9: Common hand conditions

Question 1

What cysts commonly appear at the DIP joint?

Answer 1

Mucous cyst

Question 2

What causes mucous cysts?

Answer 2

Outpouching of synovial fluid secondary to joint damage in OA

Question 3

What are some symptoms associated with mucous cysts?

Answer 3

Pain

Discharge

Nail deformity

Question 4

How are mucous cysts treated surgically?

Answer 4

Excision

Question 5

Are mucous cysts the same as ganglion cysts?

Answer 5

No

Question 6

What is a ganglion (cyst)?

Answer 6

Outpouching of synovial CAVITY

Question 7

Are ganglion cysts painful?

Answer 7

No

Question 8

If a ganglion cyst is fluctuating and causing functional problems, how may it be treated?

Answer 8

Aspiration (will probably recur)

Excision

Question 9

Which artery may be damaged during aspiration of a ganglion cyst?

Answer 9

Radial artery

Question 10

What stops flexor tendons from bowstringing by holding them to the bone?

Answer 10

Flexor tendon sheathes

Question 11

What structures, found on the flexor tendon sheath, can catch inflamed tendons and cause trigger finger?

Answer 11

Pulleys

Question 12

Which particular pulley is involved in trigger finger?

Answer 12

A1 pulley

Question 13

What are the symptoms of trigger finger?

Answer 13

Pain

Flexion > LOCKING > Forced extension to unlock it

Question 14

What gets caught on the A1 pulley in trigger finger?

Answer 14

Inflamed nodule of tendon

Question 15

If trigger finger doesn’t resolve itself, how can it be treated?

Answer 15

Steroid injections into tendon sheath

Question 16

Steroid injections often ___ trigger finger.

Answer 16

cure

Question 17

How many steroid injections should be given for trigger finger before considering alternative therapy?

Answer 17

3

Question 18

What surgical options exist for trigger finger?

Answer 18

Division of A1 pulley

Question 19

What may be damaged in trigger finger surgery?

Answer 19

Digital arteries

Digital nerves

Question 20

Why can the A1 pulley be sacrificed without causing functional issues in the hand?

Answer 20

There aren’t any pulleys distal to it

Question 21

What does DeQuervain’s tenosynovitis affect?

Answer 21

Extensor tendons of the thumb

Question 22

What test is done on examination for DeQuervain’s tenosynovitis?

Answer 22

Finklestein test

Thumb into fist, adduct fist

Will be painful

Question 23

How is DeQuervain’s tenosynovitis treated?

Answer 23

NSAIDs

Splint

Rest

Steroid injections

Decompression

Question 24

What is Dupuytren’s contracture?

Answer 24

Contraction/fibrosis of PALMAR FASCIA

Question 25

What sort of deformity occurs due to Dupuytren's contracture?

Answer 25

**Fixed flexion deformity** of fingers

Question 26

What particular aspect of the palmar fascia fixes the palmar skin to the hand?

Answer 26

**Palmar aponeurosis**

Question 27

What pathological process occurs in the specific cells of the palmar fascia implicated in Dupuytren's contracture?

Answer 27

**Metaplasia** Fibroblast \> Myofibroblast (muscle - CONTRACTILE)

Question 28

Is Dupuytren's painful?

Answer 28

**No**

Question 29

Dupuytren's contracture has a gradual onset. How does it initially present?

Answer 29

**Palmar pit / nodule**

Question 30

What are some possible causes of Dupuytren's?

Answer 30

**Genetics** **Diabetes** **Alcohol** **Smoking**

Question 31

What are the two offshoots of Dupuytren's which you should know about?

Answer 31

**Ledderhose disease** - plantar fascia **Peyronie's disease** - penis

Question 32

What movement of the MCP joints is **lost** in Dupuytren's contracture?

Answer 32

**Hyperextension** but patients don't usually notice as we don't hyperextend very much

Question 33

Can the deformity of a) MCP joints b) PIP joints be corrected following Dupuytren's contracture?

Answer 33

**a)** Yes **b)** No

Question 34

Dupuyren's contracture may be treated ___ or \_\_\_.

Answer 34

**conservatively** **surgically**

Question 35

Why are **zig-zag incisions** made in Dupuytren's contracture surgery?

Answer 35

**Incisions PERPENDICULAR** **to the the flexor creases of skin will always heal with a contracture**

Question 36

Why are nerves always at risk in finger surgery?

Answer 36

**Tendons often pull nerves into unusual positions**

Question 37

Contractile ___ cause symptoms of Dupuytren's.

Answer 37

**cords**

Question 38

Why is the skin overlying cords also removed in Dupuytren's surgery?

Answer 38

**Skin also contains myofibroblasts which may allow for recurrence**

Question 39

Why is revision surgery for Dupuytren's highly risky?

Answer 39

**Digital nerve displacement**

Question 40

What are alternative surgeries for Dupuytren's?

Answer 40

**Needle fasciectomy** **Collagenase injections** (dissolves cords)

Question 41

The recurrence rate of Dupuytren's is **(low / high)**.

Answer 41

**high recurrence rate**

Question 42

What is an infection of the nail fold called?

Answer 42

**Paronychia**

Question 43

Who tends to get paronychia? Why?

Answer 43

**Children** **Nail biting**

Question 44

How is paronychia treated?

Answer 44

**Antibiotics** **Drain pus**

Question 45

What is an important hand infection which must be treated immediately to prevent deformity?

Answer 45

**Flexor tendon sheath infection**

Question 46

What are the features of flexor tendon sheath infection?

Answer 46

**Extreme pain**; tracking up palm and arm **Tracking lymphangitis**

Question 47

How is flexor tendon sheath infection treated?

Answer 47

**Fluroscopically**