Hand conditions Flashcards
(33 cards)
What is the pathophysiology of “trigger finger”?
Mechanical impingement of smooth tendon gliding, due to stenosing tenosynovitis of the A1 pulley at the base of the finger
Give 3 risk factors for trigger finger
Female
Over 50
Diabetes
How does trigger finger present?
Pain at the base of the finger
Finger clicking/catching
Finger locked in flexed position at the PIP joint
What can be done in examination to reproduce symptoms of trigger finger?
Flexion or extension of the finger
What is the first line management of trigger finger?
Splinting
Activity modification
NSAIDs
(Corticosteroid injection is another option)
What is the indication for surgery for trigger finger?
Failure of nonoperative management
What is the main risk of surgery for trigger finger?
Radial digital nerve injury
Which tendons are affected by De Quervain’s tenosynovitis?
Abductor pollicis longus
Extensor pollicis brevis
Give 5 risk factors for De Quervain’s tenosynovitis
Female Age 30-50 Overuse (golf and racket sports) Post-trauma Post-partum
How does De Quervain’s tenosynovitis present?
Radial wrist pain worsened by gripping objects
Where might tenderness be felt in De Quervain’s tenosynovitis?
Over the 1st dorsal extensor compartment
What is the first line management of De Quervain’s tenosynovitis?
Rest, NSAIDs, thumb splint and steroid injection
What is the indication for surgery for De Quervain’s tenosynovitis?
Severe symptoms despite 6 months of nonoperative management
What is the main risk of surgery for De Quervain’s tenosynovitis?
Sensory branch of radial nerve injury
Give 4 complications of extensor tendon injuries
Adhesion formation
Tendon rupture
Swan neck deformity
Boutonniere deformity
Give 7 risk factors for carpal tunnel syndrome
Female Obesity Diabetes Hypothyroidism Rheumatoid arthritis Pregnancy Amyloidosis
What tests can be done during examination for carpal tunnel syndrome?
Durkan’s/Tinel’s test: compress carpal tunnel for 30s. Produces pain/parasthesia in the median nerve distribution
Phalen’s test: flexing wrist for 1min produces pain/parasthesia in the median nerve distribution
What is the first line management of carpal tunnel syndrome?
NSAIDs, night splints and activity modification
What is the second line management of carpal tunnel syndrome?
Steroid injection
What is the indication for surgical carpal tunnel release in carpal tunnel syndrome?
Failure of nonoperative treatment
What is the pathophysiology of Dupuytren’s contracture?
Proliferation of myofibroblasts, causing development of fascial nodules and contractures
What is the inheritance pattern of familial Dupuytren’s contracture?
Autosomal dominant with variable penetrance
Give 4 associations of Dupuytren’s contracture
HIV
Alcoholism
Diabetes
Use of anti-seizure medications
What test can be used in examination for Dupuytren’s contracture?
Hueston’s tabletop test: ask the patient to place the palm flat on the table and look for contractures
