Orthopaedic Problems on the Hand Flashcards
Which gender is more prevalent of dupytrens disease and when does this occur?
M > F
occurs earlier in males
Genetics of dupytrens disease
autosomal dominant - variable penetrance
sporadic 30% of cases
Associations of dupytrens contracture
Diabetic alcohol tobacco HIV epilepsy
What is dupytren’s diathesis?
A more aggressive dupytrens
Features of dupytrens diathesis
Early onset disease
Bilateral disease
FH
Ectopic disease
Pathology of dupytrens
myofibroblast
- intracellular contractile elements
- regulated by growth factors
- production of collagen
Presentation of dupytrens
Not painful usually Loss of finger extension (active or passive) Hand in pocket gripping things problems curse of the macrrimmonds
treatment of dupytrens
observe radiotherapy partial fasciectomy dermo-fasiectomy arthrodesis amputation percutanoues needle fasciotomy collagenase
What is trigger finger?
A condition in which tendons of the hand become swollen and inflamed and “catch” in the pulley it runs through in the tendon sheath
Who gets trigger finger?
W > M
40-60s
Which finger are mostly affected in trigger finger?
Ring > thumb > middle
Associations of trigger finger
repetitive use of the hand local trauma RA DM Gout
Presentation of trigger finger
Clicking sensation of movement of digit
Lump on palm under pully
may have to use the other hand to ‘unlock’
‘clicking’ may progress to ‘locking’
Treatment of trigger finger
splintage
Steriod
percutaneous release
open surgery
What is De Quervians syndrome?
Painful inflammation of the tendons of your wrist and lower thumb - the sheath of containing the extensor pollicus brevis and abductor pollicus longus tendons are inflamed
Presentation of De Quervians syndrome
Several weeks pain localised to the radial side of the wrist
Tenderness over radial styloid process
Aggravated pain by movement of the thumb
Abduction of thumb against resistance is painful
localised swelling
localised tenderness over tunnel
Who gets de Quervians syndrome?
F > M
30-50s y/o
assosiations of de quervians syndrome
post partum
lactating females
activities with frequent thumb abduction and ulnar deviation
washerwomans sprain
Pathology of de quervians syndrome
1st dorsal extensor compartment
fibro-osseous tunnel at distal radius
30% 1st compartment divided by septum
investigations of de quervians syndrome
examine thumb joints
Friklesteins tests
resistricted thumb extension
Treatment of de quervian syndrome
non operative = splints, steroid injections, analgesia
Operative decompression
What is a ganglia?
A myxoid degeneration from joint synovia
Where can ganglions arise from?
joint capsule
tendon sheath
ligament
Who gets ganglias?
F > M
20 - 40 y/o
dorsal > volar
What can a ganglia be associated with?
Recurrent injury around the wrist
Presentation of a ganglia
lump firm non tender change in size smooth occasionally lobulated not normally fixed to any underlying tissues never fixed to the skin
treatment of ganglia
reassure and observe
aspiration
excision; including the ‘root’
Presentation of OA of the thumb
pain stiffness swelling deformity loss of function pain opening jars/pinching
Pathology of OA of the thumb
dorsal sublaxation
metacarpal adduction
MCPJ extension
Treatment of OA of the thumb
Life style modifications NSAIDs splint steroid injections operative - trapeziectomy - fusion - replacement
What is the gold standard operative treatment for OA of the thumb?
Trapeziectomy
What drug treatment can dupytrens contracture be a S/E for?
Phenytoin treatment
What is friklestones test used for and how does it work?
De Quervians tenosynovitis
Pull thumb in ulnar deviation and longitudinal traction. This action (if have the condition) causes pain over the radial styloid process and along the length of the extensor pollicus brevis and abductor pollicus longus
What is a common cause of bilateral carpal tunnel syndrome?
Rheumatoid arthritis
