Orthopaedic Problems of the Hand Flashcards
What populations are most commonly affected by Dupuytren’s?
Disease of northern Europe
Males more than females
In 15-64, M:F = 8:1
Over 65 2:1
What are the risk factors for Dupuytren’s disease?
Genetic (autosomal dominant condition)
Sex linked
Almost exclusively white populations
Associations have been made with diabetes, alcohol, tobacco, HIV and epilepsy
What are the characteristics of Dupuytren’s?
Not normally painful, but serious functional consequences
Loss of finger extension both actively and passively
Onset is gradual and is often tender in early stages
Commonly presents as one or more lump in the hand that join together into a cord over time
Describe the pathological processes behind Dupuytren’s contracture
Dupuytrens involves thickening and contracture of the normal fascia of the hand. This progresses due to intracellular contractile elements that are regulated by growth factors, resulting in the production of collagen and formation of a myofibroblast.
What are the treatment options for Dupuytren’s?
Very limited non-surgical treatment Partial fasciectomy first line Can also help: Dermo-fasciectomy Arthodesis Amputation Percutaneous needle fasciectomy Collagenase injections
What are the pros and cons of a percutaneous needle fasciectomy?
Pros- quick and non-invasive
Cons- higher recurrence rate and chance of nerve injury
What is the pathological cause of trigger finger?
Swelling of the tendon causes it to get caught on pulley inside finger
What is the characteristic sign of trigger finger?
Someone who can make a fist, but when they open the fist they cannot initially extend a finger, which then pops extended
What populations are most affected by trigger finger?
More common in females than males
Aged 40-60
Associations have been made with gout, rheumatoid arthritis, diabetes and trauma
What fingers are most commonly affected by trigger finger?
From most to least common:
Ring finger
Thumb
Long finger
How would you examine trigger finger clinically?
Palpation of A1 pulley
Feeling a lump or triggering around pulley
What are the possible treatments of trigger finger?
Majority treated with intraarticular steroids Non-operatively: -Splintage -Steroids Operatively: -Percutaneous release -Open surgery
What are the symptoms of DeQuervain’s syndrome?
Several week history of pain localised to radial side of wrist that is aggravated by thumb movement
Can also be localised swelling with tenderness over carpal tunnel
In what populations is DeQuervain’s most common?
Aged 50-60
M:F = 1:6
Increased incidence in post-partum and lactating females
What part of the hand is affected by DeQuervain’s?
1st dorsal extensor compartment, specifically fibro-osseous tunnel at distal radius
How is DeQuervain’s examined clinically?
Examination of thumb joint to exclude base of thumb arthritis
Finkelstein’s test (clenched fist and ulnar deviation)
Resisted thumb extension
How is DeQuervain’s syndrome treated?
Non-surgical: -Splintage -Intraarticular steroid injection Surgical: -Surgical decompression
How do ganglion develop pathologically?
Formed from outpouching of synovial fluid that results in lump in hand. Water is reabsorbed and so fluid retained is thick, viscous substance
What populations are more commonly affected by ganglions?
Females (2:1)
Wide age range affected, peaking at 20-40
Dorsal more common than volar
Can be associated with recurrent injury around wrist
What are the characteristics of ganglion?
Firm, non-tender lumps that present with a change in size, are smooth and can be lobulated
They are normally not fixed to underlying structures and never fixed to skin
How is a ganglion treated?
Self-limiting and usually resolves spontaneously
Non-operative treatment is reassurance, observation and aspiration
Operative treatment is excision
What are the characteristics of base of thumb osteoarthritis?
Pain
Swelling
Stiffness
Deformity
Loss of function
Begins as pain when opening jars or pinching
Affects 1 in 3 females at some point in life
What are the treatment options for base of thumb osteoarthritis?
Non-operative treatments: -Lifestyle modifications -NSAIDs -Splinting -Steroid injection Operative treatments: -Trapeziectomy (first line) -Fusion -Thumb joint replacement
What are the features of Dupuytren’s diathesis?
Early onset, bilateral disease
Family history
Ectopic disease can also occur (most commonly feet and penis)
