Hand

Question 1

What is Dupuytren’s contracture?

Answer 1

palmar fascia undergoes hyperplasia with normal fascial bands forming nodules and cords progressing to contractures at the MCP and PIP joints

Question 2

What does pathology of Dupuytren’s contracture involve?

Answer 2

proliferation of myofibroblast cells and the production of abnormal collagen (type 3 rather than type 1

Question 3

Approximately half of cases of Dupuytren’s contracture have bilateral involvement.

Answer 3

T

Question 4

In Dupuytren’s contracture females are much more commonly affected

Answer 4

F

males

Question 5

Dupytrens can also be seen as a feature of - and is more common in -

Answer 5

alcoholic cirrhosis, diabetics.

Question 6

What is Peyronie’s disease?

Answer 6

Fibromatoses which can occur with Dupytrens - it affects the penis

Question 7

Mild contractures may be tolerated but surgical treatment can be offered if contractures are interfering with function.

Answer 7

T

Question 8

What is the difference between fascietomy and fascectomy?

Answer 8

removal of all diseased tissue (fasciectomy) or division of cords (fasciotomy).

Question 9

What is trigger finger?

Answer 9

Tendonitis resulting in a nodule in the tendon

Movement of ifnger causes clicking underneath fascial pulley in fingers

Question 10

How is trigger finger treated?

Answer 10

steroid around the tendon within the sheath will relieve symptoms
Surgery can be offered in recurrent and persistent cases

Question 11

Division of a fascial pulley in the finger will cause irreperable loss of function

Answer 11

F. Due to the system of other pulleys, division of the A1 pulley does not affect function.

Question 12

80% of over 60s will have symptoms of OA

Answer 12

F

80% have radiological evidence but minority have symptoms

Question 13

Distal interphalangeal joints (DIP) OA is very common in which group?

Answer 13

post menopausal women

Question 14

What are Herberdens nodes?

Answer 14

Stiffness and bony thickening due to OA and consistent trauma

Question 15

How can mild OA be treated?

Answer 15

removal of osteophytes and excision of any mucous cyst.

Question 16

Arthrodesis can be performed for pain relief

Answer 16

(artificial fusion)

T

Question 17

For proximal interphalangeal joint OA how can pinch grip be preserved in the index finger?

Answer 17

Arthrodesis

Question 18

OA commonly affects the metocarpalphalageal joints

Answer 18

F it is a rare occurence

Question 19

Where is the site where RA causes the most problems?

Answer 19

THE HANDS

Question 20

RA tends to spare which joints in the hands?

Answer 20

Distal interphalangeal joints

Question 21

What is the progression of RA inthe hands

Answer 21

Synovitis and tenosynovitis – swelling and pain

Erosions of the joints – pannus

Joint instability and tendon rupture – subluxation and chronic tenosynovitis extensor tendon ruptures.

Question 22

Boutonniere deformity is?

Answer 22

flexion at PIPJ with hyperextension at DIPJ

Question 23

Swan neck deformity is?

Answer 23

hyperextension at PIPJ with flexion DIPJ

Question 24

In RA, how can you prevent tendon rupture?

Answer 24

Tenosynovectomy (excision of synovial tendon sheath)

Question 25

Ruptured tendons can be surgically repaired

Answer 25

F

Question 26

How can contractures ( permanent shortening of a muscle or joint) due RA be treated?

Answer 26

soft tissue releases ( technique of assisted stretching involves repeatedly and quickly stretching small areas of the soft tissue.)

Question 27

wrist replacement or fusion may be required for severe arthritic change

Answer 27

T

Question 28

A multidisciplinary approach is required for the management of RA with rheumatologists, orthopaedic surgeons, physiotherapists, occupational therapists and orthotists all having a role in improving symptoms and maintaining function.

Answer 28

T

Question 29

Ganglion cysts are rare

Answer 29

F

Question 30

What are ganglion cysts ?

Answer 30

mucinous filled cysts found adjacent to a tendon or synovial joint

Question 31

Ganglion cysts can be removed on the nhs for cosmetic reasons and the patient is beautiful afterwarfd

Answer 31

F

can leave tender scar

Question 32

Patient with smooth and rubbery and transilluminate lump

Answer 32

Ganglion cyst

Question 33

Ganglion cyst are painless

Answer 33

f

can cause pain or irritation

Question 34

Ganglion cyst are removed by striking the wrist with a heavy book (“bible technique”) to burst the swelling

Answer 34

FALSE!

curgical excision if causes discomfort