Orthopaedic problems of the hands Flashcards
what is the epidemiology of Dupuytrens?
M:F 8:1 in 15-64s
M:F 2:1 in over 75s
disease of northern europe - white race
what is the genetic inheritance of Dupuytrens?
autosomal dominant
30% don’t have family history
what associations have been made with increasing risk of Dupuytrens?
diabetes alcohol smoking epilepsy HIV
what features make the likelihood of a strong genetic predisposition to severe Dupuytrens ?
bilateral disease
ectopics
family history
early onset disease
what is the pathology of dupuytrens?
thickening and contracture of the palmar fascia of the palm of the hand due to an increase in myofibroblasts
what is the treatment options for dupuytrens?
partial or demo fasciectomy
percutaneous needle fasciotomy
collagenase
what is the pathology of trigger finger?
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
what conditions are associated with trigger finger?
diabetes
rheumatoid arthritis
gout
in what age and sex is trigger finger most common in?
females
40s-60s
what is the commonest angers to be affected in trigger finger?
ring > thumb > middle
what clinical sign is found in trigger finger?
palpable amp in the palm over A1 pulley
what are the treatment options for trigger finger?
splintage
steroid
percutaneous release or open surgery
what is de quervain’s syndrome?
inflammation of the tendon sheath (causing thickening) that surrounds the 2 tendons that run from the wrist to the thumb
what is the presentation of de quervains syndrome?
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
in what age and sex is de quervains more common in?
F:M 6:1
50s-60s
what test is carried out to diagnose De Quervains syndrome?
Finklestein’s test
what are the treatment options for De quervains syndrome?
non-operative: - splints - steroid injection surgical; - decompression
what is a ganglion cyst?
weakness in the joint capsule, tendon sheath or ligament causes out patching of synovial fluid
what is the epidemiology of a ganglion cyst?
F:M 2:1
peak 20s-40s
what is the presentation of a ganglion cyst?
firm, non-tender lump changes in size smooth occasionally lobulated not fixed to underlying tissues not fixed to the skin
what are the treatment options for a ganglion cyst?
observe
aspiration
excision
what is the presentation of osteoarthritis of the base of the thumb?
pain stifness swelling deformity loss of function thumb is hyperextended at MCPJ and adducted
what is the epidemiology of OA of the base of the thumb?
1/3 women
what type of joint is the base of the thumb?
synovial saddle
what is the treatment options for OS of base of thumb?
NSAIDS splint steroid injection surgical: - trapeziectomy - fusion - replacement
