Hand Problems

Question 1

fingertip injuries

Answer 1

subungual haematoma

Question 2

what are 5 types of nail injuries

Answer 2

Type 1- Soft tissue only
Type 2- Soft tissue + nail
Type 3- Soft tissue + nail + bone
Type 4- Proximal ⅓ of phalanx
Type 5- proximal to DIPjt

Question 3

Tx for 5 types of nail injuries

Answer 3

Level 1 + 2 = dressing only
Level 3 = repair nail bed + stabilise bone
Level 4 = as above unless > ablate
Level 5 - if tip not available, terminalise of V-Y flap

Question 4

what is a boxers fracture

Answer 4

minimally comminuted, transverse fractures of the 5th metacarpal

Question 5

features of boxers fracture

Answer 5

minimal displacement
no rotation
more distal

Question 6

Tx of boxers fracture

Answer 6

‘Buddy strap’

early mobilisation

Question 7

what is a mallet finger

Answer 7

disruption of the extensor mechanism of the finger at the distal interphalangeal joint

stave injury

Question 8

what can mallet finger refer to

Answer 8

avulsion bony injury or just tendinous injury

Question 9

Ex of mallet finger

Answer 9

resiste finger extension

tenderness/bruising

Question 10

Tx of mallet finger

Answer 10

mallet splint 6/52
large avulsions - wire
dermatotenodesis - chronic cases

Question 11

PIPjt dislocation

Answer 11

common

vital to be treated acutely - pull to reduce, buddy strap

Question 12

problems with delayed presentation of PIPjt dislocation

Answer 12

impossible to reduce

may require fusion

Question 13

PIPjt fracture Tx

Answer 13

needs fixation/stabilisation

Question 14

what is Bennett’s fracture

Answer 14

fracture of the base of the first metacarpal bone which extends into the carpometacarpal (CMC) joint

Question 15

principles of mutilating injury

Answer 15

Preserve amputated parts on ice
Early debridement - excise everything dirty
Establish stable bony support
Establish vascularity
Repair all tissues- nerves, tendons
Establish skin cover- grafts/flaps
Prevent/treat infection
Aggressive mobilisation

Question 16

hand burns Tx

Answer 16

Excise damaged skin and perform split skin grafts early
Aggressive mobilisation to prevent finger stiffness
Escharotomy

Question 17

what is eschar

Answer 17

Thick, leathery, inelastic skin which can form after burns

May require surgical release to allow movement

Question 18

what is a mucous cyst

Answer 18

outpouching of synovial fluid from DIPjt OA

Question 19

symptoms/signs of mucous cysts

Answer 19

may be painful
may fluctuate/discharge
may deform nail, cause ridge

Question 20

pathogenesis of trigger finger

Answer 20

• Tendons run within flexor tendon sheath
• Any swelling on tendon leads to irritation
  
  • more swelling
  • tendon gets caught on edge on A1 pulley

Question 21

symptoms/signs of trigger finger

Answer 21

pain over A1 pulley (MS head)
Sticking of finger, usually in flexion
may or may not be able to extend
can use other hand to extend finger

Question 22

Ex of trigger finger

Answer 22

demonstrate triggering
tender over A1 pulley
feel nodule pass beneath pulley
NB- distinguish from Dupuytrens

Question 23

Mx of trigger finger

Answer 23

Conservative - can resolve spontaneously
- splint to prevent flexion

Tendon sheath injection

• steroid + LA
• can be repeated 3x

Surgery
- divide A1 pulley

Question 24

what is De Quervain Tenosynovitis

Answer 24

entrapment tendinitis of the tendons contained within the first dorsal compartment at the wrist; it causes pain during thumb motion

Question 25

symptoms of DeQuervains

Answer 25

spontaneous painful swollen/red

Question 26

what test can be done to confirm DeQuervains

Answer 26

Finklestein's test - patient puts thumb into a fist and then ulna deviate. Very painful if DeQuerains is present

Question 27

Mx of DeQuervains

Answer 27

``` NSAIDs Splint Rest Steroid injection Surgery - decompression ```

Question 28

what is Dupuytren's contracture

Answer 28

proliferation of myofibroblast cells and the production of abnormal collagen (type 3 rather than type 1) thickening and contracture of subdermal fascia leading to fixed flexion deformity of fingers

Question 29

what does Dupuytren's contracture cause

Answer 29

- skin of the hand may be adherent to the disease fascia and puckered - progressing to contractures at the MCP and PIP joints

Question 30

symptoms/signs of Dupuytren's

Answer 30

painless, gradual progression | starts as palmar pit/nodule

Question 31

causes of Dupuytren's

Answer 31

DM Alcohol/cirrhosis smoking

Question 32

Ex of Dupuytren's

Answer 32

Feel cords MCP/PIP joint involvement - measure angles Table-top tests

Question 33

Tx of Dupuytren's

Answer 33

Conservative - stretches Surgery - segmental fasciectomy - fasciectomy - dermofasciectomy - amputation

Question 34

what are newer treatment options for Dupuytrens

Answer 34

- collagenase injection | - percutaneous needle fasciotomy

Question 35

what is paronychia

Answer 35

infection within the nail fold often in children - nail biting! may result in pus collection

Question 36

Mx of paronychia

Answer 36

elevate antibiotics incise and drain collection

Question 37

surgical emergency in the hand

Answer 37

flexor tendon sheath infection

Question 38

how does a flexor tendon sheath infection present

Answer 38

infection within sheath, tracking up the palm and arm extremely painful limited extension, including passive

Question 39

Mx of tendon sheath infection

Answer 39

wash out tendon sheath