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MSK > Orthopoedic Problems of the Hnad > Flashcards

Orthopoedic Problems of the Hnad Flashcards

1
Q

Who gets Dupuytren’s disease?

A
  • Disease develops earlier and his more common in males
  • M : F = 8 : 1 in 15 – 64s
  • M : F = 2 : 1 in over 75s
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2
Q

What are the genetics of Dupuytren’s disease?

A
  • Autosomal dominant - variable penetrance
  • Sporadic in 30% of cases
  • Onset may be sex-linked
  • Almost exclusively white races
  • Fewer sporadic reports in other cases
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3
Q

Dupuytren’s is related to which diseases/risk factors?

A
  • Diabetes
  • HIV
  • Epilepsy
  • Alcohol
  • Tobacco
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4
Q

What are the features of Dupuytren’s?

A
  • Early onset disease - tends to more aggressive
  • Bilateral disease
  • Family history
  • Ectopic disease - such as fibrous conditions in the foot
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5
Q

What is the pathology of Dupuytren’s?

A
  • Myofibroblast
  • Intracellular contractile elements
  • Regulated by growth factors
  • Overproduction of collagen
  • Pretendinous bands thicken and contract pulling fingers permanently into flexion
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6
Q

What are the functional problems caused by Dupuytren’s?

A
  • Usually not painful - only painful in early stages
  • Loss of finger extension - active or passive
  • Hand in pocket
  • Gripping things
  • Washing face
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7
Q

What are the non-operative treatments of Dupuytren’s?

A
  • Observe
  • Radiotherapy
  • Splints do not work!
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8
Q

What are the operative treatments of Dupuytren’s?

A
  • Partial fasciectomy
  • Dermo-fasciectomy
  • Arthrodesis - artificial joint ossification
  • Amputation
  • Percutaneous needle fasciotomy
  • Collagenase
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9
Q

What is a partial fasciectomy and how effective is it?

A
  • Open skin and excise thickened bands
  • Wounds take 2-3 weeks to heal
  • Stiffness requires physiotherapy
  • Can’t be cured
  • recurrence 50% ar 5 years
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10
Q

What is a dermo-fasciectomy and how effective is it?

A
  • More radical procedure
  • Carried out in more early aggressive disease
  • Removal of skin may reduce recurrence rates
  • Requires intensive physiotherapy
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11
Q

What is a percutaneous need fasciotomy and how effective is it?

A
  • Band is cut
  • Quick
  • No wounds
  • Recovery 2-3 days
  • Does not prevent traditional surgery in future
  • Higher recurrence - up to 50% at 3 years
  • Can be repeated
  • Risk of nerve injury
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12
Q

What is collagenase treatment and how effective is it?

A
  • Injected and dissolves collagen in the band
  • Presented 3 year recurrence rate 34.8%
  • Flexor Tendon Ruptures risk
  • Cost
  • Await longer term recurrence rates
  • Not used in Aberdeen as benefit not seen over needle fasciotomy
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13
Q

Who gets trigger finger?

A
  • More common in women
  • 40s-60s
  • Ring > Thumb > Middle
  • Repetitive use of hand ?
  • Local trauma
  • Associations - RA, DM, Gout
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14
Q

What is the pathology of trigger finger?

A
  • 2 tendons to each finger
  • Tendons run in sheath
  • Thickenings in sheath known as pulleys - keep tendon close to bone (like line in a rod)
  • Swelling in tendon catches on pulley in trigger finger
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15
Q

How is trigger finger diagnose?

A
  • Patient history
  • Pain at level of distal palmer crease
  • Clicking sensation with movement of digit
  • Lump in palm under pulley
  • May have to use other hand to unlock the finger
  • Clicking may progress to locking
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16
Q

What are the specific features of trigger finger in the hand?

A
  • Palpable lump in palm over A1 pulley

* Feel the triggering around the A1 pulley (when flexing and extending the finger)

17
Q

What are the non-operative treatments of trigger finger?

A
  • Splintage
  • Steroid
  • Works in 50%
18
Q

What are the operative treatments of trigger finger?

A
  • Percutaneous release (usually release of A1 pulley)

* Open surgery

19
Q

What is De Quervain’s tenovaginitis?

A
  • Takes place in the 1st dorsal extensor compartment
  • Fibro-osseous tunnel at the distal radius
  • There is thickening of the localised segment
  • 30% 1st compartment divided by septum

RETINACULUM

20
Q

How does DQT present?

A
  • Several weeks pain localised to radial side of wrist
  • Aggravated by movement of the thumb
  • May have seen a localised swelling
  • Localised tenderness over tunnel
21
Q

Who suffers from DQT?

A
  • More common in females
  • M:F 1:6
  • Age 50s - 60s
  • Increased in post partum and lactating females
  • Activities with frequent thumb abduction and ulnar deviation
  • Washerwoman’s sprain – Gray’s anatomy
22
Q

How is DQT diagnoses?

A
  • Examine thumb joints - consider base of thumb OA
  • Perform Finklestein’s Test
  • Perform resisted thumb extension
23
Q

What are the non-operative treatments of DQT?

A
  • Splints
  • Steroid injection
  • Settles 50%
24
Q

What is the operative treatment of DQT?

A

•Decompression - open retinaculum and divided compartments if the are present

25
Q

What is a ganglion?

A
  • A myxoid degeneration from joint synovia
  • Arise from joint capsule, tendon sheath or ligament
  • Fluid concentrates - become firm
26
Q

How common are ganglia?

A

•70% of all discrete swellings in the hand and wrist

27
Q

Who gets ganglia?

A
  • More common in females (2:1)
  • Wide age distribution (peak 20-40yrs)
  • Dorsal > Volar (3:1)
  • May be associated with recurrent injury around the wrist
28
Q

What are the signs of ganglia?

A
  • Present with lump
  • Firm, non-tender
  • Change in size
  • Smooth
  • Occasionally lobulated
  • Normally not fixed to underlying tissues
  • Never fixed to the skin
29
Q

What are the non-operative treatments of ganglia?

A
  • Reassure & Observe - they can be resilient
  • Aspiration (and inject steroid)
  • Hit it with a bible!?
30
Q

What are the operative treatments of ganglia?

A

•Excision (including ‘the root’)

31
Q

How does base of thumb OA present?

A
  • Pain at base of the thumb
  • Pain may be worse at night after a busy day
  • Stiffness
  • Swelling
  • Deformity
  • Loss of function
32
Q

Who gets base of thumb OA?

A
  • Common - most common OA in the body
  • 1 in 3 women
  • Pain opening jars/pinching
  • Dorsal subuxation, metacarpal adduction, MCPJ hyperextension
  • Look for STT OA
33
Q

What are the non-operative treatments of base of thumb OA?

A
  • Life style modifications
  • NSAIDS
  • Splint - limit movement, limit pain
  • Steroid Injection
34
Q

What are the operative treatments of base of thumb OA?

A
  • Trapeziectomy - take away part of the joint leaving fibrous space
  • Fusion
  • Replacement
35
Q

What is a trapeziectomy?

A

•The “gold standard”
•Good pain relief
•Moderate pinch grip
+/- interposition flap or ligament reconstruction

MSK (28 decks)

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