Week Nine - Subungual Hematoma, Nail Disorders, and Ganglion Flashcards
In the absence of physical trauma, what appears to be a subungual hematoma might be a ______ or _______ infection
- Proteus
- Pseudomonas
Why might you have to repeat the procedure (any method) several times when draining a subungual hematoma?
- To provide a hole that’s large enough to remain open for continued drainage
What do you advise the patient to do if the drainage hole made in a nail for a subungual hematoma closes up and pressure and pain reoccur?
- Soak the digit in cold water, perhaps with added peroxide to dissolve the clot
What are the five etiologies of onycholysis?
- Idiopathic
- Systemic (ie. thyrotoxicosis)
- Congenital/hereditary
- Cutaneous diseases (eg. psoriasis, drug-induced photo-onycholysis)
- Local causes (eg. trauma, onychomycosis, chemicals)
What are the various causes of onychogryphosis?
- Acute injury - dropping something on toe
- Chronic injury - from ill-fitting shoes
- Infection
- Poor blood supply
- Diabetes
- Inadequate intake of nutrients
What are four ways to help prevent onychogryphosis?
- Avoid footwear or stockings that gather tightly at the toes
- Keep nails trimmed
- Avoid tight-fitting footwear
- Avoid nail polish, which can damage the nail tissue
Tinea unguium is usually caused by one dermatophyte, either T. ______ or T. ______
- Trichophyton mentagrophytes
- Trichophyton rubrum
What are thought to be the two likely causes of ganglion cysts?
- May be a degenerative process in the mesoblastic tissues surrounding the joint
- May be a herniation of a tendon sheath
What is the consistency of a ganglion cyst?
Variable consistency
- Usually smooth and rounded; at other times multiocular
- Usually hard/firm - often misdiagnosed as a bony or cartilaginous lesion
- May be cystic and definitely fluctuant
What may be associated with the area involved by the ganglion?
- Weakness, such as of the wrist, finger, or toe
What are the three typical indications for treatment of ganglia?
- Patient wants relief of the pain/soreness
- Patient wants the unsightly mass removed
- Patient wants relief of the feeling of weakness of the infected part
What are the pros and cons of the four types of treatments for a ganglion cyst?
Intentional Rupture
- Dramatic, but permanent cure rate is quite low
- No longer recommended and is considered malpractice
Aspirarion
- Aspiration alone may be disappointing and unsuccessful
Aspiration and Injection of Sclerosing Agent
- Mixed results obtained
- The injections produce moderate pain and local edema that lasts a day or two, but is not disabled
Excision
- No guarantee of cure
- Most successful
