Orthopedic Problems of the Hand

Question 1

Who gets Dupuytrens?

Answer 1

M:F
8:1 (15 - 64)
2:1 (over 75s)
Develops earlier in males
Autosomal dominant
White

Question 2

Dupuytrens is associated with what?

Answer 2

Diabetes
Alcohol
Tobacco
HIV
Epilepsy

Question 3

What is Dupuytrens Diathesis?

Answer 3

Early onset bilateral disease

Question 4

Dupuytrens Diathesis is caused by what?

Answer 4

Myofibroblast producing excess collagen on palmar aponeurosis

Question 5

What functional problems are associated with Dupuytrens Diathesis?

Answer 5

Not (usually) Painful
Loss of finger extension
Hand in pocket
Gripping issues
Washing

Question 6

How is Dupuytrens Disease managed?

Answer 6

Radiotherapy
Surgery:
- Partial Fasciectomy
- Dermo-fasciectomy
- Arthrodesis
Percutaneous Needle Fasciotomy
Collagenase

Question 7

What recurrence rate of Dupuytrens is associated with Partial fasciectomy?

Answer 7

50% at 5 years

Question 8

What are the benefits and risks of Percutaneous Needle Fasciotomy for Dupuytrens?

Answer 8

Fast
Return to normal 2-3 days
No surgery 
Higher recurrence 
Risk of nerve injury

Question 9

How does Trigger Finger present?

Answer 9

Women
40 - 60s
Ring > Thumb > Middle
Local trauma

Question 10

Trigger finger is associated with what?

Answer 10

Rheumatoid Arthritis
Diabetes Mellitus
Gout

Question 11

How is Trigger finger diagnosed?

Answer 11

Clicking sensation with digital movement
Lump in palm under pulley
May have to use other hand to ‘unlock’
Locking

Question 12

How is Trigger finger managed?

Answer 12

Splintage
Steroids
Percutaneous release
Open surgery

Question 13

How does De Quervain’s Syndrome present?

Answer 13

Pain localised to radial rist
Worsened with thumb movement
Localised swelling
Tenderness over tunnel

Question 14

De Quervain’s Syndrome is more common in which patients?

Answer 14

M:F - 1:6
50 - 60s
Post-partum/lactating females
Frequent thumb abduction
Washerwoman's sprain

Question 15

What is the cause of De Quervain’s Syndrome?

Answer 15

1st dorsal extensor
Fibro-osseus tunnel at distal radius
Thickening of localised segment

Question 16

How is De Quervain’s Syndrome investigated?

Answer 16

Examine thumb joints
Finklestein’s test
Resisted thumb extension

Question 17

How is De Quervain’s Syndrome managed?

Answer 17

Splints
Steroids
Surgical Decompression

Question 18

What is a ganglion cyst?

Answer 18

Myxoid degeneration from joint synovia

Arise from joint capsule, tendon sheath, ligament

Question 19

Ganglia are more common in which patients?

Answer 19

M:F - 1:2
Wide age distribution
Dorsal > Volar
Associated with recurrent wrist injury

Question 20

Which proportion of hand/wrist swellings are ganglia?

Answer 20

70& of discreet swellings

Question 21

How are Ganglia diagnosed?

Answer 21

Firm, non-tender lump
Change in size
Smooth, may be lobulated
Normally not fixed to tissues
Never fixed to skin

Question 22

How are ganglia manged?

Answer 22

Aspiration

Surgical Excision + root

Question 23

How does osteoarthritis of the base of the thumb present?

Answer 23

Pain when pinching, dorsal subuxation, metacarpal adduction
Stiffness
Swelling
Deformity
Loss of function

Question 24

How common is base of thumb osteoarthritis?

Answer 24

Common

1 in 3 women

Question 25

How is base of thumb osteoarthritis managed?

Answer 25

Lifestyle change
NSAIDS
Splint
Steroids
Trapeziectomy 
Fusion
Replacement

Question 26

What is Trapeziectomy?

Answer 26

Surgery for OA base of thumb
Moderate pinch grip
Gold standard for therapy
Good pain relief