Orthopedic Problems of the Hand Flashcards
Who gets Dupuytrens?
M:F 8:1 (15 - 64) 2:1 (over 75s) Develops earlier in males Autosomal dominant White
Dupuytrens is associated with what?
Diabetes Alcohol Tobacco HIV Epilepsy
What is Dupuytrens Diathesis?
Early onset bilateral disease
Dupuytrens Diathesis is caused by what?
Myofibroblast producing excess collagen on palmar aponeurosis
What functional problems are associated with Dupuytrens Diathesis?
Not (usually) Painful Loss of finger extension Hand in pocket Gripping issues Washing
How is Dupuytrens Disease managed?
Radiotherapy Surgery: - Partial Fasciectomy - Dermo-fasciectomy - Arthrodesis Percutaneous Needle Fasciotomy Collagenase
What recurrence rate of Dupuytrens is associated with Partial fasciectomy?
50% at 5 years
What are the benefits and risks of Percutaneous Needle Fasciotomy for Dupuytrens?
Fast Return to normal 2-3 days No surgery Higher recurrence Risk of nerve injury
How does Trigger Finger present?
Women
40 - 60s
Ring > Thumb > Middle
Local trauma
Trigger finger is associated with what?
Rheumatoid Arthritis
Diabetes Mellitus
Gout
How is Trigger finger diagnosed?
Clicking sensation with digital movement
Lump in palm under pulley
May have to use other hand to ‘unlock’
Locking
How is Trigger finger managed?
Splintage
Steroids
Percutaneous release
Open surgery
How does De Quervain’s Syndrome present?
Pain localised to radial rist
Worsened with thumb movement
Localised swelling
Tenderness over tunnel
De Quervain’s Syndrome is more common in which patients?
M:F - 1:6 50 - 60s Post-partum/lactating females Frequent thumb abduction Washerwoman's sprain
What is the cause of De Quervain’s Syndrome?
1st dorsal extensor
Fibro-osseus tunnel at distal radius
Thickening of localised segment
How is De Quervain’s Syndrome investigated?
Examine thumb joints
Finklestein’s test
Resisted thumb extension
How is De Quervain’s Syndrome managed?
Splints
Steroids
Surgical Decompression
What is a ganglion cyst?
Myxoid degeneration from joint synovia
Arise from joint capsule, tendon sheath, ligament
Ganglia are more common in which patients?
M:F - 1:2
Wide age distribution
Dorsal > Volar
Associated with recurrent wrist injury
Which proportion of hand/wrist swellings are ganglia?
70& of discreet swellings
How are Ganglia diagnosed?
Firm, non-tender lump Change in size Smooth, may be lobulated Normally not fixed to tissues Never fixed to skin
How are ganglia manged?
Aspiration
Surgical Excision + root
How does osteoarthritis of the base of the thumb present?
Pain when pinching, dorsal subuxation, metacarpal adduction Stiffness Swelling Deformity Loss of function
How common is base of thumb osteoarthritis?
Common
1 in 3 women
How is base of thumb osteoarthritis managed?
Lifestyle change NSAIDS Splint Steroids Trapeziectomy Fusion Replacement
What is Trapeziectomy?
Surgery for OA base of thumb
Moderate pinch grip
Gold standard for therapy
Good pain relief
