Wrist and hand conditions Flashcards
Dupuytren’s contracture
Contraction of the longitudinal palmar fascia
Presentation of dupuytren’s contracture
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
Who commonly gets dupuytrens contractures
M > F 6:1
40-60yrs
Risk factors for Dupuytren’s contractures
Smoking
Alcoholic liver cirrhosis
Diabetes mellitus
Use of vibration tools or heavy manual work
Ix of Dupuytren’s contractures
Diagnosis mainly clinical
Routine bloods
HbA1c
CBG
Mx of for Dupuytren’s contractures
Conservative management:
- hand therapy - keeping the hand active with stretching exercises
- Injectable collagenase clostridum histolyticum
Surgical management:
- Fasciectomy
When is surgery indicated for dupuytren’s contractures
Functional impairment
MCP joint contracture >30 degrees
PIP contracture
Rapidly progressive disease
Types of fasciectomy
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
De Quervain’s tenosynovitis
Inflammation of the tendons within the first extensor compartment of the wrist
Presentation of De Quervain’s tenosynovitis
Wrist pain near thumb
Swelling
Movements involving grasping or pinching are particularly painful and difficult
RF for De Quervain’s tenosynovitis
30-50 yo
Repetitive movements of the wrist
Female
Pregnancy
Extensor muscles
- Extensor pollicis brevis
- Extensor pollicis longus
- Abductor pollicis longus
- Extensor carpi radialis longus and brevis
- Extensor indicis
- extensor digitorum
- Extensor digiti minimi
- Extensor carpi ulnaris
Which tendons are affected by de Quervain’s tenosynovitis
Extensor pollicis brevis and abductor pollicis longus
Finkelstein’s Test
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
Diagnosis of de Quervain’s tenosynovitis
Clinical
Management of de Quervain’s tenosynovitis
Conservative management:
- avoid repetitive actions
- wrist splint
- steroid injections
Surgery:
- Decompression
Ganglionic
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
Risk factors for ganglionic cysts
Female
Osteoarthritis
Previous joint or tendon injury
Clinical Features of ganglionic cysts
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.
Investigations for ganglionic cysts
Diagnosed clinically.
Can do:
Xray - rule out OA or bone malignancies
USS
Mx of ganglionic cysts
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)
Trigger finger
Stenosing flexor tenosynovitis - finger or thumb click or lock when in flexion, preventing a return to extension due to node formation
Associated conditions of trigger finger
RA
Amyloidosis
Diabetes mellitus
Risk factors fro trigger finger
Occupation or hobby that involves prolonged gripping and use of the hand
RA
DM
Female
Increasing age
Presentation of trigger finger
Painless clicking/snapping/catching when trying to extend their finger
Can become painful
Ix of trigger finger
Clinical diagnosis
Mx of trigger finger
Mild - conservative
- avoid painful activities
- small splint at night
Severe - steroid injections
Surgical:
- percutaneous trigger finger release
