Surgery of the hand

Question 1

Dupuytren’s disease

Answer 1

Thickening of the palmar fascia in the hand—> contracture.

Risk factors:

• Alcohol
• Smoking
• Alcohol
• Diabetes
• Epilepsy

Question 2

Trigger fingers

• Pathology
• Causes
• Symptoms
• Treatment

Answer 2

Catching of tendons at A1 pulley

• Tendon sheath too narrow for flexor tendon
• Forms a tendon nodule

Caused by overuse of digit

Symptoms:

• Pain the the palm or knuckles
• Popping sound made when affected finger is moved

Treatment

• Rest
• Splinting
• NSAIDs
• Steroid injections

Question 3

Carpal tunnel

Answer 3

Median nerve compression at the wrist
- Compressed by flexor retinaculum

Sensation affected
- Radial half of the hand (esp fingers)

Motor affected
- Thenar muscles (wasted)–> loss of abudction and opposition

Question 4

Thenar muscles

Answer 4

abductor pollicis brevis

Opponens policis

Flexor pollicis brevis

Question 5

Cubital tunnel syndrome

Answer 5

Ulnar nerve compression at the elbow (proximal)
- Progresses into ulnar claw

Functions affected

• Ulnar half of FDP
• Flexor carpi ulnas
• Hypothenar muscles
• Interossei
• Lumbricals
• Sensation of 5th and half of 4th digit.

Question 6

Hypothenar muscles

Answer 6

Abducts, flexes and opposes the 5th digit.

• Abductor digiti minimi
• Flexor digiti minimi
• Opponens digit minimi

Question 7

Ulnar nerve damage signs

Answer 7

Wasted Hypothenar muscles

Paradoxical thenar wasting

Forearm wasting

Ulnar claw

Question 8

De Quervain’s disease

Answer 8

Inflammation of the tendons that control thumb movement

• Abductor pollicus longus
• Extensor pollicus brevis

Symptoms:

• Pain in radial side of the wrist
• Pain whilst gripping or rotating wrist.

Causes:

• Overuse
• Pregnancy
• Trauma
• Drugs: ciprofloxacin, anastrozole