Flashcards in Orthopaedic Problems of the Hand Deck (30)
What elective hand conditions are there?
-De Quervain’s Tenovaginitis
-Nerve entrapments (Carpal Tunnel Syndrome, Cubital Tunnel Syndrome)
-OA Base of Thumb
What is the epideminiology of Dupuytren's?
-M:F 8:1 (15-64s)
-M:F 2:1 (75+)
Disease develops earlier in males
What is the aetiology of Dupuytren's?
Autosomal dominant of variable penetrance
-Sporadic in 30% of cases
-Onset may be sex linked
-Almost exclusively white races
-Few sporadic reports in other races
What is Dupuytren's associated with?
What are the features of Dupuytren's diatheses?
-Early onset disease
What is the pathophysiology of Dupuytren's?
-Intracellular contractile elements
-Regulated by growth factors
-Production of collagen
What functional problems does Dupuytren's present?
-Usually not painful
-Loss of finger extension (active or passive)
-Hand in pocket
What are the treatment option for Dupuytren's?
-Splints don’t work
-Percutaneous needle fasciotomy
What are the features of a partial fascieotomy?
-Most common procedure performed in UK
-Good correction can be achieved
-Wounds can take 2-3 weeks to heal
-Stiffness requires physiotherapy
-Can’t be cured
-Recurrence 50 % at 5 years
What are the features of a dermo-fasciotomy?
-More radical than partial fasciotomy
-Removal of skin may reduce recurrence rates
-Requires intensive physiotherapy
What are the features of a percutaneous needle fasciotomy?
-Return to normal activities 2-3 days
-Does not prevent traditional surgery in future
(? 50% at 3 years)
-Can be repeated
-Risk of Nerve Injury
What is the anatomy behind trigger finger?
-2 tendons to each finger
-Tendons run in sheath
-Thickenings in the sheath are called pulleys
-Pulleys keep tendons close to the bone
-Swelling in tendon catches on the pulleys
Who gets trigger finger?
-Ring > Thumb > Middle
-Repetitive use of hand ?
-Associations: RA, DM, Gout
How is trigger finger diagnosed?
-Clicking sensation with movement of digit
-Lump in palm under pulley
-May have to use other hand to ‘unlock’
-‘Clicking’ may progress to ‘locking’
What are the treatment options for trigger finger?
What history may a patient with de Quervain's syndrome present with?
-Several weeks pain localised to radial side of wrist
-Aggravated by movement of the thumb
-May have seen a localised swelling
-Localised tenderness over tunnel
What is the epidemiology of de Quervain's syndrome?
-50s to 60s
-Increased in post partum and lactating females
-Activities with frequent thumb abduction and ulnar deviation
What is the pathophysiology of de Quervain's syndrome?
-1st dorsal extensor compartment
-Fibro-osseous tunnel at the distal radius
-Thickening of localised segment
-30% 1st compartment divided by septum
What examination should be done in Quervain's syndrome?
-Examine thumb joints and consider base of thumb OA
-Resisted thumb extension
What are the treatment options for de Quervain's syndrome?
What is the anatomy of a ganglion?
-A myxoid degeneration from joint synovia
-Arise from joint capsule, tendon sheath or ligament
Who gets ganglia?
-Peak 20-40 years
-Account for 70% of discrete swelling of the hand and wrist
-Dorsal> volar 3:1
What may ganglia be associated with?
Recurrent injury around the wrist
How is a diagnosis of hand/wrist ganglia made?
-Present with lump
-Change in size
-Normally not fixed to underlying tissues
-Never fixed to the skin
What are the treatment options for ganglia?
-Reassure and observe
-Hit with a book
-Excision (including the root)
How does OA of the base of the thumb present?
-Loss of function
Who is affected by base of the thumb OA?
-Common condition affecting 1 in 3 women
-They have difficulty opening jars and pinching
What should you look for in base of the thumb OA?
What are the treatment options for base of the thumb OA?
-Life style modifications