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Muscluloskeletal Systems > Common Conditions of the Hand and Foot > Flashcards

Common Conditions of the Hand and Foot Flashcards

1
Q

What is Dupuytren’s contracture?

A

Nodular hypertrophy of the palmar fascia

  • NOT the skin
  • NOT the tendons
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2
Q

Where in the hand is Dupuytren’s contracture common?

A

Ring and little fingers

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3
Q

What is the epidemiology of dupuytren’s contracture?

A

Most common in middle aged men

Caucasian
-North european (Viking lands)

Sporadic in 30% of cases

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4
Q

What is Dupuytren’s diathesis?

A

Early onset disease

Bilateral

Family history

Ectopic disease

  • Peyronie’s disease
  • Ledderhose disease
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5
Q

What is Peyronie’s disease?

A

A connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis affecting an estimated 5% of men.

Specifically, scar tissue forms in the tunica albuginea, the thick sheath of tissue surrounding the corpora cavernosa causing pain, abnormal curvature, erectile dysfunction, indentation, loss of girth and shortening.

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6
Q

What is Ledderhose disease

(what are its other names

A

Plantar fibromatosis or Morbus Ledderhose is a fibromatosis, like Dupuytren’s contracture.

When suffering from Ledderhose disease benign nodules grow at the arch of the foot. Initially these nodules are usually painless but as they grow they can cause considerable pain when walking. The nodules can also inflame causing additional pain.

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7
Q

Name some causes of Dupuytren’s contracture

A

Familial (most common) - Viking Gene

Alcohol excess

Phenytoin Treatment

Smoking

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8
Q

What are the clinical features of Dupuytren’s contracture?

A

Usually not painful

Loss of finger extension (active or passive)

“Cant get hand in pocket”,
“trouble gripping things”
“Fingers in the way when washing face”

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9
Q

What are Garrod’s Pads?

A

Garrod’s pads (also known as violinist’s pads) are a cutaneous condition characterized by calluses on the dorsal aspect of the interphalangeal joints, i.e. the back side of the finger joints. They are often seen in violin, viola, and cello players, along with fiddler’s neck and other dermatologic conditions peculiar to string musicians

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10
Q

What are the 4 broad causes of Garrod’s pads?

A

Idiopathic

Genetic

Acquired
-Repetative Trauma

Associated with other acquired conditions

  • Dupuytren’s
  • Peyronie’s disease
  • Lederhose disease
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11
Q

What are ganglion cysts?

What are they filled with? DO they have synovial lining?

A

Aka Gideon’s Disease, or a Bible Cyst, is a mucin filled cyst attached to a synovial cavity like a joint or tendon.

NO synovial lining

These cysts are caused by leakage of thick clear fluid from the joint into the surrounding tissue.

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12
Q

What do ganglion cycts look and feel like?

Who are they most common in?

A

More obvious on flexion

More common dorsally
Firm, non tender
Smooth
Dont adhere to skin
Benign
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13
Q

What are the treatments for a ganglion cyst?

A

Reassure and observe

Aspiration

  • easy, quick,
  • can do on recurrence until they stop coming back

Hit with a bible?

Operative excision

  • High patient dissatisfaction
  • Not really advised
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14
Q

What causes trigger finger?

A

Inflammaed nodule of tendon

Nodule gets trapped behind tendon sheath and finger becomes stuck in flexed position

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15
Q

What is the medical term for trigger finger?

A

Stenosing tenosynovitis

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16
Q

What are the common fingers effected by stenosing tenosyntovitis?

A

Ring and middle fingers common

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17
Q

Who is stenosing tenosynovitis common with?

What is it associated with?

A

Middle age women
Neonates- resolves in 30%

Associated with

  • Carpal tunnel syndrome
  • De Quervain’s tenosynovitis
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18
Q

How do you treat stenosing tenosynovitis?

A

Splintage
-Stops you waking up with trigger finger)
Steroid (very popular)

Operative

  • Percutaneous release
  • Open surgery
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19
Q

What is De Quervain’s syndrome?

A

A tenosynovitis of the sheath or tunnel that surrounds two tendons that control movement of the thumb.

20
Q

What are the signs and symptoms of de Quervain’s syndrome?

A

Pain
-radial side of the wrist,
Spasms,
Tenderness,

Occasional burning sensation in the hand, and swelling over the thumb side of the wrist, and difficulty gripping with the affected side of the hand.

The onset is often gradual.

Pain is made worse by movement of the thumb and wrist, and may radiate to the thumb or the forearm.

21
Q

What should you consider as a differential in De Quervain’s syndrome?

A

Base of thumb osteoarthritis

-> examine joints

22
Q

What is the Finglestein’s test?

A

Put thumb in palm and adduct wrist

like marching

23
Q

What is the epidaemiology of De Quervain’s syndrome?

A

M:F = 1:6

Increased in post partum and lactating females

24
Q

Describe the sensory area the median nerve supplies in the hand

A

Palmar side:

  • lateral 2/3 of the palm
  • Thumb, index, middle and half of ring finger

Dorsal side:
-From just proximal to PIP joint to tip of index, middle and half of ring finger

25
Q

What are the signs and symptoms of carpal tunnel syndrome?

