Non-Arthritic Hand Conditions

Question 1

What are mucous cysts?

Answer 1

Outpouching of the synovial fluid from DIP joint due to osteoarthritis

Question 2

What are some presentations of mucous cysts?

Answer 2

May be painful, fluctuate/discharge, may deform nail and cause ridge

Question 3

How are mucous cysts treated?

Answer 3

Do nothing

Excision = often needs advancement/rotation flap

Question 4

What are ganglions?

Answer 4

Outpouching of synovial cavity = more common, often synovial joints (e.g wrist)

Question 5

Where is the most common site for ganglions?

Answer 5

Next to site of palpation of radial pulse = often stuck to artery

Question 6

What are some features of ganglions?

Answer 6

Filled with synovial fluid, fluctuate/transilluminate, usually painless but may feel tight, usually resolve with time

Question 7

How are ganglions treated?

Answer 7

Do nothing, aspirate, excision

Question 8

What is the pathogenesis of trigger finger?

Answer 8

Tendons run within flexor tendon sheath, any swelling of tendon leads to irritation = more swelling, tendon gets caught on edge of A1 pulley

Question 9

What are some symptoms of trigger finger?

Answer 9

Pain over A1 pulley (MC head), sticking of finger in flexion, may need other hand to extend finger or may not be able to extend finger at all

Question 10

What are some examination features of a patient with trigger finger?

Answer 10

Demonstrate triggering, tender over A1 pulley, feel nodule pass beneath pulley, may affect thumb

Question 11

What is the conservative treatment for trigger finger?

Answer 11

Often resolves spontaneously = splint to prevent flexion

Question 12

How are tendon sheath injections given for trigger finger?

Answer 12

Steroid and local anaesthetic, often curative, may be repeated up to two time

Question 13

What surgery can be done for trigger finger?

Answer 13

Offered after failure to resolve after two tendon sheath injections, given under local or general anaesthetic, divide A1 pulley

Question 14

What are the contents of the carpal tunnel?

Answer 14

4 x FDP tendons, 4 x FDS tendons, 1 x FPL tendon, median nerve

Question 15

Where does the median nerve innervate?

Answer 15

Motor to LOAF muscles

Sensory to palmar hand, thumb, index and middle finger and radial half of ring finger

Question 16

What are the LOAF muscles?

Answer 16

Lumbricals I and II, opponens pollicis, abductor pollicis brevis, flexor pollicis brevis

Question 17

What are the symptoms of carpal tunnel syndrome?

Answer 17

Often sensory involvement to radial 3 and a half fingers, often worse at night, relieved by shaking the hand, palmar sensation often spared

Question 18

What are some associations of carpal tunnel syndrome?

Answer 18

Diabetes, pregnancy, hypothyroidism, fluid overload, acromegaly, rheumatoid arthritis, most commonly idiopathic, more common in women

Question 19

What are some investigations for carpal tunnel syndrome?

Answer 19

Phalen’s test and Tinnel’s test
Compressive neuropathy = increased latency, decreased amplitude
Kamath and Stothard carpal tunnel questionnaire

Question 20

How is carpal tunnel syndrome treated?

Answer 20

Splintage, diagnostic steroid injection, surgery

Question 21

What is DeQuervain’s tenosynovitis?

Answer 21

Inflammation of the tendon sheath = affects the back of the thumb

Question 22

How does DeQuervain’s tenosynovitis present?

Answer 22

Spontaneous, painful, swollen/red, positive Finklestein’s test

Question 23

What are the treatment options for DeQuervain’s tenosynovitis?

Answer 23

NSAIDs, splint, rest
Steroid injection
Surgery = decompression

Question 24

What is Dupuytren’s contracture?

Answer 24

Thickening and shortening of the subdermal fascia = causes fixed flexion deformity of fingers

Question 25

What is the initial presentation of Dupuytren’s contracture?

Answer 25

Painless gradual progression = usually starts as palmar pit/nodule

Question 26

What are some associations of Dupuytren’s contracture?

Answer 26

Genetics (Northern European), diabetes, alcohol/cirrhosis, smoking, epilepsy/anti-epileptic medicine, Dupuytren’s diathesis (Lederhosen’s = foot, Peyronnie’s = penis)

Question 27

What should be done in an examination of a patient with suspected Dupuytren’s contracture?

Answer 27

Feel cords, establish involvement of MCP/PIP joints by measuring angles, table-top test

Question 28

What are the conservative treatments for Dupuytren’s contracture?

Answer 28

Stretches and activity modification

Question 29

What are some surgical options for Dupuytren’s contracture?

Answer 29

Segmental fasciectomy, fasciectomy, dermofasciectomy, amputation

Question 30

What are some newer treatment options for Dupuytren’s contracture?

Answer 30

Collagenase injection, percutaneous needle fasciotomy

Question 31

What is paronychia?

Answer 31

Infection of the nail fold = common in children and nail biters, may result in pus collection

Question 32

What is the management for paronychia?

Answer 32

Elevate, antibiotics, incise and drain collection

Question 33

What is flexor tendon sheath infection?

Answer 33

Rare surgical emergency = infection within the sheath, tracking up palm and arm

Question 34

What may a patient with flexor tendon sheath infection complain of?

Answer 34

Extreme pain, limited extension (including passive) due to pain

Question 35

What are Kanavel’s cardinal signs of flexor tendon sheath infection?

Answer 35

Affected finger held in fixed flexion
Fusiform swelling over finger
Painful to percuss over sheath
Painful on passive extension

Question 36

How is flexor tendon sheath infections treated?

Answer 36

Wash out tendon sheath (A1 and A5 pulleys)