Common hand conditions

Question 1

What is a mucous cyst?

Answer 1

Outpouching of synovial fluid at distal interphalangeal joint

Question 2

What causes mucous cysts?

Answer 2

Osteoarthritis

Question 3

How do mucous cysts present?

Answer 3

Regular appearance 
Pain/painless
Fluctuating 
Discharging
Deformed nail bed

Question 4

How are mucous cysts managed?

Answer 4

Nothing

Excision

Question 5

Why might mucous cysts warrant an x-ray?

Answer 5

To determine extent of osteoarthritis

Question 6

What are ganglions?

Answer 6

Outpouchings of the synovial cavity

Question 7

Ganglions are most commonly found around the wrist for what reason?

Answer 7

The greater the number of synovial joints the greater the likelihood of synovial cavity outpouching

Question 8

What are ganglions filled with?

Answer 8

Synovial fluid

Question 9

How do ganglions present?

Answer 9

Fluctuating

Painless +/- tightness

Question 10

How are ganglions managed?

Answer 10

Self resolving

Question 11

Why is surgical management avoided in the treatment of ganglions?

Answer 11

They come back

Question 12

Are ganglions related to osteoarthritis?

Answer 12

Occasionally - most often not

Question 13

What is allan’s test used for?

Answer 13

To determine if the blood supply of the hand is intact

Question 14

What is trigger finger?

Answer 14

Inflammation and swelling of the tendons running within the flexor tendon sheath causing catching on the pulleys

Question 15

How does trigger finger present?

Answer 15

Pain over A1 pulley (metacarpal head)
Sticking of finger in flexion
+/- forced extension

Question 16

What should be avoided in the management of trigger finger?

Answer 16

Immobilisation

Question 17

What should be found on the hand examination of someone with trigger finger?

Answer 17

Tenderness over A1 pulley
Fixed flexion
Palpable tendon nodule

Question 18

How is trigger finger managed?

Answer 18

Conservatively (spontaneous resolution, splinting)
Steroid & local anaesthetic injection (curative)
Surgery

Question 19

Which compartment does DeQuervians tenosynovitis affect?

Answer 19

First extensor compartment

Question 20

How does DeQuervians tenosynovitis present?

Answer 20

Spontaneous
Painful radial wrist
Swelling
Erythema

Question 21

What test will be positive in DeQuervians tenosynovitis?

Answer 21

Finkelstein’s (ulnar deviation of the hand)

Question 22

How is DeQuervians tenosynovitis managed?

Answer 22

NSAIDs
Splint 
Rest
Steroid injection
Surgical decompression

Question 23

Where is the pathology in Dupuytrens contracture?

Answer 23

Palmar fascia

Question 24

How common is Dupuytrens contracture?

Answer 24

Very

Question 25

What is Dupuytrens contracture?

Answer 25

Thickening of palmar fascia causing fixed flexion deformity of the fingers

Question 26

How does Dupuytrens contracture present?

Answer 26

Painless Gradual Begins as palmar pit or nodule

Question 27

What conditions are associated with Dupuytrens contracture?

Answer 27

``` Alcoholism Liver cirrhosis Diabetes mellitus Smoking Epilepsy medications ```

Question 28

What is Dupuytren's diathesis?

Answer 28

Tendency towards more aggressive disease i.e Lederhosen's (feet) Peyronie's (penis

Question 29

What should be found on examination of someone with Dupuytren's disease?

Answer 29

Palpable cords MCP and/or DIP joint involvement Positive table top test

Question 30

How is Dupuytren's disease managed?

Answer 30

Conservative (stretching, activity modification) Surgical (fasciotomy, amputation) Collagenase injection?

Question 31

Dupuytren's contracture reoccurs after treatment. T/F

Answer 31

True - within several years

Question 32

What is paronychia?

Answer 32

Infection within the nail fold

Question 33

What is a risk factor for paronychia?

Answer 33

Nail biting

Question 34

Which age range most commonly gets paronychia?

Answer 34

Children

Question 35

How is paronychia managed?

Answer 35

Elevation Antibiotics Excision and drainage of pus

Question 36

How common is flexor tendon sheath infection?

Answer 36

Rare but surgical emergency

Question 37

How does flexor tendon sheath infection present?

Answer 37

Tracking up palm and arm Extremely painful Loss of movement (even passive) due to pain Tracking lymphangitis

Question 38

How is flexor tendon sheath infection managed?

Answer 38

Tendon sheath wash out