orthopaedic problems of the hands Flashcards

1
Q

men and women patterns in dupuytren’s

A

males 8:1 (15-64) but only 2:1 after 75

men - develops earlier

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2
Q

inheritance of dupuytrens

A

autosomal dominant with variable penetrance

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3
Q

% of sporadic cases in dupuytrens

A

30

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4
Q

5 associations made with dupuytrens

A
DM
HIV 
epilepsy 
tobacco 
alcohol
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5
Q

4 types of dupuytrens

A

early onset
bilateral
FH
ectopic

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6
Q

briefly explain the pathology of dupuytrens

A

myofibroblast
intracellular contractile elements and production of collagen
regulated by growth factors

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7
Q

5 functional problems of dupuytrens

A
not usually painful 
washing face 
hand in pocket
gripping things 
loss of active or passive finger extension
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8
Q

non op - dupuytrens

A

observe
radiotherapy?
no use for splints

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9
Q

Operations for dupuytrens

A

partial fasciectomy
dermo-fasciectomy
arthrodesis
amputation

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10
Q

2 newer treatments for dupuytrens

A

percutaneous needle fasciectomy

collagenase

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11
Q

recurrence of partial fasciectomy

A

50% in 5 years

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12
Q

Positive of dermo-fasciectomy

A

removal of skin may prevent recurrence

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13
Q

positives of percutaneous needle fasciotomy

A

quick and no wounds

can be repeated

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14
Q

Negatives of percutaneous needle fasciotomy

A

risk of nerve injury

higher recurrence

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15
Q

thickenings in sheath are called…

A

pulleys

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16
Q

briefly describe trigger finger pathology

A

tendon swelling catches on pully

17
Q

who gets trigger finger?

A

females, 40-60, repetitive use of hand, localised trauma

18
Q

fingers affected in trigger finger

A

ring > thumb > middle

19
Q

3 associations with trigger finger

A

RA
DM
gout

20
Q

diagnosing trigger finger

A

clicking when digit moves which can proceed to locking
lump In palm under pulley
may have to use other hand to unlock

21
Q

non op - trigger finger

A

splintage and steroid

22
Q

op - trigger finger

A

percutaneous release and open surgery

23
Q

3 symptoms of de quervains

A

several weeks pain localised to radial side of wrist
aggravated by moving thumb
localised tenderness and swelling over tunnel

24
Q

who gets de quervains?

A

females - lactating and post partum
50-60
frequent thumb abduction and ulnar deviation

25
What to always check for when examining thumb joints in de quervains?
base of thumb OA
26
2 tests for de quervains
finklestein's test | resisted thumb extension
27
non op and op of de quervains
non op - splint and steroid injection | op - decompression
28
Where does a ganglion arise from?
joint capsule, tendon sheath or ligament
29
who gets ganglion?
``` 20-40 is peak age female recurrent wrist injury 70% discrete swellings in hand and wrist dorsal > volar ```
30
diagnosing ganglion
smooth non tender lump which is firm lobulated not fixed to tissues and never fixed to skin
31
non op - ganglion
reassure and observe, aspirate, bible?
32
op - ganglion
excision including the root
33
5 symptoms of base of thumb OA
``` pain stiffness swelling deformity loss of function ```
34
How many women have base of thumb OA?
1 in 3
35
non op - base of thumb OA
lifestyle, NSAIDS, splint, steroid injection
36
3 operations for base of thumb OA
trapeziectomy arthrodesis fustion
37
Positives of trapeziectomy
gold standard good pain relief moderate pinch grip