What is Duputren's contracture?
- A proliferative connective tissue disorder
- Leads to the formation of nodules and cord
- Progresses to contractures at the MCP and PIP joints
What is the pathology behind Dupuytren's contracture?
- Proliferation of myofibroblast cells
- Production of abnormal collagen (type 3 vs type 1)
Dupuytren's contracture most commonly affects which fingers?
- Ring finger
- Little finger
What are the risk factors for developing Dupuytren's contracture?
- Male gender
- North European/Scandinavian descent
- Alcoholic cirrhosis
- Phenytoin therapy
- Other fibromatosis
Besides Dupuytren's contracture, name two other fibromatoses
- Peyronie's disease (penis)
- Lederhose disease (plantar fibromatosis)
What does surgery for Dupuytren's contracture involve?
- Removal of diseased tissue (fasciectomy)
- Division of cords (fasciotomy)
- Amputation (for the most severe cases)
How is trigger finger caused?
- Tendonitis of a flexor tendon can cause nodular enlargement
- This can cause the tendon to get trapped under the fascial pulley
- Usually the involved pulley is the A1 pulley
Why may a patient who has trigger finger experience their finger becoming trapped in a flexed position?
The nodule of the flexor tendon (as a result of tendonitis) becomes trapped under the fascial pulley
Which fingers are most commonly implicated in trigger finger?
Middle and ring fingers
How can symptoms be quickly relieved in trigger finger?
Injection of steroid around the tendon
If trigger finger is recurrent, what is the treatment?
Surgery to incise the affected pulley to allow free movemnt of the tendon
(division of just the A1 pulley does not affect function)
Postmenopausal women are associayed with high rates of OA in which joints in the hand?
How may mild-moderate OA in the hand be treated?
Removal of osteophytes and excision of associated mucous cysts
How may severe OA in the hand be treated?
In order to preserve pincer grip, which treatment is required for OA at the index finger?
(other fingers can have replacement arthroplasty)
Which joints in the hand are least commonyl affected by OA?
Which single joint in the hand is commonly affected by OA especially in women?
1st carpo-metacarpal joint
How can OA in the 1st carpo-metacarpal joint be treated?
- Injection of steroid aids an acute flare up
- Excision arthroplasty (trapeziectomy) or fusion for chronic pain
Which joints does RA avoid in the hand?
What are the three stages of hand disease in RA?
- Synovitis and tenosynovitis (swelling and pain)
- Erosions of the joints (inflammatory pannus)
- Joint instability and tendon rupture (subluxation and chronic tenosynovitis may cause extensor tendon ruptures)
What are the common hand deformities of RA?
- Volar MCP joint subluxation
- Ulnar deviation
- Swan neck deformity (hyperextension at PIPJ with flexion at DIPJ)
- Boutonniere deformity (Flexion at PIPJ with hyperextension at DIPJ)
- Z-shaped thumb
Which procedure may prevent tendon rupture in RA?
If extensor tendons to the wrist or fingers rupture in RA, which treatment is not suitable and which treatment is suitable for preserving function?
- Direct surgical repair cannot be undertaken due to the diseased state of the tendon
- Tendon transfers or joint fusions are required to preserve function
a) Contractures associated with RA treated
b) Affected joints with serve arthritic damage treated?
a) Soft tissue releases
b) Joint replacements or fusions