A 
Numbness
Tingling
Pain
Night Pain
Clumsiness
26
Q

What is the epidemiology of carpal tunnel syndrome?

A

> 80% oler than 40 years

1:2 = male: female

27
Q

What are the causes of carpal tunnel syndrome?

A 
P = Pregnancy
R = RA
A = Arthritis (degenerative)
G = Growth hormone abnormalities
M = Metabolic (hypothyroid, Gout, DM)
A = alcoholism
T = tumours
I = idiopathic (mostly)
C = connective tissue disorders
  • Fracture (acute Carpal tunnel syndrome)
  • Occupation? (vibration)
28
Q

If you had only 1 question to ask a patient you thought had carpal tunnel what would it be?

A

“Do you wake up at night with a numb hand?”

29
Q

How do you treat carpal tunnel syndrome?

A

Underlying problem

Splint

Sometimes steroid but by this point your thinking or surgery

Operative:
-Capral tunnel decompression/release
(almost guarenteed to get rid of night symptoms)

30
Q

What is the most common fractured bone in the carpus?

Where do 80% of these fractures occur?

A

Scaphoid

80% occur at waist of scaphoid

31
Q

It is often difficult to see a scaphoid fracture on X-ray.

What should you do to be absolutely sure you havent missed a scaphoid fracture?

A

Repeat x-ray at 2 weeks or MRI

32
Q

Name 2 complications of a scaphoid fracture

A

Risk of non-union

Avascular necrosis if fracture in proximal third

33
Q

Why can avascular necrosis occur in scaphoid fracture?

A

Retrograde blood supply to distal pole so proximal pole can recieve no blood during fracture

Avascular necrosis of proximal pole

34
Q

What is Ulnar collateral ligamnet injury of thumb also called?

What is it?

A

Gamekeeper’s thumb (also known as skier’s thumb or UCL tear)

Injury to the ulnar collateral ligament (UCL) of the thumb.

The UCL is torn at (or in some cases even avulsed from) its insertion site into the proximal phalanx of the thumb in the vast majority (approximately 90%) of cases. This condition is commonly observed among gamekeepers and Scottish fowl hunters, as well as athletes (such as volleyballers). It also occurs among people who sustain a fall onto an outstretched hand.

35
Q

Who is Ulnar Collateral ligament injury of thumb common in?

A

This condition is commonly observed among gamekeepers and Scottish fowl hunters, as well as athletes (such as volleyballers). It also occurs among people who sustain a fall onto an outstretched hand.

36
Q

What is Bennett’s fracture?

A

Intra-articular fracture at base of 1st metacarpal

This intra-articular fracture is the most common type of fracture of the thumb, and is nearly always accompanied by some degree of subluxation or frank dislocation of the carpometacarpal joint.

37
Q

What causes displacemnet in Bennett’s fracture?

A

Proximal dull from abductor pollicis longus

38
Q

What is the aetiology of Bennett’s fracture?

A

Axial compression of slightly flexed Carpometacarpal joint

  • FOOSH
  • Boxing
39
Q

What is a Boxer’s fracture?

A

Fracture of little finger metacarpal neck

May also be the ring finger

Swelling will be seen

40
Q

Why does an ulnar nerve palsy lead to claw hand?

Why does it occur in a LOW ulnar nerve lesion?

A

In the hand the ulnar nerve supplies the medial two lumbricals of the hand

As lumbricals normally flex the MCPJ, palsy of ulnar nerve leads to hyperextension of ulnar two fingers

Sparing of nerve supply to ulnar side FDP flexes finger.
Higher nerve lesion will show hyperextension but not flexed fingers

41
Q

Compare ulnar clawing and dorso-ulnar sensation in an ulnar nerve lesion at the level of the wrist and elbow

A

Wrist:

  • Ulnar clawing = severe
  • Dorso-ulnar sensation = spared

Elbow:

  • Ulnar clawing = moderate
  • Dorso-ulnar sensation = lost
42
Q

What is the Ulnar Nerve Paradox?

A

Ulnar nerve innervates the medial half of the FDP (little and ring)

Lesion at elbow, FDP also denervated

Lesion at wrist, FDP is still intact causing more severe “clawing” of ulnar two fingers

43
Q

Osteoarthritis of the hand is most common in what joints?

A

Distal Interphalangeal joints

Carpal-Metacarpal Joints thumb (Base of thumb)

44
Q

What are the symptoms and signs of osteoarthritis in the hand?

A

Night pain

Pain associated with use
-Opening jars, pinching

Pain with passive motion

Crepitus

45
Q

What sign may you see in very severe base of thumb arthritis?

A

Squaring of the base of thumb

- Subluxation of the base as the thumb slips out dorsally

46
Q

What are the treatments of osteoarthritis of the hand?

A

Life style modifications
NSAIDs
Splint
Steroid injections

Operative
-Trapexiectomy (gold standard, lose a but of pinch strength but good pain relief)

  • Fusion (usually more young men from traumatic, rare)
  • Replacement (lots of different designs because they dont know what’s best)
47
Q

Give 4 x-ray changes seen in osteoarthritis

A

Narrowing of joint space

Subchondral sclerosis

Subchondral cysts

Osteophyte Formation

Muscluloskeletal Systems (29 decks)

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