orthopaedic problems of the hands

Question 1

men and women patterns in dupuytren’s

Answer 1

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

men - develops earlier

Question 2

inheritance of dupuytrens

Answer 2

autosomal dominant with variable penetrance

Question 3

% of sporadic cases in dupuytrens

Answer 3

30

Question 4

5 associations made with dupuytrens

Answer 4

DM
HIV 
epilepsy 
tobacco 
alcohol

Question 5

4 types of dupuytrens

Answer 5

early onset
bilateral
FH
ectopic

Question 6

briefly explain the pathology of dupuytrens

Answer 6

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

Question 7

5 functional problems of dupuytrens

Answer 7

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

Question 8

non op - dupuytrens

Answer 8

observe
radiotherapy?
no use for splints

Question 9

Operations for dupuytrens

Answer 9

partial fasciectomy
dermo-fasciectomy
arthrodesis
amputation

Question 10

2 newer treatments for dupuytrens

Answer 10

percutaneous needle fasciectomy

collagenase

Question 11

recurrence of partial fasciectomy

Answer 11

50% in 5 years

Question 12

Positive of dermo-fasciectomy

Answer 12

removal of skin may prevent recurrence

Question 13

positives of percutaneous needle fasciotomy

Answer 13

quick and no wounds

can be repeated

Question 14

Negatives of percutaneous needle fasciotomy

Answer 14

risk of nerve injury

higher recurrence

Question 15

thickenings in sheath are called…

Answer 15

pulleys

Question 16

briefly describe trigger finger pathology

Answer 16

tendon swelling catches on pully

Question 17

who gets trigger finger?

Answer 17

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

Question 18

fingers affected in trigger finger

Answer 18

ring > thumb > middle

Question 19

3 associations with trigger finger

Answer 19

RA
DM
gout

Question 20

diagnosing trigger finger

Answer 20

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

Question 21

non op - trigger finger

Answer 21

splintage and steroid

Question 22

op - trigger finger

Answer 22

percutaneous release and open surgery

Question 23

3 symptoms of de quervains

Answer 23

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

Question 24

who gets de quervains?

Answer 24

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

Question 25

What to always check for when examining thumb joints in de quervains?

Answer 25

base of thumb OA

Question 26

2 tests for de quervains

Answer 26

finklestein’s test

resisted thumb extension

Question 27

non op and op of de quervains

Answer 27

non op - splint and steroid injection

op - decompression

Question 28

Where does a ganglion arise from?

Answer 28

joint capsule, tendon sheath or ligament

Question 29

who gets ganglion?

Answer 29

20-40 is peak age 
female
recurrent wrist injury 
70% discrete swellings in hand and wrist
dorsal > volar

Question 30

diagnosing ganglion

Answer 30

smooth non tender lump which is firm
lobulated
not fixed to tissues and never fixed to skin

Question 31

non op - ganglion

Answer 31

reassure and observe, aspirate, bible?

Question 32

op - ganglion

Answer 32

excision including the root

Question 33

5 symptoms of base of thumb OA

Answer 33

pain 
stiffness 
swelling 
deformity 
loss of function

Question 34

How many women have base of thumb OA?

Answer 34

1 in 3

Question 35

non op - base of thumb OA

Answer 35

lifestyle, NSAIDS, splint, steroid injection

Question 36

3 operations for base of thumb OA

Answer 36

trapeziectomy
arthrodesis
fustion

Question 37

Positives of trapeziectomy

Answer 37

gold standard
good pain relief
moderate pinch grip