomy (standard treatment)
• dermofasciectomy
• percutaneous needle fasciotomy
• collagenase injection

Question 7

Partial fasciectomy for Dupuytrens

Answer 7

• Good correction can be achieved
• Wounds can take 2-3 weeks to heal
• Stiffness requires physiotherapy
• Recurrence 50 % at 5 years

Question 8

Dermofasciectomy for Dupuytrens

Answer 8

• More radical than partial fasciectomy
• Removal of skin may reduce recurrence rates
• Requires intensive physiotherapy

Question 9

Percutaneous Needle Fasciotomy

Answer 9

• Quick
• No wounds
• Return to normal activities 2-3 days
• Does not prevent traditional surgery in future
• Higher recurrence (50% at 3 years)

Question 10

Collagenase injections

Answer 10

• patient returns the day following the injections for extension manoeuvre, in which the finger is extended to break the cord
• expensive
• possible tendon ruptures

Question 11

Trigger finger diagnosis

Answer 11

• Clicking sensation with movement of digit
• Lump in palm under pulley
• May have to use other hand to ‘unlock’

Question 12

Who gets trigger finger?

Answer 12

• women > men
• 40-60
• ring>thumb>middle
• local trauma
• associations
  
  • rheumatoid arthritis
  • diabetes mellitus
  • gout

Question 13

Trigger finger treatment

Answer 13

• Non-operative
  
  • Splintage
  • Steroid
• Operative
  
  • Percutaneous release
  • Open surgery

Question 14

Who gets De Quervain’s Tenovaginitis?

Answer 14

• M:F 1:6
• 50-60
• increased in post partum and lactating females
• activities with frequent thumb abduction and ulnar deviation

Question 15

De Quervain’s Syndrome Patient History

Answer 15

• 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

Question 16

De Quervain’s Syndrome Investigations

Answer 16

• Finklestein’s Test
• Resisted thumb extension

Question 17

De Quervain’s Syndrome Treatment

Answer 17

• Non-operative
  
  • Splints
  • Steroid injection
• Operative
  
  • Decompression

Question 18

Ganglia diagnosis

Answer 18

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

Question 19

Ganglia Treatment

Answer 19

• Non-operative
  
  • Reassure, Observe
  • Aspiration
• Operative
  
  • Excision (Including the root)

Question 20

OA Base of Thumb

Answer 20

• Pain
• Stiffness
• Swelling
• Deformity
• Loss of function

Question 21

OA Base of Thumb Treatment

Answer 21

• Non Operative
  
  • Life style modifications
  • NSAIDS
  • Splint
  • Steroid Injection
• Operative
  
  • Trapeziectomy
  • Base of thumb replacement