orthopaedic problems of the hands Flashcards
men and women patterns in dupuytren’s
males 8:1 (15-64) but only 2:1 after 75
men - develops earlier
inheritance of dupuytrens
autosomal dominant with variable penetrance
% of sporadic cases in dupuytrens
30
5 associations made with dupuytrens
DM HIV epilepsy tobacco alcohol
4 types of dupuytrens
early onset
bilateral
FH
ectopic
briefly explain the pathology of dupuytrens
myofibroblast
intracellular contractile elements and production of collagen
regulated by growth factors
5 functional problems of dupuytrens
not usually painful washing face hand in pocket gripping things loss of active or passive finger extension
non op - dupuytrens
observe
radiotherapy?
no use for splints
Operations for dupuytrens
partial fasciectomy
dermo-fasciectomy
arthrodesis
amputation
2 newer treatments for dupuytrens
percutaneous needle fasciectomy
collagenase
recurrence of partial fasciectomy
50% in 5 years
Positive of dermo-fasciectomy
removal of skin may prevent recurrence
positives of percutaneous needle fasciotomy
quick and no wounds
can be repeated
Negatives of percutaneous needle fasciotomy
risk of nerve injury
higher recurrence
thickenings in sheath are called…
pulleys
briefly describe trigger finger pathology
tendon swelling catches on pully
who gets trigger finger?
females, 40-60, repetitive use of hand, localised trauma
fingers affected in trigger finger
ring > thumb > middle
3 associations with trigger finger
RA
DM
gout
diagnosing trigger finger
clicking when digit moves which can proceed to locking
lump In palm under pulley
may have to use other hand to unlock
non op - trigger finger
splintage and steroid
op - trigger finger
percutaneous release and open surgery
3 symptoms of de quervains
several weeks pain localised to radial side of wrist
aggravated by moving thumb
localised tenderness and swelling over tunnel
who gets de quervains?
females - lactating and post partum
50-60
frequent thumb abduction and ulnar deviation