Pathology of the Hand

Question 1

What is the mechanism of pathology behind development of Dupuytren’s Contracture?

What cell type is involved?

Answer 1

Palmar fascia undergoes hyperplasia with normal fascial bands forming nodules and cords = contracture of the MCP and PIP joints

Caused by a proliferation of myofibroblasts

Question 2

What type of collagen is formed in Dupuytren’s Contracture?

Answer 2

Type III collagen (as opposed to normal type I)

Question 3

Who gets Dupuytren’s Contracture?

Answer 3

Men more commonly (10:1)

Northern European/Scandinavian descent

Secondarily seen in…

• Alcoholic cirrhosis
• Phenytoin therapy
• Diabetics

Question 4

What is Dupuytren’s Contracture known as if it presents in the following place instead…

• soles of the feet
• penis

Answer 4

Feet - Ledderhose’s disease

Penis - Peyronie’s disease

Question 5

Which fascial pulley is most commonly affected in Trigger Finger?

Which fingers are most commonly affected?

How is this condition treated?

Answer 5

A1

Most commonly seen in ring and middle fingers

In most cases, a steroid injection underneath the sheath will reduce inflammation of the tendon and relieve symptoms of locking

Question 6

What are the two types of nodes that develop on the hands in Osteoarthritis?

Where do they occur?

Answer 6

Heberden’s nodes = seen at the DIPs

Bouchard’s nodes = seen at the PIPs

Question 7

What different hand pathologies can occur in RA?

Answer 7

Swan necking

Boutonniere’s

Z-thumbing

Subluxation of MCPs

Question 8

What is the treatment of choice for someone with RA? How soon should this be started?

What if they want to get pregnant?

Answer 8

Treatment of choice are DMARDs, specifically methotrexate

Want to start immediately to prevent development of deformities, begin treatment within 3 months of diagnosis

If patient wants to get pregnant, switch to another DMARD such as Sulfasalazine (as methotrexate is teratogenic!)