Orthopaedic Problems of the Hand Flashcards
What are some common conditions of the hand?
- Dupuytren’s disease
- Trigger finger
- De Quervain’s tenovaginitis
- Nerve entrapments
- Carpal tunnel syndrome
- Cubital tunnel syndrome
- Ganglion
- OA base of thumb
What sex and ethnicity does Dupuytren’s disease affect more?
Males > females
Almost exclusively white
Are there any genetic factors to Dupuytren’s disease?
Autosomal dominant
What are some risk factors for Dupuytren’s disease?
- Diabetes
- Alcohol
- Tobacco
- HIV
- Epilepsy
- Genetics
Describe the pathology of Dupuytren’s disease?
- Contraction of pretendinous bands and palmar aponeurosis (fascia) causes disease
- Myofibroblast
- Intracellular contractile elements
- Regulated by growth factors
- Production of collagen
What are some functional problems of dupuytren’s disease?
- Usually not painful
- Loss of finger extension
- Problems gripping things, putting hands in pockets or washing face
What is the treatment of dupuytren’s disease?
- Non operative
- Observe
- Splints don’t work
- Radiotherapy
- Operative
- Partial fasciotomy
- Most common procedure in UK
- Doesn’t get rid of all fascia
- Recurrence 50% at 5 years
- Dermo-fasciectomy
- More radical procedure, gets rid of all fascia and removes some skin
- Requires intensive physiotherapy
- Arthrodesis
- Amputation
- Percutaneous needle fasciotomy
- Quick and no wounds
- Higher reoccurrence rate
- Risk of nerve injury
- Collagenase
- Dissolves collagen in the band
- Major problem is the flexor tendon may rupture
- Expensive procedure
- Partial fasciotomy
What causes trigger finger?
- 2 tendons to each finger that sits in sheath
- Thickenings in sheaths known as pulley, keep tendon close to bone
- Swelling in tendon catches the pulley
What age group and sex is more affected by trigger finger?
- Woman more than men
- 40-60 years
Which fingers does trigger finger affect most commonly?
ring>thumb>middle
Describe the clinical features of trigger finger?
- Patient history
- Clicking sensation, may progress to locking
- Examination
- Palpable lump over A1 pulley
What is the treatment of trigger finger?
- Non operative
- Splintage
- Steroid
- Operative
- Percutaneous release
- Open surgery
What does De Quervain’s Tenovaginitis occur due to?
Occurs in 1st dorsal extensor compartment due to thickening of localised segment
What is the presentation of de quervain’s tenovaginitis?
- Pain
- Localised to radial side of wrist
- Aggravated by movement of thumb
- Localised swelling
- Tenderness over tunnel
What sex and age group is most affected by de quervain’s tenovaginitis?
- Females more than males
- 50-60 years
How is de quervain’s tenovaginitis diagnosed?
- Examination of joints
- Finkelstein’s test
- Resisted thumb extension
What is the treatment of de quervain’s tenovaginitis?
- Non operative
- Splints
- Steroid injection
- Operative
- Decompression
What is a ganglion?
Ganglion = a myxoid degeneration from joint synovial
What can a ganglion arise from?
Arise from joint capsule, tendon sheath or ligaments
What age group and sex are most affected by ganglion?
- More common in females
- 20-40 years
What are the clinical features of ganglion?
- Present with lump
- Firm, non-tender
- Change in size
- Smooth
- Normally not fixed to underlying tissues and never fixed to skin
What is the treatment of ganglion?
- Non operative
- Reassure and observe
- Aspiration
- Operative
- Excision
- Make sure also excise the ‘root’
- Excision
What does OA stand for?
Osteoarthritis
What is the presentation of osteoarthritis of base of thumb?
- Pain
- At base of thumb
- Worse on activity
- Stiffness
- Swelling
- Deformity
- Loss of function
Which sex does OA of the base of thumb affect more?
Females > males
What is the treatment of OA of the base of the thumb?
- Non-operative
- Life style modifications
- NSAIDs
- Splint
- Steroid injection
- Operative
- Trapeziectomy
- Gold standard
- Good pain relief
- Fusion
- Replacement
- Trapeziectomy
