Orthopaedic Problems of the Hand Flashcards
Who tends to get Dupuytren’s disease? What sort of inheritance pattern does it follow?
Males (8:1 M to F in 15-64 year olds)
White people
Autosomal dominant pattern w variable penetrance
What is Dupuytren’s disease?
Myofibroblasts - proliferation, and excessive collagen deposition leading to contractures of the palmar fascia
- Causes one or more of the fingers of the hand to be in a flexed position
Symptoms of Dupuytren’s disease?
- Difficulty gripping / hand in pocket / washing face
- Not usually painful
- Loss of finger extension
- Swollen tendon visible through hand according to quiz
Treatment of Dupuytren’s disease?
- Partial / dermo - fasciectomy
- Arthrodesis
- Amputation
- Percutaneous needle fasciotomy
- Collagenase (injected into hand, dissolves extra thickened fasica, but often dissolves tendons too)
What is the most commonly performed treatment for Dupuytren’s disease? Brief description
- Partial fasciectomy
- remove the thickened collagen bands that are causing finger flexion, recurrence usually 50% at 5 years
Describe percutaneous needle fasciotomy
- Insert blades through the skin and cut the thickened fascia through the skin
- High risk of recurrence, but can be redone
Small entry wound and return to normal activity within 2-3 days
Who tends to be affected by trigger finger? Which fingers are usually affected?
Women, 40-60 year olds
Ring > thumb > middle
Signs / Symptoms of trigger finger?
- Pain in hand at distal palmar crease
- Clicking sensation with movement of digit
- Lump over palmar aspect of metacarpal head
- Finger may lock in flexed position
Treatment of trigger finger?
Non-operative:
- Splints
- Steroid injection (resolves about 50%)
Operative:
- Percutaneous release
- Open surgery
What is De Quervain’s tenosynovitis?
Inflammation of the sheath (synovium) surrounding the thumb
- Makes moving the thumb very painful
Symptoms of De Quervain’s tenosynovitis?
- Weeks of pain localized to radial side of wrist (aggravated by thumb movement)
- May have localized swelling at thumb area
- Localized tenderness at tunnel
Who tends to be affected by De Quervain’s tenosynovitis?
Women
- Age 50-60s
- Increased post partum, during lactation, and in activities with frequent thumb abduction and ulnar deviation
What clinical tests can be used to diagnose De Quervain’s tenosynovitis?
- Resisted thumb extension (patient should feel pain)
- Finklestein’s test: place thumb over palm, fingers over thumb and then ulnar deviate wrist
Treatment of De Quervain’s tenosynovitis?
Non-operative:
- Splints
- Steroid injection (resolves about 50%)
Operative:
- Decompression
What is a ganglion?
- Out pouching of the joint capsule, tendon sheath or ligament. Fills with fluid
- Fluid becomes concentrated, less water making them fairly firm
- Appears as a lump (commonly on dorsal wrist)
Symptoms of ganglia?
Non-tender, firm lump
Lumps are usually smooth, may be lobulated, not fixed to the skin and usually not fixed to underlying tissue
Treatment of ganglia?
- Not usually needed
- Hit it with a bible / aspirate
- Operative: excision
What is the commonest osteoarthritis in the body?
OA at Base of thumb
How does base of thumb osteoarthritis tend to present?
- Pain
- Stiffness
- Swelling
- Deformity
- Loss of function
How common in base of thumb osteoarthritis? What tends to happen to to the bones?
- Common, occurs in 1/3 women
- Dorsal subluxation, metacarpal adduction and metacarpal phalangeal joint hyperextension
Non-operative treatment of base of thumb osteoarthritis?
- NSAIDS
- Splints
- Steroid injection
Operative treatment of base of thumb osteoarthritis?
- Trapeziectomy (gold standard - remove part of joint (trapezium) and +/- interposition flap or ligament reconstruction)
- Fusion
- Joint Replacement (most common)
