The Elbow and Hands Flashcards
Where does tennis elbow affect
lateral epicondyle (lateral epidcondylitis)
When can lateral epicondylitis occur
repetitive strain injury in tennis players degenerative enthesopathy (inflammation of origin or insetion of a tendon or ligament into bone)
What are the clinical features of lateral epicondylitis
Painful and tender lateral epicondyle
Pain on resisted middle finger and wrist extensions
Where does golfers elbow effect
medial epicondyle (medial epicondylitis)
What is dupytens contracture?
A proliferative connective tissue disorder where the specialised palmar ascia undergoes hyperplasia with normal fascial bands forming nodules and cords progressing to contractures at the MCP and PIP joints
Where do contractures most commonly affect
the ring and little fingers
What is the pathology of dupytrens
proliferation of myofibroblast cells and the production of abdnormal collagen (type 3 rather than type 1)
Which gender is more commonly affected by dupytrens
males
also more common in scandanavians
What conditions may dupytens be seen in
alcoholic cirrhosis
side effect of phenytoin therapy
more common in diabetics
Fibromatoses- Peyronie’s disease and plantar fibromatosis (ledderhose disease)
What is a faciectomy
removal of all the diseased tissue
what is a fasciotomy
division of cords
What causes a trigger finger
tendonitis of a flexor tendon to a digit can result in nodular enlargement of the affected tendon (usually distal to a fascial pulley over the metacarpal neck)
What happens in a trigger finger
movement of the finger produces a clicking sensation which may be painful and the finger may lock in a flexed position and must be forcibly extended
What can relieve symptoms in a trigger finger
steroid injection around the tendons within the sheath will relieve symptoms
What is a ganglion cyst?
Mucininous filled cysts found adjacent to a tendon or synovial joint
What is a ganglion cyst in the knee called
baker’s cyst
What are the cysts like
firm, smooth rubbery and should transilluminate
How can ganglion cysts be treated
Needle aspiration (be careful volar ganglion may be near radial artery)
recurrence is common
usually cosmetic - will almost always recurr
surgical excision if localised discomfort - must remove entire cyst or will come back
Give another cause for a swelling in the hand
giant cell tumour of tendon sheath
Where are giant cell tumours of the tendon sheath usually
on the palmar surface around PIP joints or index and middle fingers
What is the histology of the giant cell tumours
multinucleated giant cells
haemosiderin (hence their brown appearance)
what is the common insertion point of the extensors at the elbow
lateral epicondyle
what is the common insertion point of the flexors t the elbow
medial epicondyle
management of tennis and golfers elbow
rest from activity causing the pain physio NSAIDS steroid injection - risk of ulner never damage in golfers elbow use of brace (elbow claso) rarely surgery
in an elbow replacement what are patients resticted to
can only lift 2.5 kg in that arm post op
what is fibromtoses of the penis called
peyronie’s disease
what is planta fibromatorisi called
ledderhose disease
indications for surgery in dupytrens
if interfering with function
more than 30 degrees contracture at MCP
any contracture at PIP as these are poorly tolerated
what pulley is usually affected in trigger finger
A1
what fingers are usually affected in trigger finger
middle or ring
treatment of trigger finger
steroid injection
surgery if recurrent or persitant - division of pulley
NB division of A1 pully does not affect function
treatment of giant cell tumour of tendon sheathq
excision to prevent local spread and to treat symptoms
can reoccur in around 10-20 percent
what is de quervians tenosynovitis
sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed
features of de quervians tenosynovitis
pain on the radial side of the wrist
tenderness over the radial styloid process
abduction of the thumb against resistance is painful
Finkelstein’s test: with the thumb is flexed across the palm of the hand, pain is reproduced by movement of the wrist into flexion and ulnar deviation
