Hand Problems Flashcards by Jane Keery

What are ganglions?

Fluid filled cysts, found adjacent to a tendon or synovial joint (outpourings of a synovial cavity)

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When can ganglions/mucous cysts be removed? What is the rate of recurrence?

If they are causing pain- 50% chance of recurrence

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When can ganglions not be removed?

For cosmetic reasons

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If a patient wants a ganglion removed for cosmetic reasons, what should you inform them?

It will leave a scar, which may be just as cosmetically unacceptable. It may also remain tender which can be worse than the cyst in the first place.

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What is a mucous cyst?

A ganglion at the flexor tendon of the DIP joint, often associated with OA

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What are some symptoms of a mucous cyst?

May be painful, produce discharge, deform the nail

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Will the size of a mucous cyst remain constant?

No, it will fluctuate

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How would you describe what a ganglion feels like?

Smooth, rubbery, firm and should transilluminate

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What kind of lumps will transilluminate?

Fluid filled

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What are mucous cysts filled with? What are ganglions filled with?

Mucus cysts = mucous, ganglions = synovial fluid

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What side of the wrist are ganglion cysts seen at?

Both, can be dorsal or volar

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Is there normally treatment for a ganglion?

No, they usually resolve with time and do not require treatment

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What type of ganglion shouldn’t be excised? Why?

Volar wrist ganglion cysts: close association with the radial artery

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What type of tendons can be affected by trigger finger? What tendon is mostly affected?

Flexor tendons, especially flexor digitorum superficialis

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What happens in trigger finger?

There is swelling of the tendon and tendon sheath, until the tendon gets caught on the edge of the A1 pulley

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Where will there be pain in trigger finger?

Over the A1 pulley at the metacarpal head

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In trigger finger, the finger will be stuck in what position? Why?

Stuck in flexion because the nodule passes below the pulley but then can’t get back through on extension

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How can the affected finger in trigger finger be extended?

Using the other hand to pull it which can be painful, or over time it will suddenly ping into extension

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Will all patients with trigger finger be able to extend their finger?

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Movement of the finger in trigger finger causes what? Why?

A clicking sensation as the nodule catches onto and then passes under the pulley

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Who does trigger finger affect?

Anyone at any age, even kids

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What is the conservative management for trigger finger?

It often resolves spontaneously, in the meantime you can give a splint to prevent flexion, and up to 3 tendon sheath injections which are often curative

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What is the downside of using a splint in trigger finger?

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Can cause stiffening

What is the surgical management of trigger finger? When is this used?

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Division of the A1 pulley to allow the tendon to move freely. Only used in recurrent/persistent cases.

DeQuervain's tenosynovitis affects where?

The first extensor compartment, containing abductor policies longs and extensor pollicis brevis

What causes DeQuervain's tenosynovitis? Where does it cause pain?

Usually a repetitive strain injury causing pain over the radial styloid process at the wrist

Who does DeQuervain's tenosynovitis occur in? What conditions is it related to?

Mostly women aged 30-50, associated with pregnancy and RA

What tests and investigations are used for DeQuervain's tenosynovitis?

Finklestein's test, US, x-ray

Describe a presentation of DeQuervain's tenosynovitis?

Spontaneous and painful, red and swollen

Describe the Fincklestein's test?

Get the patient to make a fist and then press down on the base of the thumb- this will elicit a lot of pain

What are the treatment options for DeQuervain's tenosynovitis?

NSAIDs, splinting, rest, steroid injections, decompression surgery

What is Dupuytren's contracture?

Connective tissue disorder where the palmar fascia undergoes hyperplasia. Normal fascial bands then form nodules and cords.

Dupuytren's causes contractures where? What deformity does this result in?

Contractures at the MCP and PIP joints, resulting in a fixed flexion deformity

What is the underlying pathology of Dupuytren's contracture?

Proliferation of myofibroblast cells rather than fibroblasts and the production of abnormal collagen- type 3 rather than type 1

Which fingers do contractures in Dupuytren's most commonly affect?

Little and ring fingers (though can affect any)

How common is it for Dupuytren's to be bilateral?

Half of cases

Describe the onset of Dupuytren's?

Painless, gradual progression which usually begins as a palmar pit/nodule

What are some factors which can be related to Dupuytren's?

Genetics, diabetes, alcohol/cirrhosis, smoking, phenytoin therapy (epilepsy), fibromatosis

What is a clinical sign which is a fairly strong indicator of Dupuytren's?

The patient cannot put their hand flat on a table

Who is Dupuytren's most common in?

Older men (10:1)

Diathesis is a severe type of Dupuytren's. Who is a more severe type more common in?

Young people, and those with fibromatosis elsewhere

What are some conservative management options for Dupuytren's?

Stretches, activity modification, splintage

What two surgeries are mostly used for Dupuytren's?

Fasciectomy (removal of diseased fascia) or fasciotomy (division of cords)

What are some outcomes to be aware of following surgery for Dupuytren's?

A lot of therapy and rehab to get it moving again, and chance of recurrence (especially younger patients)

If Dupuytren's is familial, how is it inherited? Where are descendents commonly from?

Autosomal dominant, high prevalence in North Europe/Scandinavia

Up to 30% of Dupuytren's contractors at which joint can be tolerated?

MCP

Dupuytren's at which joint is usually an indicator for surgery? Why?

PIP- readily stiffens

What is paronychia?

Infection within the nail fold

Paronychia usually occurs in who? Why?

Children, due to nail biting

What can paronychia result in?

Formation of pus, may affect the growth of the nail

What are some management options for paronychia?

Elevation, antibiotics, incision and drainage

Flexor tendon sheath infection is what? Is it associated with trauma or injury?

An emergency! Not necessarily associated with trauma or injury.

Why is flexor tendon sheath infection an emergency?

It can track up the palm and arm

What are some signs and symptoms of flexor tendon sheath infection?

Extreme pain, limited extension, tracking lymph node involvement

How is a flexor tendon sheath infection treated? What can occur if not treated?

Make an incision at the top and bottom and wash it out. If this is not done it can cause permanent disability.

Hand Problems Flashcards

(55 cards)