Orthropaedic Problems Of The Hand

Question 1

What are the common soft tissue disorders of the hand?

Answer 1

Dupuytrens disease
Trigger finger
De quervain’s tenovaginitis 
Nerve entrapment
Ganglion
Base of thumb OA

Question 2

What are the clinical features and management of: dupuytrens disease, trigger finger, de quervain’s tenovaginitis and basal thumb OA?

Answer 2

Dupuytrens 
Features
- nodules under the palm of the hand
- loss of finger extension
- problems functionally eg grip, washing 
Management 
- non operative: observe, radiotherapy
- operative: partial fasciectomy, dermofascievtomy, arthrodesis, amputation, percutaneous needle fasciotomy, collagenase

Trigger finger
Features
- clicking sensation with movement of digit
- lump in palm under pulley
- clicking may lead to locking 
Managment
- non operative: splints, steroid
- operative: percutaneous release, open surgery 

De Quervain’s 
Features
- pain localised to radial side of wrist
- aggravated by movements of the thumb
- localised swelling
- localised tenderness over tunnel
Management 
- non operative: splint for acute, steroid injections 
- operative: decompression

Base of thumb OA
Features
- pain, stiffness, swelling, deformity, loss of function
Management
- non operative: life style modification, NSAIDs, splint, steroid injections
- operative: trapeziectomy, fusion, replacement

Question 3

What is the presentation and management of soft tissue ganglia?

Answer 3

Presentation: firm, non tender lump which changes in size, smooth, occasionally lobulated, normally not fixed and never fixed to skin

Management:

• non operative: reassure and observe, aspiration
• operative: excision, include root

Question 4

What are the common types of hand trauma and it’s management and rehab?

Answer 4

X