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