Flashcards in Disorders of the Hand and Wrist Deck (43):
What is a ganglion cyst?
Benign, fluid filled cyst forms as a herniation of the synovium of the wrist joint, or from the tendon sheath
What are the symptoms of a ganglion cyst?
Usually painless mass. Can be quite firm. Often fluctuates in size.
What is the treatment of a ganglion cyst?
-Aspiration and injection of corticosteroid can be performed but high chance of reoccurrence
-Surgical excision still has 20 % reoccurrence
Where is the pain located for a scaphoid fracture?
the anatomical snuff box
how do scaphoid fractures usually occur?
1. young male
2. high energy fall on outstretched hand
3. radial sided wrist pain
4. treatment not sought early
what do you have to keep in mind about a scaphoid fracture on X-ray?
they usually don't show!
if high suspicion--> re-xray in 2 weeks
How do you treat scaphoid fractures?
1. thumb spica cast for non-displaced fx (12 weeks)
2. open reduction internal fixation for acute fx
3. bone graft for displaced or non-vascular frx
Describe how a triquetral avulsion fracture may occur:
Usually fall on outstretched hand of low to moderate intensity
Where will the pain be for a triquetral avulsion fracture? what is the treatment?
over the dorsum of the wrist in the midline position
Treatment is cast or splint for 3 weeks if having a lot of pain
How does a "hook of the hamate" fracture normally occur?
Usually caused by forceful blow while holding bat, golf club, tennis racket
Can occur with high energy fall to ulnar side of hand
What will the pain symptom be that accompanies a HOH fx?
What is the treatment?
pain with grasp
treatment = excision
What are the three post-traumatic reasons for wrist arthritis?
Old Scapholunate ligament injury
Malunion or intra-articular Distal Radius Fractures
What is a mucous cyst?
-Benign cyst usually arising from the distal interphalangeal joint (DIP)
-Often associated with an arthritic joint
-Many times causes ridging or deformity of nail
What is the treatment for a mucous cyst?
a pressure wrap or surgical excision (but there is a high recurrence rate)
What is a retinacular cyst? What is the treatment?
Benign ganglion cyst arising from the flexor tendon sheath
Treatment is aspiration with corticosteroid injection or surgical excision
What is a Giant Cell Tumor of the Tendon Sheath? How do you treat it?
Aggressive, locally growing benign tumor of the tendon sheath
Surgical excision before too large
What is a mallet finger? how is a mallet finger normally caused?
Definition: Loss of continuity of the extensor tendon to the Distal Phalanx.
Cause: Forceful hyper-flexion of the DIP
what do you lose with a mallet finger?
ability of extend finger
how do you treat a mallet finger?
Splint in full extension for at least 6-8 weeks.
Splint must be worn 24 hours a day 7 days a week.
Surgery may be required if a large bony fragment has pulled away with the tendon
What is a jersey finger? how do you cause a jersey finger?
Definition: Loss of continuity of the flexor tendon to the distal phalanx
Cause: Forced hyperextension of a flexed DIP. Common in football players
how will someone with a jersey finger present? what is the treatment?
Presentation: Loss of active flexion of the DIP. Frequently in ring finger.
Treatment: Surgery only. Important to refer within a few days.
What is a Boutonniere Deformity?
Definition: Rupture of central slip of the extensor digitorum communis tendon from the base of the middle phalynx
how will someone with a Boutonniere Deformity present?
PIP flexion and secondary DIP extension
Initial swelling of PIP
Loss of ability to actively extend at PIP
Often left untreated “jammed finger”
What is a the treatment for a Boutonniere Deformity?
Must be caught early to prevent long term problems
Splint PIP in extension for 4-6 weeks
May leave DIP free from splint
Chronic deformity may need surgery
What is a swan neck deformity?
Definition: Loss of integrity of the volar capsule of the PIP usually secondary to forced hyperextension of the PIP joint
Hyperextension of PIP and secondary flexion of DIP
What is the treatment for swan neck deformity?
If acute-->dorsal extension stop splint limiting extension to approximately 30 degrees for 3 weeks
Chronic requires surgical reconstruction
What is an ulnar collateral ligament rupture? how will the patient present?
Definition: Partial or complete rupture of the ulnar collateral ligament of the MCP joint of the thumb.
Sometimes called “gamekeepers thumb” or “skiers thumb”
Ulnar sided tenderness at the MCP joint of thumb
Laxity of UCL in comparison to other side
What usually causes an ulnar collateral ligament rupture?
traumatic abduction of the thumb
Sometimes a bony avulsion can occur with an ulnar collateral ligament rupture, what would the treatment be? What is the treatment otherwise?
-If Xray shows bony avulsion –treat in cast for 6 weeks
-If clinically stable it may be a partial injury and cast for 3 weeks
-If no fracture and lax-send for ortho consult
What is it called when OA affects the DIPS? What about the PIPs?
Osteoarthritis commonly affects the DIP joints (Heberden nodes) and PIP joints (Bouchard nodes)
What disease affects the MCPs?
What disease affects the basal joint of the thumb?
What can you do for basal joint arthritis?
Treatment: Splinting, NSAID, corticosteroid injection
Surgery: fusion, replacement, reconstruction
What is Dupuytren’s Contracture?
Progressive contracture of the fingers into the palm caused by proliferative fibroplasia of the subcutaneous tissues of the hand
What is the presentation of Dupuytren’s Contracture?
Presentation: Formation of painless nodules and cords in the palm and fingers. Ring and small are most commonly affected
What do you lose with Dup. contracture?
is it uni or bilateral?
what co-morbidity do we see this in?
Loss of passive extension of fingers (Cannot lay hand flat on table)
May be unilateral or bilateral
More common in men with Northern European ancestry
Common in diabetics
What is the treatment for dup. contracture?
Treatment: Nothing in early stages. High recurrence rate when removed in early (active growth) phase
Surgical treatment if MCP joint has 30 degree or more contracture or if any PIP joint contracture
what is keinbock's disease?
Interruption of blood supply to the lunate, causes osteonecrosis.
Can be caused by trauma to the wrist.
how will the patient present with keinbock's? what do we see on X-ray?
Wrist will be painful and may be swollen.
X-ray shows sclerosis and collapse of lunate
What is the treatment for keinbock's?
Surgical treatment may involve a proximal row carpectomy or wrist fusion if diffuse arthritis is also present.
What is paronychia? how does it look? what is the treatment?
Definition: Infection of the Paronychial fold around nail
Presentation: Erythematous swelling of the soft tissues near the nail
Treatment: Incision and Drainage; oral antibiotics
What is felon? How does it look? How does it normally get caused? What is the treatment?
Definition: Infection of the fingertip pulp space.
Presentation: Painful swollen fingertip along volar side and may extend to either side
May be caused by a penetrating injury or cause may be unknown
Treatment: I&D and oral antibiotics