T&O: hand presentations - CTS, cubitalTS Dupuytrens, trigger finger

Question 1

Describe the presentation Dupytren’s disease

Answer 1

Hx of slow progression over years. Nodules present on palm of hands. Nodules are fixed. Nodules have thickened and can form tough cords under skin, fingers are pulled inwards towards palm. May also present with thickened skin on the feet or penis.

Question 2

What are risk factors for Dupytren’s disease?

Answer 2

Being male,
FHx,
alcohol use,
PMH of DM or seizures, increasing age.

Question 3

What are complications of surgically treating dupytren’s?

Answer 3

• Pain,
• scarring,
• injury to surrounding N and BV,
• wound infection,
• stiffness,
• loss of sensation,
• loss of finger (v v rare).

Question 4

How does Carpal tunnel syndrome present?

Answer 4

Pain, numbness and parasthesia in the lateral 3.5 digits. Worse during the night. Pain subsides on shaking wrist. Wasting of thenar eminence, weakness of thumb abduction

Question 5

What initial investigations/examinations would you do for suspected CT?

Answer 5

Tinel’s test - percuss over median N. Phalen’s test - hold wrist in full flexion for a minute. Both tests bring on symptoms.

Question 6

What are RF for CT syndrome?

Answer 6

Female, increasing age, obesity, previous injury, RSI, DM, RA, Hypothyroidism

Question 7

What complications of CT (carpal tunnel) surgery would you make a patient aware of?

Answer 7

Persistent CTS symptoms. Infection. Scar formation. Nerve damage. Trigger thumb.

Question 8

If CTS was untreated, what complications would it lead to?

Answer 8

Increased MN damage, impairment, disability.

Question 9

What condition involves painless (sometimes painful) clicking or snapping of the finger when trying to extend?

Answer 9

Trigger finger

Question 10

What may be present in PMH of pt with trigger finger?

Answer 10

Flexor tenosynovitis

Question 11

How is trigger finger managed?

Answer 11

Conservatively - give splint to hold finger in extension at night. Steriod injections. Surgical decompression of tendon tunnel or surgery via percutaneous trigger finger release via needle.

Question 12

What are risk factors for getting trigger finger?

Answer 12

Having occupation/hobby involving prolonged gripping and use of hand.
PMH of RA, DM.
Female.
Increasing age

Question 13

What can form as a complication of trigger finger surgery?

Answer 13

Adhesions

Question 14

Numbness in the ring and little fingers may mean there is involvement of which nerve?

Answer 14

Ulnar nerve

Question 15

Define cubital tunnel syndrome

Answer 15

Compressive neuropathy of the ulnar nerve

Question 16

How would you conduct a Tinel’s test for cubital nerve syndrome?

Answer 16

Tap over space between medial epicondyle of humerus and the olecranon process of the ulna

Question 17

What is Saturday night palsy?

Answer 17

Wrist drop and paralysis of the radial nerve - get weakness of hand and finger extensors

Question 18

What is De Quervain’s tenosynovitis?

Answer 18

Inflammation of abductor policies longus and extensor policies brevis tendons as they pass through the first dorsal compartment of the wrist at the radial styloid process

Question 19

What test would you carry out in a patient with suspected De Quervain’s tenosynovitis, and what does positive test show?

Answer 19

Finkelstein’s test. Positive - pain induced by ulnar deviation of the wrist with the thumb clasped in the palm. (Get tenderness over the styloid process too).

Question 20

What is the mechanism of injury of a hook of hamate fracture?

Answer 20

Typically in athletes- FOOSH or direct blow to volar proximal palm e.g. athletes who grip hard and big force -hockey stick

Question 21

How does hook of hamate fracture present?

Answer 21

tenderness over the hypothenar eminence/ ulnar side wrist pain/ Flexion of thumb whilst palpating the hypothenar eminence also causes pain in that area

Question 22

How are hook of hamate fractures diagnosed?

Answer 22

Plain x-ray with ‘carpal tunnel’ view the most useful for visualisation.