Orthopaedic problems of the hands

Question 1

what is the epidemiology of Dupuytrens?

Answer 1

M:F 8:1 in 15-64s
M:F 2:1 in over 75s
disease of northern europe - white race

Question 2

what is the genetic inheritance of Dupuytrens?

Answer 2

autosomal dominant

30% don’t have family history

Question 3

what associations have been made with increasing risk of Dupuytrens?

Answer 3

diabetes
alcohol
smoking 
epilepsy
HIV

Question 4

what features make the likelihood of a strong genetic predisposition to severe Dupuytrens ?

Answer 4

bilateral disease
ectopics
family history
early onset disease

Question 5

what is the pathology of dupuytrens?

Answer 5

thickening and contracture of the palmar fascia of the palm of the hand due to an increase in myofibroblasts

Question 6

what is the treatment options for dupuytrens?

Answer 6

partial or demo fasciectomy
percutaneous needle fasciotomy
collagenase

Question 7

what is the pathology of trigger finger?

Answer 7

swelling in the tendons in the finger which catches on the pulley of the tendon sheath
the thickened tendon can’t therefore get through the pulley so with force (straightening your finger) it pops out

Question 8

what conditions are associated with trigger finger?

Answer 8

diabetes
rheumatoid arthritis
gout

Question 9

in what age and sex is trigger finger most common in?

Answer 9

females

40s-60s

Question 10

what is the commonest angers to be affected in trigger finger?

Answer 10

ring > thumb > middle

Question 11

what clinical sign is found in trigger finger?

Answer 11

palpable amp in the palm over A1 pulley

Question 12

what are the treatment options for trigger finger?

Answer 12

splintage
steroid
percutaneous release or open surgery

Question 13

what is de quervain’s syndrome?

Answer 13

inflammation of the tendon sheath (causing thickening) that surrounds the 2 tendons that run from the wrist to the thumb

Question 14

what is the presentation of de quervains syndrome?

Answer 14

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

Question 15

in what age and sex is de quervains more common in?

Answer 15

F:M 6:1

50s-60s

Question 16

what test is carried out to diagnose De Quervains syndrome?

Answer 16

Finklestein’s test

Question 17

what are the treatment options for De quervains syndrome?

Answer 17

non-operative:
- splints
- steroid injection
surgical;
- decompression

Question 18

what is a ganglion cyst?

Answer 18

weakness in the joint capsule, tendon sheath or ligament causes out patching of synovial fluid

Question 19

what is the epidemiology of a ganglion cyst?

Answer 19

F:M 2:1

peak 20s-40s

Question 20

what is the presentation of a ganglion cyst?

Answer 20

firm, non-tender lump
changes in size
smooth
occasionally lobulated 
not fixed to underlying tissues
not fixed to the skin

Question 21

what are the treatment options for a ganglion cyst?

Answer 21

observe
aspiration
excision

Question 22

what is the presentation of osteoarthritis of the base of the thumb?

Answer 22

pain 
stifness
swelling
deformity 
loss of function 
thumb is hyperextended at MCPJ and adducted

Question 23

what is the epidemiology of OA of the base of the thumb?

Answer 23

1/3 women

Question 24

what type of joint is the base of the thumb?

Answer 24

synovial saddle

Question 25

what is the treatment options for OS of base of thumb?

Answer 25

NSAIDS
splint
steroid injection
surgical:
- trapeziectomy
- fusion
- replacement