Orthopaedic Problems Of The Hand

Question 1

Who’s more likely to get Duputrens? Male or female?

Answer 1

Age 15-64 males are more likely to get 8:1

Over 76s M:F 2:1

Question 2

Name some risk factors for dupuytrens?

Answer 2

Diabetes, alcohol, tobacco, HIV, epilepsy, family history

Question 3

Presentation of dupuytrens

Answer 3

Painful lump in palm, becomes not painful,
Loss of passive and active finger extension,
Functional problems- cant put hand in pocket, gripping things, washing face

Question 4

Non-operative treatment of Dupuytrens disease?

Answer 4

Observe, radiotherapy

Question 5

Operative treatment of dupuytrens?

Answer 5

Partial fasciectomy, dermo-fasciectomy, arthrodesis, amputation, percutaneous needle fasciotomy, collagenase

Question 6

Pathology of trigger finger

Answer 6

Thickening in sheath creates a pulley and swellings in tendons get caught on the pulley

Question 7

Risk factors of trigger finger?

Answer 7

Female, 
40-60s, 
Local trauma,
RA,
DM,
Gout

Question 8

Presentation of trigger finger?

Answer 8

Clicking sensation with movement of digit,
Lump in palm under pulley,
Clicking may progress to locking

Question 9

Examination of trigger finger?

Answer 9

Palpable lump in palm over A1 pulley

Question 10

Nor operative treatment of trigger finger?

Answer 10

Splintage, steroid

Question 11

Operative treatment of trigger finger?

Answer 11

Percutaneous release,

Open surgery

Question 12

Presentation of De Quervain’s Syndrome?

Answer 12

Several weeks pain localised to radial side of wrist,
Aggravated by movement of the thumb,
Localised swelling,
Localised tenderness over tunnel

Question 13

Risk factors of De Quervain’s Syndrome?

Answer 13

Female, 
50-60s,
Postpartum,
Lactating females, 
Activities with frequent thumb abduction and ulnar deviation

Question 14

Investigations for De Quervain’s Syndrome?

Answer 14

Finklestein’s test,

Resisted thumb extension

Question 15

non-operative treatment of De Quervain’s Syndrome?

Answer 15

Splints, steroid injection

Question 16

Operative treatment of De Quervain’s syndrome?

Answer 16

Decompression

Question 17

What is a ganglion?

Answer 17

A myxoid degeneration from joint synovial which arises from joint capsule, tendon sheath or ligament

Question 18

What is a ganglion lump appear like?

Answer 18

Firm,
Non-tender,
Smooth,
Not fixed to skin

Question 19

Non operative treatment of ganglion?

Answer 19

Reassure and observe,

Aspiration

Question 20

Operative treatment of ganglion?

Answer 20

Excision

Question 21

Presentation of OA base of thumb?

Answer 21

Pain, stiffness, swelling, deformity, loss of function

Question 22

Non-operative treatment of OA base of thumb?

Answer 22

Life style modifications, NSAIDs, splint, steroid injection

Question 23

Operative treatment methods of OA base of thumb?

Answer 23

Trapeziectomy, fusion, replacement