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Year 3 Trauma And Orthopaedics > Wrist and hand conditions > Flashcards

Wrist and hand conditions Flashcards

1
Q

Dupuytren’s contracture

A

Contraction of the longitudinal palmar fascia

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2
Q

Presentation of dupuytren’s contracture

A

Painless nodules
Fibrous cords and flexion contractures develop at the MCP and interphalangeal joints

Can severely limiting digital movement

Commonly affects the ulnar digits (ring and little finger

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3
Q

Who commonly gets dupuytrens contractures

A

M > F 6:1

40-60yrs

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4
Q

Risk factors for Dupuytren’s contractures

A

Smoking
Alcoholic liver cirrhosis
Diabetes mellitus
Use of vibration tools or heavy manual work

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5
Q

Ix of Dupuytren’s contractures

A

Diagnosis mainly clinical
Routine bloods
HbA1c
CBG

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6
Q

Mx of for Dupuytren’s contractures

A

Conservative management:

  • hand therapy - keeping the hand active with stretching exercises
  • Injectable collagenase clostridum histolyticum

Surgical management:
- Fasciectomy

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7
Q

When is surgery indicated for dupuytren’s contractures

A

Functional impairment
MCP joint contracture >30 degrees
PIP contracture
Rapidly progressive disease

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8
Q

Types of fasciectomy

A

Regional fasciectomy - entire cord is removed

Segmental fasciectomy - short segments of the cord are removed

Dermofasciectomy - cord and overlying skin are removed, to be followed by a skin graft

Closed fasciotomy - if unsuitable for major surgery

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9
Q

De Quervain’s tenosynovitis

A

Inflammation of the tendons within the first extensor compartment of the wrist

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10
Q

Presentation of De Quervain’s tenosynovitis

A

Wrist pain near thumb
Swelling
Movements involving grasping or pinching are particularly painful and difficult

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11
Q

RF for De Quervain’s tenosynovitis

A

30-50 yo
Repetitive movements of the wrist
Female
Pregnancy

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12
Q

Extensor muscles

A
  1. Extensor pollicis brevis
  2. Extensor pollicis longus
  3. Abductor pollicis longus
  4. Extensor carpi radialis longus and brevis
  5. Extensor indicis
  6. extensor digitorum
  7. Extensor digiti minimi
  8. Extensor carpi ulnaris
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13
Q

Which tendons are affected by de Quervain’s tenosynovitis

A

Extensor pollicis brevis and abductor pollicis longus

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14
Q

Finkelstein’s Test

A

The examiner applies longitudinal traction and ulnar deviation to the affected thumb.

Pain specifically at the radial styloid process and along the length of the extensor pollicis brevis and abductor pollicis longus tendons

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15
Q

Diagnosis of de Quervain’s tenosynovitis

A

Clinical

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16
Q

Management of de Quervain’s tenosynovitis

A

Conservative management:

  • avoid repetitive actions
  • wrist splint
  • steroid injections

Surgery:
- Decompression

17
Q

Ganglionic

A

Benign soft tissue lumps filled with synovial fluid that occur along any joint or tendon due to degeneration within the joint capsule or tendon sheath of the joint

18
Q

Risk factors for ganglionic cysts

A

Female
Osteoarthritis
Previous joint or tendon injury

19
Q

Clinical Features of ganglionic cysts

A

Smooth spherical painless lump adjacent to the joint

Sudden or gradual onset

May have subsided initially and reappear

On examination:
Lump is soft and will transilluminate

May mechanically restrict the full range of motion in the affected joint.

If the cyst exerts any pressure upon an adjacent nerve(s), the patient may present with localised paresthesia, pain, or motor weakness.

20
Q

Investigations for ganglionic cysts

A

Diagnosed clinically.

Can do:
Xray - rule out OA or bone malignancies

USS

21
Q

Mx of ganglionic cysts

A

If asymptomatic - monitor as can disappear spontaneously

Symptomatic:
- Aspiration +/- steroid injection - associated with infection and high rate of recurrence.

Cyst excision- removing the cyst capsule along with a portion of the associated tendon sheath (recurrence is less than with aspiration, but still possible)

22
Q

Trigger finger

A

Stenosing flexor tenosynovitis - finger or thumb click or lock when in flexion, preventing a return to extension due to node formation

23
Q

Associated conditions of trigger finger

A

RA
Amyloidosis
Diabetes mellitus

24
Q

Risk factors fro trigger finger

A

Occupation or hobby that involves prolonged gripping and use of the hand

RA
DM
Female
Increasing age

25
Q

Presentation of trigger finger

A

Painless clicking/snapping/catching when trying to extend their finger

Can become painful

26
Q

Ix of trigger finger

A

Clinical diagnosis

27
Q

Mx of trigger finger

A

Mild - conservative

  • avoid painful activities
  • small splint at night

Severe - steroid injections

Surgical:
- percutaneous trigger finger release

Year 3 Trauma And Orthopaedics (25 decks)

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