Orthopaedic Problems of the Hand Flashcards
What are the risk factors for Dupuytrens?
- M:F = 8:1 (15-64 yrs)
- M:F = 2:1 (> 75 yrs)
- autosomal dominant
- white race
- diabetes, epilepsy, HIV
- alcohol, tobacco
What is the pathology of Dupuytrens?
- myofibroblast
- intracellular contractile element
- regulated by growth factor
- production of collagen
What are the clinical features of Dupuytrens?
- loss of finger extension- active/passive
- difficulty gripping objects
*usually not painful
What is the treatment of Dupuytrens?
- non-operative
- observe
- radiotherapy
- operative
- partial fasciectomy (+ physiotherapy)
- dermo-fasciectomy (+ physiotherapy)
- arthrodesis
- amputation
- percutaneous needle fasciotomy
- collagenase
What are the risk factors for trigger finger?
- F > M
- 40-60 yrs
- repetative use of hand
- local trauma
- RA, DM, gout
* ring > thumb > middle
What are the clinical features of trigger finger?
- clicking sensation with movement of digit
- palpable lump in palm over A1 pulley
- feel triggering around A1 pulley
- ‘locking’
What is the treatment for trigger finger?
- non-operative
- splintage
- steroid
- operative
- percutaneous release
- open surgery
What are the risk factors for De Quervains syndrome?
- M:F = 1:6
- 50-60 yrs
- postpartum + lactating females
- activities with frequent thumb abduction + ulnar deviation
What is the pathology of De Quervains syndrome?
- 1st dorsal extensor compartment
- fibro-osseous tunnel at end of distal radius
- thickening of localised segment
- 30% 1st compartment divided by septum
What are the clinical features of De Quervains syndrome?
- several weeks pain, localised to radial side of wrist
- pain aggrevated by movement of thumb
- localised swelling
- localised tenderness over tunnel
What are the investigations for De Quervains syndrome?
- examine thumb joint (possible OA)
- Finklestein test
- resisted thumb extension
What is the treatment for De Quervains syndrome?
- non-operative
- splints
- steroid injection
- operative
- decompression
What are the risk factors for ganglia?
- F:M = 2:1
- 20-40 yrs
- recurrent wrist injury
* dorsal > volar (3:1)
* 70% in hand + wrist
What is the pathology of a ganglion?
- myxoid degeneration from joint synovia
- arise from joint capsual, tendon sheath, ligament
What are the clincal features of ganglia?
- lump
- firm, non-tender
- change in size
- smooth
- occasionally lobulated
- not normally fixed to underlying tissue
- never fixed to skin
