Orthopaedic problems of the hand Flashcards
What are some examples of orthopaedic hand conditions?
Dupuytren's Trigger finger De Quervain's tenovangitis Nerve entrapment - carpal/cubital tunnel syndrome Ganglion Osteoarthritis base of thumb
Who is most likely to get Dupuytrens?
M:F = 8:1 in 15-64a
M:F = 2:1 in over 75s
Disease develops earlier in males
What is the aetiology of Dupuytrens?
Sporadic in 30% of cases
Onset may be sex linked
Almost exclusively white races
Autosomal dominant
What are risk factors for developing dupuytrens?
Diabetes Alcoholism Tobacco HIV Epilepsy
What is the pathology of Dupuytrens?
There is an increase in the number of myofibroblasts which leads to thickening of the palmar fascia
What are functional problems in patients with Dupuytrens?
Usually no pain Loss of extension - can be active or passive Difficulty putting hand into pocket Difficulty gripping things Difficulty with face washing
What are non-operative options for treatment of Dupuytrens?
Wait and observe
Radiotherapy
What are operative options for Dupuytrens?
Partial fasciectomy Dermo-fasciectomy Arthrodesis Amputation Percutaneous needle Fasciotomy Collagenase
Can Dupuytrens be completely fixed in a patient?
Not completely, it is recurrent
What is usually done to treat Dupuytrens?
Partial fasciectomy
What is the rate of recurrence in Dupuytrens treated with partial fasciectomy?
50% at 5 years
What is dermo-fasciectomy?
Skin is removed - thought to reduce recurrence rates but requires intensive physiotherapy
What is percutaneous needle fasciotomy?
A needle is put through the skin and the bevel is used to saw through some fibres of the fascia to increase ability of movement
What are advantages and disadvantages of percutaneous needle fasciotomy?
Advantages - quick, no wounds, return to normal activities within 3 days, can be repeated
Disadvantages - Higher recurrence - 50% at 3 years, Risk of nerve injury
What is the pathology of trigger finger?
Swelling in the tendon running to the finger causes it to catch on a pulley in the tendon sheath
Who is most likely to get trigger finger?
Women>Men
40s-60s
Ring finger>thumb>middle finger
Associated with rheumatoid arthritis, Diabetes Mellitus, and gout
How is trigger finger diagnosed?
Patient history
Clicking sensation with movement of the digit
Lump in the palm under the pulley
May have to use the other hand to unlock the finger
Clicking may progress to locking
Palpable lump over A1 pulley/feel triggering
What are non-operative treatment options for trigger finger?
Splintage
Steroids
What are operative treatment options for trigger finger?
Percutaneous release
Open surgery
What is De Quervain’s syndrome?
Inflammation of the tendons at the base of the thumb leading to the sheath thickening, causing pain at the base of the thumb
What is the history of a patient with De Quervain’s syndrome?
Several weeks of pain localised to the radial side of the wrist
Aggravated by thumb movement
May see localised swelling
Localised tenderness over tunnel
Who is most likely to get DeQuervain’s syndrome?
M:F = 1:6
50-60y
Increased prevalence in post partum and lactating females
Activities with frequent thumb abduction
What is the pathology of De Quervain’s syndrome?
1st dorsal extensor compartment - fibro-osseus tunnel at the distal radius with thickening of the localised segment
What can be used to make a diagnosis of De Quervain’s syndrome?
Examination of thumb joints, base for osteoarthritis
Finklestein’s test
Resisted thumb extension
What options are available for treatment of De Quervain’s?
Non-operative - Splints, Steroid injection
Operative - Decompression
What is a ganglion?
A lump - myxoid degeneration from joint synovia which arises from joint capsule, tendon sheath or ligament
Where are you most likely to see ganglia?
Dorsal 3 times more than volar
May be associated with recurrent wrist injury
Twice as common in female
20-40y
How is a ganglia diagnosed?
Presents with a lump Firm, non tender Change in size Smooth Occasionally lobulated Normally not fixed to umderlying tissues Never fixed to skin
How can ganglia be treated?
Reassure and observe
Aspiration
Excision including the root
What are symptoms of Osteoarthritis?
Pain Stiffness Swelling Deformity Loss of function
What are non-operative options for treatment of Osteoarthritis of the base of the thumb?
Life style modifications
NSAIDs
Splint
Steroid injection
What are operative options for treatment of Osteoarthritis of the base of the thumb?
Trapeziectomy
Fusion
Replacement
What is the gold standard for treatment of osteoarthritis of the base of the thumb?
Trapeziectomy
