Orthopaedic Problems of the Hand

Question 1

What happens in Dupuytren’s?

Answer 1

Abnormal thickening of tissues of the palm and causes one or more finger to be flexed towards the palm

Question 2

Who is more likely to develop Dupuytrens?

Answer 2

Males, especially when younger but more women get it with age
Genetic link
Pretty much only seen in Caucasians, very very rare in Asia

Question 3

Dupuytrens has a genetic link in some cases, not all. Some are sporadic. What kind of genetic condition is Dupuytrens?

Answer 3

Autosomal dominant

Question 4

Which factors can be associated with developing Dupuytrens?

Answer 4

Diabetes
Alcohol
Tobacco
HIV
Epilepsy

Question 5

Dupuytrens is not usually painful but can a pain from day to day life. Which functional problems may a patient with Dupuytrens experience?

Answer 5

Struggles putting hands in pockets
Grapping things
Washing face (would poke eye)

Question 6

What is the test for Dupuytrens which determines if a patient needs an operation?

Answer 6

Table Top Test
If patient is able to fully flatten their hand down on a table, they do not need surgery

Question 7

The only real treatment for Dupuytrens is surgery- non-operative measures don’t really work.
There are a couple of surgery options. List some of them.

Answer 7

Partial fasciectomy
Dermo-fasciectomy
Arthrodesis
Percutaneous Needle Fasciectomy

Question 8

What is the most common operation for Dupuytrens?

Answer 8

Partial fasciectomy

Question 9

Pros and cons of partial fasciectomy for Dupuytrens?

Answer 9

Good correction
Wound heals 2-3 weeks
50% reoccurrence
Requires physio after for finger stiffness

Question 10

Which operation for Dupuytrens may be more suitable for a a younger patient, especially if they have a more hands on job?

Answer 10

Dermo Fasciectomy

Question 11

Pros and cons of Dermo Fasciectomy for Dupuytrens?

Answer 11

Reduced reoccurrence rates
Requires intense physio

Question 12

Percutaneous Needle Fasciectomy is a procedure which can be carried out in clinics under local anaesthetic.
It involves a needle scratching the bands that are contracting and causing the issue.

Pros and cons?

Answer 12

Quick, no wounds
Can be repeated and doesn’t prevent surgery in future
Higher reoccurrence
Risk of nerve injury

Question 13

What happens in trigger finger?

Answer 13

Swelling of tendons of the hand catches on the pulleys (thickening of sheath) causing difficulties in extending their finger

->patients are able to make a fist and bend fingers but struggle to straighten fingers out again after

Question 14

Who is more likely to get trigger finger?

Answer 14

Women > men
40-60

Question 15

Which fingers tend to be more commonly affected by trigger finger?

Answer 15

Ring > thumb > middle

Question 16

What can trigger finger be associated with?

Answer 16

Potentially repetitive use of hand
Local trauma
Certain conditions: rheumatoid arthritis. diabetes, gout

Question 17

Trigger finger diagnosis is made based on history and examination. What may the patient describe and what may be found?

Answer 17

Patient will mention clicking sensation during movement of the digit, may even lock in position
Have to actively use other hand to unlock hand

Can feel small lump at base of finger on the palmar aspect

Question 18

Non-operative treatment options for trigger finger?

Answer 18

Splints
Steroid injection

->steroid injection reduces collagen strength and allows pulley to stretch more. Injection give about 70% cure rate and if not, second one gives 90%

Question 19

Operative treatment for trigger finger?

->e.g. if steroid injection doesn’t work in the 10%

Answer 19

Percutaneous release
Open surgery

Question 20

What would a patient with De Quervain’s Syndrome present with?

Answer 20

Several weeks of pain localised to radial side of wrist
Pain aggravated by movement of thumb
May be localised swelling

->if put stethoscope over, may hear a creaking noise

Question 21

Who is more likely to get De Quervain’s Syndrome?

Answer 21

Females
50-60
Increased in postpartum and lactating females- perhaps due to picking baby up a lot?

Question 22

How is De Quervain’s Syndrome diagnosed?

Answer 22

Examination of base of thumb

Question 23

Considering the fact that De Quervain’s Syndrome needs to be diagnosed by examination of thumb base, which differential needs to be excluded?

Answer 23

Osteoarthritis as most commonly occurs at the base of the thumb

Question 24

Which test confirms De Quervain’s Syndrome?

Answer 24

Finklesteins test

->hehe love it, put thumb in palm and move sharply to other side and will cause agonising pain if have De Quervain’s Syndrome

Question 25

Non-operative treatment of De Quervain’s Syndrome?

Answer 25

Splints
Steroid injection

->physio does not help as movement elicits more pain

Question 26

Operative treatment of De Quervain’s Syndrome?

Answer 26

Decompression

Question 27

Ganglion?

Answer 27

Lump on hand, mostly dorsum but some palmar

Question 28

Who is more likely to get a ganglia?

Answer 28

More common in females
Peak 20-40yrs

->pretty common condition, lecturer said in the lecture he can almost guarantee someone in the lecture theatre has one

Question 29

In examination of a ganglion, what would be seen?

Answer 29

Firm, non-tender lump
Can change is size, patient may say after a bath it’s bigger and in the cold it’s disappeared
ALWAYS smooth
Hard to move as fixed to underlying tissues

->if unsure of diagnosis, can aspirate it and see a viscous fluid

Question 30

Treatment of ganglia?

Answer 30

Reassurance and observation
Can be excised but rarely done

->majority of patients are young and don’t like the look of them so will want it removed but by removing them, they will be left with a scar which they probably won’t like either

Question 31

Which joint is most commonly affected by osteoarthritis?

Answer 31

Base of thumb

Question 32

What are the symptoms of OA at the base of thumb>?

Answer 32

Pain
Stiffness
Swelling
Deformity
Loss of function

Question 33

Who is more likely to get base of thumb OA?

Answer 33

Women, 1 in 3 :) fab

Question 34

No-operative treatment of OA of base of thumb?

Answer 34

Lifestyle modifications
NSAIDs
Splints
Steroid injections

Question 35

Operative treatment for OA base of thumb?

Answer 35

Trapeziectomy - gold standard
Fusion
Replacement

Question 36

What happens in a trpaeziectomy?

Answer 36

Type of excision arthroplasty- removal of bone and it forms scar tissue in the gap

Question 37

When would a trapeziectomy not be the operation of choice of OA of base of thumb?

Answer 37

If a person requires a good pinch grip and downside of the surgery is that pinch grip is fine but not amazing

->however, much better grip than they’re had before

Question 38

If someone needs to have a strong pinch grip, maybe for their job, what can be done?

->lecturer gave examples he carried out of professional horse rider and a man on Orkney who fixes shoes :)