Hand and Wrist Disorders

Question 1

Causes and conditions associated with flexor tenosynovitis (trigger finger)

Answer 1

• Diabetes mellitus
• Gout
• Arthritis
• Systemic sclerosis
• Overuse or repetitive movements
• Infection
• Older age

Question 2

Management of flexor tenosynovitis (trigger finger)

Answer 2

• Steroid injection
  
  • Corticosteroids decreases swelling sufficiently to restore normal mechanics (high risk of recurrence)
• A1 pulley release
  
  • Small incision in palm to access and release the A1 pulley (by cutting) to allow flexor tendons to move through without getting stuck

Question 3

Presentation of Dupuytren’s contracture

Answer 3

• M>F
• Middle age/elderly
• Skin puckering and tethering
• Fixed flexion contracture of ring and little fingers
• Often bilateral and symmetrical
• MCP and IP joint flexion

Question 4

Associations/Causes of Dupuytren’s contracture (remember BAD FIBERS)

Answer 4

• Bent penis (peyronies)
• Aids
• DM
• FHx of AD
• Idiopathic
• Booe
• Epilepsy and epilepsy medications (phenytoin)
• Reidel’s thyroiditisand other fibromatoses
• Smoking

Question 5

Management of Dupuytren’s contracture

Answer 5

• Coservative
  
  • PT
  • Exercises
  • Splinting
• Fasciotomy
  
  • When hand can’t be placed flat on a table
  • Z-shaped scars - prevent contracture
  • Can damage ulnar nerve
  • Usually recurs