Orthopaedic problems of hand

Question 1

What are the common soft tissue disorders of the hand?

Answer 1

Dupuytren’s disease. Trigger finger. De Quervain’s Tenovaginitis.

Question 2

What is Dupuytren’s disease?

Answer 2

A flexion deformity of the finger (usually the ring and little fingers) caused by a nodular hypertrophy and contracture of the fascia in the palm. The characteristic sign is a nodule at the distal palmar crease or over the proximal phalanx of the finger.

Question 3

What is trigger finger?

Answer 3

An impairment in the ability to extend a finger, resulting either from a nodular thickening in the flexor tendon or a narrowing of the flexor tendon sheath.

Question 4

What is De Quervain’s Tenovaginitis?

Answer 4

Inflammation of two tendons that control movement of the thumb and their tendon sheath. This results in pain at the outside of the wrist. Pain is typically increased with gripping or rotating the wrist. The thumb may also be difficult to move smoothly.

Question 5

What are the clinical features of Dupuytren’s disease?

Answer 5

Usually not painful. Loss of finger extension – active or passive – hand in pocket, gripping things, washing face.

Question 6

What is the management of Dupuytren’s disease?

Answer 6

Non-operative – observe, splints don’t work, radiotherapy. Operative – partial fasciectomy, dermo-fasciectomy, arthrodesis, amputation. Partial needle fasciotomy. Collagenase. Usually recurrence.

Question 7

What are the clinical features of trigger finger?

Answer 7

Clicking sensation with movement of digit. Lump in palm under pulley. May have to use other hand to ‘unlock’. ‘Clicking’ may progress to ‘locking’.

Question 8

What is the management of trigger finger?

Answer 8

Non-operative – splintage, steroid injection. Operative – decompression, open surgery.

Question 9

What are the clinical features of basal thumb osteoarthritis?

Answer 9

Pain, stiffness, swelling, deformity, loss of function.

Question 10

What is the management for basal thumb osteoarthritis?

Answer 10

Non-operative – lifestyle modifications, NSAIDS, splint, steroid injection. Operative – trapeziectomy (gold standard), fusion.

Question 11

Describe the presentation of soft tissue ganglia

Answer 11

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

Question 12

Describe the principles of management of soft tissue ganglia

Answer 12

Non-operative – reassure and observe, aspiration. Operative – excision, including ‘the root’.