De Quervains Tenosynovitis + Ganglion cysts Flashcards

1
Q

What is DQT?

A
  • Inflammation of tendons within first extensor compartment of the wrist
  • = wrist pain and swelling
  • Women 30-50, repetitive movements of the wrist in job/hobbies
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2
Q

Extensor compartment of the wrist contents

A
  • 6 compartments - lateral to medial
  • 1 = extensor pollucis brevis and abductor pollucis longus
  • 2 = extensor carpis radialis longus and brevis
  • 3 = extensor pollucis longus
  • 4 = extensor indicis and extensor digitorum
  • 5 = extensor digiti minimi
  • 6 = extensor carpis ulnaris
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3
Q

Which tendons does DQT involve?

A
  • Extensor pollucis brevis
  • Abductor pollucis longus
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4
Q

RF for DQT

A
  • Age - 30-50
  • Female
  • Pregnancy
  • Occuptations/hobbies that involve repetitive movements of wrist
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5
Q

Clinical features of DQT

A
  • Pain near base of thumb
  • Associated swelling - due to thickening of tendon sheath
  • Grasping + pinching are difficult
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6
Q

Examination of DQT

A
  • Swelling
  • Palpable thickening over tendon group fibrous sheath
  • Finkelsteins test +ve
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7
Q

What is Finkelsteins test?

A
  • Longitudinal traction and ulnar devitation of thumb
  • Pain at radial styloid process and along length of EPB and APL tendons = +ve
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8
Q

Differentials for base of thumb pain/wrist swelling

A
  • Arthiritis of CMC joint - more gradual, negative finkelstein but +ve grind test
  • Intersection syndrome - tendons of 1st compartment cross over with those of 2nd, = pain over second compartment
  • Wartenbergs syndrome - neuritis of superficial radial nerve, wearing tight jewellery
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9
Q

Investigations DQT

A
  • Clinical
  • Plain radiographs to exclude other diagnosis?
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10
Q

Management - conservative DQT

A
  • Lifestyle advice - avoid repetitive actions
  • Wrist splint
  • Steroid injections
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11
Q

Surgical management DQT

A
  • Failure to respond to conservative
  • Surgical decompression under LA or GA
  • Transverse or longitudinal incision in tendon sheath roof
  • Allows to heal and form roof again but will be wider with more space
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12
Q

Complications of surgery DQT

A
  • Failure to resolve
  • Reduced ROM in wrist/hand
  • Neuroma formation
  • Nerve impingement
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13
Q

What is a ganglion cyst?

A
  • Non-cancerous
  • Soft tissue lumps
  • Occur along any joint or tendon
  • Arise from degeneration within the joint capsule or tendon sheath of joint
  • Then become filled with synovial fluid
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14
Q

Most common location for ganglion cyst

A
  • Hands and feet
  • Dorsal wrist most common
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15
Q

RF for gangion cyst

A
  • Female
  • OA - increase fluid in joint, leakage through sheath into cyst
  • Previous joint/tendon injury
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16
Q

Clinical features of ganglion cyst

A
  • Painless
  • Smooth spherical lump
  • Appear suddenly or grow over time
  • Sometimes can subside then reappear
17
Q

Examination of ganglion cyst

A
  • Transilluminate
  • May mechanically restrict ROM
  • If cyst exerts pressure on adjacent nerves can have localised parasthesia, pain or motor weakness
18
Q

Differentials for ganglion cyst

A
  • Giant cell tumour of tendon sheath - solid, does not transilluminate, fixed to sheath so less mobile
  • Tenosynovitis - no discrete mass, swelling along tendon
  • Lipoma - no transillumination
  • OA
  • Sarcoma - not well circumscribed, immobile
19
Q

Investigations ganglion cyst

A
  • Clinically
  • X-ray to rule out OA or bone malignancies - ganglions not apparent on x-ray
  • If uncertain, can USS or MRI
  • Aspiration - temporary relief and send fluid for microscopy +/- cytology
20
Q

Management ganglion cysts

A
  • Monitor usually - as painless
  • If pain or limits ROM then intervene
21
Q

Interventions for ganglion cyst if painful or limits ROM

A
  • Aspiration +/- steroid injection - BUT infection risk and high rate recurrence
  • Cyst excision - remove cyst capsule with portion of tendon sheath
22
Q
A