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Flashcards in Hand conditions Deck (19)
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1
Q

What is the pathophysiology of Dupuytren’s contracture?

A

Myofibroblast proliferation and collagen deposition thicken the palmar fascia. Nodules form, become cords and contract fingers towards the palm - stuck in flexion.

2
Q

What are they symptoms of Dupuytren’s?

A

Develops earlier in males.

Non-painful loss of active and passive finger extension. 4th and 5th fingers most affected. Difficulties washing face etc.

3
Q

How is Dupuytren’s diagnosed?

A

Houston’s table top test. Positive? Refer for surgery. Otherwise - observe.

4
Q

Which surgical procedures are done for Dupuytren’s and their complications?

A

Partial fasciectomy (most common): back to normal in 2-3 weeks, 50% recurrence at 5 years.

Dermofasciectomy: most invasive, longest recovery, intense physio, lowest recurrence.

Complications: recurrence, nerve injury, artery injury, haematoma, infection etc.

5
Q

Which non-surgical procedures can be performed for Dupuytren’s?

A

Percutaneous needle fasciotomy and collegenase injection.

6
Q

What is the pathophysiology of trigger finger?

A

FDS and FDP run in a tendon sheath through pulleys to keep them close to the bone. Swellings in the tendon mean that they catch on the sheath.

7
Q

What are the symptoms of trigger finger?

A

Clicking sensation when digit moves, may need to unlock digit with other hand, pain in base of affected finger, lump in palm under pulley.

More common in females and ring finger most affected.

8
Q

How is trigger finger treated?

A

Non-surgical: splinting, NSAID’s, corticosteroid injections.

Surgical: percutaneous release or open surgery.

9
Q

What is Raynaud’s phenomenon?

A

Episodic vasospasm in arteries in the extremities when exposed to cold.

10
Q

Raynaud’s can be due to an underlying cause like…

A

SLE, RA, scleroderma, polymyositis or Sjorgen’s syndrome.

11
Q

How is Raynaud’s treated?

A

Conservative: stop smoking, keep warm, exercise, minimise stress.

Medical: nifedipine as prophylaxis (side-effects).

12
Q

What is de Quervain’s tenosynovitis?

A

Swelling of the tendon and sheath surrounding the base of the thumb. Pain localised to radial side of wrist and worse on thumb movements.

13
Q

What is Finklestein’s test?

A

For de Quervain’s tenosynovitis. Sharply ulnar deviate thumb - pain in distal radius.

14
Q

Who commonly gets de Quervain’s?

A

Post-partum or lactating females.

15
Q

How is de Quervain’s treated?

A

Conservative: ice, NSAID’s, splinting.

Surgical decompression.

16
Q

What is a ganglion?

A

A common, benign swelling of the hand - firm, non-tender, smooth lump that is not fixed to underlying tissues or skin.

17
Q

What are the symptoms of base of thumb OA?

A

Pain, stiffness, swelling, deformity and loss of function. Difficulty in pinching movements - opening jars etc.

18
Q

How is base of thumb OA treated?

A

Non-surgical: life-style modifications, NSAID’s, splinting and steroid injections.

Surgical: trapeziotomy (gold standard) - makes thumb weak; fusion or replacement.

19
Q

What is seen on x-ray of an osteoarthritic joint?

A

LOSS

Loss of joint space
Osteophytes
Subchondral cysts
Sclerosis