Tumors/Cysts/Dupuytren's Flashcards
which SF tendon is often involved in Dupuytren’s?
Abductor digit minimi, because the SF does not contain a natatory ligament ont the ulnar side
what is a natatory ligament?
helps create webspace between fingers, tightens with finger abductionn, and contributes to contracture of webspaces and PIPs by preventing separation of fingers during immobilization
what are common types of fibromatosis?
- Peyronie’s disease - dorsum of penis
- Lederhosen disease - plantar fascia
- Garrod’s nodes - knuckle pads
wrist ganglions typically arise from which ligament?
SL
dorsal wrist ganglions often seen in females with SL laxity
types of wrist ganglions
- dorsal wrist ganglion – most common
- volar wrist ganglion- second most common, usually occur over scaphoid tubercle
at what intervals should measurements be taken with truncated surface measures?
every 4cm or every 10cm along the affected UE where edema is located nothing the landmark at the measurement site
how many times can collagenase tx be performed for DD?
up to three times per area of contraction
wait 24 hours to perform extension manipulation, which can be attempted 3 times in 5 to 10-min intervals
after collagenase injection, what is DD recurrance rate?
10% in MCPs and 20% in PIPs at 5yr follow-up
what procedures are available to tx Dupuytren’s?
fasciectomies
needle fasciotomy
enzymatic faciotomy
what procedure is most common in the US, after minimally invasive tx has failed?
Regional fasciectomy
segmental fasciectomy is more popular in Europe
Radical fasciectomy is no longer recommended
what is a “flare reaction”?
a complication of increased edema, redness, pain, and stiffness typically seen 2-4wks post-op. May be due to orthotics with tension or overexercising with ROM and/or resistance
what is an Enchondroma?
most common benign bone tumor of the hand
arises in the medullary canal (metaphysics) of bone
proximal phalanx is most common site
what are Garrod’s nodes?
“knuckle pads” that appear on the dorsum of the hand at PIPJs and rarely need surgery
what is a CMC boss?
osteoarthritic spur that develops at base of 2nd and 3rd metacarpals and often mistaken for a dorsal wrist ganglion
after removal, immobilize wrist 3-6 weeks to allow ligament healing and avoid CMC stress
what is an Inclusion cyst?
result from a penetrating, traumatic injury that drives a fragment of epithelium into the subcutaneous tissue. Cells grow to leave a swollen area, full of epithelial cells and keratin, with surgical excision necessary when it affect’s fxnl use of the hand
what is a xanthoma?
“giant cell tumor”
second most common soft tissue tumor of the hand
what is Bowen’s disease?
squamous cell carcinoma of epidermis, treated with surgical incision
what is a Glomus tumor?
painful lesion, common in subungual fingertips, sensitive to cold, can spread to bone
what is a soft tissue sarcoma?
rare, malignant tumors that stem from muscle and connective tissue
what is the McCash open-palm technique for treating Dupuytren’s?
one or more transverse incisions and removal of the disease. Incisions are left open, allowing for suture-free AROM immediately. Good for older patients w/o enough skin due to chronic contractures, & leaving incision open avoids skin grafts and allows no place for hematoma to form. Wounds close by secondary intention in 6-8 weeks. Other benefits include decreased edema, decreased pain, and decreased stiffness.
what is Maffucci’s syndrome?
a rare, non-hereditary disease with radiographic findings of multiple enchondromata (benign cartilaginous tumors), accompanied by multiple hemangiomas (vascular anomalies). Symptoms are stiffness and deformity that primary affect the hands.
Ollier’s diease is similar, but without the vascular involvement, and looks identical on radiography
what normal palmar structure becomes pathologic with Dupuytren’s and causes MCP contractures?
Pretendinous bands
located in the palmar fascia and have vertical fibers that are attached to the skin. they become an abnormal cord when they shorten and thicken due to DD.
BANDS are normal tissue. CORDS are ABNORMAL
what pre-op therapy is appropriate before dupuytren’s release?
serial casting for PIP extension 2x/wk can make a 25-40 degree difference in AROM measures. steady release of tissues prior to surgery can make surgery easier and may reduce likelihood of post-op flare response
what are the types of DD Cords?
- Pretendinous cord - MCP contracture
- Central Cord - PIP contracture
- Spiral Cord - MCP and PIP contracture, neurovascular band involvement
- Natatory Cord - web space contractures btwn 2nd-4th
- Lateral Cord - PIP and/or DIp contracture, potential neurovascular band displacement
- ADM - SF PIP and/or DIP contracture, potential neurovascular band displacement
- Retrovascular cord - DIP contracture
What is the “Scar Grading Scale”?
Grade 0 = soft, pliable, non-painful flat scar
Grade 1 = thick, widened scar with no joint limitation
Grade 2 = hypertrophic, inflexible scar with joint limitation, hyperemia, itching, and pain
what is a giant cell tumor?
rare, aggressive non-cancerous tumor
more common in females and typically occur in 4th decade of life
located in metacarpals, phalanges, and also the carpal bones
what are aneurysmal bone cysts?
occur in the handin the second decade of life affecting males and females equally and are more common in metacarpals than phalanges
what are osteoid osteomas?
benign bone lesion that is well described in the hand and distal end of the radius and is typically seen in late second or early third decade of life
what is a chondrosarcoma?
most common primary malignant bone tumor in the hand
usually occurs in ppl over 60
proximal phalanges and metacarpals are most commonly affected
what are the characteristics of mucous cysts?
found at the DIPJ or proximal nail fold
round to oval, dome shape
lunula discoloration
occur between 5th and 7th decades
