Non-Arthritic Hand Conditions

Question 1

what is a mucous cyst?

Answer 1

outpouching of synovial fluid from DIP joint OA

Question 2

how does a mucous cyst present?

Answer 2

often near bottom corner of nail
blister type appearance
can be painful
can fluctuate/discharge
can deform nail/cause ridging if close enough to the nail

Question 3

how is a mucous cyst managed?

Answer 3

may be left alone
can be excised (only way to get rid of it?)
- risk of nail deformity and recurrence

Question 4

what is a ganglion?

Answer 4

outpouching of synovial cavity filled with synovial fluid

- therefore more common where high concentration of synovial joints (e/g wrists)

Question 5

how do ganglions present?

Answer 5

large round swelling
can fluctuate
usually painless but may feel tight

Question 6

how is a ganglion managed?

Answer 6

can be left alone an should go away with time
“family bible”
aspiration (if superficial, high recurrence rate)
excision (rare, risk of damage to radial artery)

Question 7

what is Alan’s test?

Answer 7

test to determine whether radial or ulnar is dominant arterial supply to the hand

Question 8

what is trigger finger

Answer 8

nodule/swelling on tendon in hand which catches on the tendon sheath as it passes through and causes irritation
leads to more swelling until the tendon gets stuck on the edge of the A1 pulley

Question 9

how does trigger finger present?

Answer 9

pain over A1 pulley (MC head)
triggering = sticking of finger in flexion
may need other hand to extend the finger or be unable to extend it at all

Question 10

how is trigger finger examined?

Answer 10

demonstrate triggering
feel nodule pass beneath pulley
tender over A1 pulley
- distinguish from dupuytrens

Question 11

how is trigger finger managed?

Answer 11

conservative (splint, wait to resolve spontaneously)
tendon sheath injection (steroid and local anaesthetic)
- usually curative
- may be repeated up to 3X
surgery if recurrent after injections
- divide A1 pulley (under General or local anaesthetic)

Question 12

what is DeQuervain’s Tenosynovitis?

Answer 12

…

Question 13

how does DeQuervains present?

Answer 13

spontaneous pain
swollen/red
finklesteins test

Question 14

how is DeQuervains managed?

Answer 14

NSAIDs
splint
rest
steroid injection - usually work
decompression surgery - if steroids don't work

Question 15

what is duputrens contracture?

Answer 15

thickening and contracture of subdermal palmar fascia leading to fixed flexion deformity of fingers

Question 16

where is the issue in dupuytrens?

Answer 16

aponeurosis
metaplasia of the fibroblasts into myofibroblasts
forms fibrous cord which contracts the finger

Question 17

how does dupuytrens present?

Answer 17

painless, gradual progression

starts as palmar pit/nodule

Question 18

what are the risk factors for dupuytrens?

Answer 18

genetics?
DM
alcohol/cirrhosis
smoking
epilepsy/anti-epileptic medication
trauma
dupuytrens diathesis (lederhosens (feet))

Question 19

how is dupuytrens contracture examined?

Answer 19

feel cords
MCP/PIP joint involvement (measure angles)
table-top test

Question 20

how does site of dupuytrens affect management?

Answer 20

MCP joint involvement is basically harmless, wont progress and can be fixed at anytime
PIP joint involvement will progress and can become unfixable

Question 21

how is dupuytrens managed?

Answer 21

conservative - rarely fixes problem (stretches, activity modification)
surgery
- segmental fasciectomy
- fasciectomy
- dermofasciectomy
- amputation
newer treatment
- collagenase injection
- percutaneous needle fasciotomy (recurrence common but safe, easy procedure)

Question 22

what is paronychia?

Answer 22

infection within the nail fold

Question 23

what are the risks for paronychia?

Answer 23

usually in children

nail biting

Question 24

how does paronychia present?

Answer 24

puss collection
swelling
redness
at base of nail

Question 25

how is paronychia managed?

Answer 25

elevate
antibiotics
incise and drain collection

Question 26

how does flexor tendon sheath infection present?

Answer 26

extremely painful
limited extension (including passive) due to pain
may have tracking lymphangitis
tracking up palm and arm

Question 27

how is flexor tendon sheath infection managed?

Answer 27

surgical emergency

wash out the tendon sheath