Orthopaedic Problems of the Hand Flashcards
List the elective hand conditions
- Dupuytren’s disease
- Trigger finger
- De Quervain’s tenovaginitis
- Carpal/Cubital tunnel syndrome
- Ganglion
- OA base of thumb
Which patient groups are more likely to get Dupuytrens?
- Male
- Autosomal dominant: variable penetrance
- Almost exclusively white races
- Associations with diabetes, alcohol, tobacco, HIV and epilepsy
Describe the pathology of dupuytren’s disease
- Myofibroblast
- Intracellular contractile elements
- Regulated by growth factors
- Production of collagen
What are the functional problems associated with Dupuytren’s disease?
- Loss of finger extension
- Hand in pocket
- Gripping things
- Washing face
What are the treatment options for Dupuytren’s disease?
- Non-operative: observation and radiotherapy
- Operative: partial fasciectomy, dermo-fasciectomy, arthrodesis and amputation
- Percutaneous needle fasciotomy
- Collagenase
Which patient groups are most likely to get trigger finger and which finger is most likely to be effected?
- Women
- 40-60s
- Repetitive use of hand?
- Local trauma
- Associations: RA, DM and gout
- Ring>thumb>middle
Which features would give a diagnosis of trigger finger?
- Patient history
- Clicking sensation with movement
- Lump in palm under pulley
- May have to use other hand to unlock
- Clicking may progress to locking
What are the management options for trigger finger?
- Non-operative: splintage or steroids
- Operative: percutaneous release or open surgery
What features would suggest a diagnosis of De Quervain’s Syndrome?
- Several weeks pain localised to radial side of the wrist
- Aggravated by movement of the thumb
- May have seen localised swelling
- Localised tenderness over tunnel
Which patient groups are most likely to get De Quervain’s Syndrome?
- Females
- Aged 50-60
- Post partum and lactating females
- Activities with frequent thumb abduction and ulnar deviation
- Washerwoman’s sprain
Which tests can suggest a diagnosis of De Quervain’s Syndrome?
- Finklestein’s test
- Resisted thumb extension
What are the management options for De Quervain’s Syndrome?
- Non-operative: splints or steroid injections
- Operative: decompression
What is a ganglion?
A myxoid degeneration from joint synovia - arise from the joint capsule, tendon sheath or ligament
Which patient groups are most likely to get ganglia?
- Females
- 20-40yrs
- Recurrent injury around the wrist
- Dorsal>volar
What are the clinical features of ganglia?
- Firm, smooth, non tender lump which changes in size
- Occassionally lobulated
- Not fixed to underlying tissues
- Never fixed to the skin
