Week 5 - The Hand Flashcards
What is worse - a distal or proximal boxer’s fracture?
# of the 5th worse when proximal
site of the most common thumb fracture?
Bennets - the base of the 1st MCP, extending into the CMC joint
what is an escharotomy?
treatment of the eschar (tough leathery skin with no elastic) in a 3rd degree burn
what is dermatotendonosis?
a bent DIP joint +/- an avulsion fracture
“mallet finger” !!!
Where do mucous cysts occur?
the DIP - an outpouch of Synovial fluid
where do ganglion cysts occur?
wrists, fingers and knees
what pulley is involved in trigger finger?
what fingers?
A1
commonly fingers 3 and 4
a swollen tendon gets caught. the finger is tender, stiff and … you guessed it… tttrriiiiggered.
may feel the nodule around A1
trigger finger Tx?
- steroid and local anaesthetic injection (up to 3)
2. divide A1 under LA/GA
how would you, yes you, test DeQuervains Tenosynovitis?
Finkelsteins test - thumb inside fingers and flex away from you
carpal tunnel testing…
- phalens
- tinels
tinels = percuss the median nerve phalens = hyperflexion
Tx of carpal tunnel
conservative - splints (at night) and steroid injections
surgical = divide the carpal ligament
giant cell tumours can occur in the hand, but where exactly?
palmar PIP of the 2/3rd finger.
mostly well defined
excisions are successful
Who gets Carpal tunnel syndrome?
much more common in women.
Excess fluid - pregnancy, hypothyroidism, CKD, diabetics.
Inflammation - RA
Colle’s fractures
Can be idiopathic
Presentation of carpal tunnel
paraesthesia in fingers 1 –> half of 4
“puckered” skin of the palms?
Dupuytrens contractures
who gets duputryens?
Men FMH - autosomal dominant Northern Europe/ Scandinavian Alcoholics Diabetics
Tx of dupuytrens?
Fasciectomy
or Fasciotomy division
Severe - may need amputated
Joints affected by OA in hands
DIP - very common PIP 1st CMC - common MCP - rare Wrist - trauma
3 stages of RA in hands..
- synovitis, tenosynovitis
- joint erosions
- joint instability, tendon rupture
how do you prevent tendon rupture as the end stage of RA?
Tenosynovectomy
- removal of the synovial tendon sheath
describe a ganglion cyst and recommended management
mucinous cyst on the finger/wrist/Bakers/foot
firm, smooth, rubbery, transilluminate
may cause local pain + irritation
exision not recommended
describe Giant cell tumour of tendon sheath and recommended management
“soapy multinucleated with haemosiderin stain”
palmar surgace, around PIP of 2nd/3rd
can interfere with nerves/artery/bone
therefore excision is recommended, and don’t recur.
