Hand Problems

Question 1

What is a mucous cyst

Answer 1

Outpouching of synovial fluid from the DIP joint

Seen in OA

Question 2

How will a mucous cyst present

Answer 2

May be painful
May fluctuate in size and discharge
May lead to nail deformity or ridging

Question 3

How do you manage a mucous cyst

Answer 3

May be left alone

Can excise if causing issue

Question 4

What is a ganglion

Answer 4

Outpouching of the synovial cavity
Filled with synovial fluid
May feel tight but normally painless

Question 5

How do you manage a ganglion

Answer 5

Usually resolves with time - leave alone

Can aspirate or excise if causing trouble - not common

Question 6

How do tendons lie in the hand

Answer 6

Run within the flexor tendon sheath
Enters this around the level of palmar crease
A series of pulleys hold them to the bone

Question 7

What is trigger finger

Answer 7

Any swelling of tendon leads to irritation and it can get caught on one of the pulleys - gets stuck in flexed position
Get pain and clicking

Question 8

Which pulley is the most common site of trigger finger

Answer 8

A1 pulley

Question 9

Who is at higher risk of trigger finger

Answer 9

Diabetics

More likely to end up with fixed flexion

Question 10

How do you differentiate trigger finger from Dupuytren’s

Answer 10

In Dupuytren’s the finger will never release – unlike trigger finger

Question 11

How do you treat trigger finger

Answer 11

Often resolves itself - observe
Can splint to prevent flexion
Inject tendon sheath
Surgery - divide the pulley

Question 12

Describe the tendon sheath injections used in trigger finger

Answer 12

Combination of steroid and local anaesthetic
Often curative
Can repeat 3x (if doesn’t work refer for surgery)

Question 13

What is DeQuervain’s tenosynovitis

Answer 13

Inflammation of the extensor tendons of thumb (1st compartment)

Question 14

How does DeQuervain’s tenosynovitis present

Answer 14

Pain - in thumb
Swelling and redness
Positive Finklestein’s test

Question 15

What is Finklestein’s test

Answer 15

Tuck thumb into fist then deviate ulna (tilt hand forward)

If painful it is positive

Question 16

How do you manage DeQuervain’s tenosynovitis

Answer 16

NSAID
Splint 
Rest 
Steroid injection - usually works 
Surgery - decompression

Question 17

What is Dupuytren’s contracture

Answer 17

Thickening and contracture of subdermal fascia leading to fixed flexion deformity of fingers
There is metaplasia of the fibroblasts into myofibroblasts which then contract

Question 18

What are some potential causes of Dupuytren’s contracture

Answer 18

Exact 'cause' unknown 
Genetics - Vikings 
Alcohol 
Smoking 
Anti-epilepsy meds 
Trauma?

Question 19

Which sex is more likely to get Dupuytren’s

Answer 19

Men

But will be more aggressive in women

Question 20

How do you treat Dupuytren’s

Answer 20

Stretching, activity modification

Surgery - fasciectomy

Question 21

What is paronychia

Answer 21

Infection within the nail fold

May involve pus collection

Question 22

What increases risk of paronychia

Answer 22

Nail biting

Common in children

Question 23

How do you manage paronychia

Answer 23

Elevate
Antibiotics
Incise and drain pus

Question 24

Infection of the tendon sheath is an emergency - true or false

Answer 24

True

Must operate immediately and wash out the tendon sheath

Question 25

What are signs of flexor tendon sheath

Answer 25

The infection can track up arm Extremely painful Limited extension due to pain May have tracking lymphangitis

Question 26

What is a degloving injury

Answer 26

Separation of skin from the underlying surface

Question 27

Where would a scaphoid fracture cause tenderness

Answer 27

Anatomical snuffbox

Question 28

What is a subungual haematoma

Answer 28

A bleed under the nail | Often a result of blunt force trauma

Question 29

How do you treat a subungual haematoma

Answer 29

Usually gets better on its own - nail may fall off and grow back If pressure is causing pain you can puncture the nail to release

Question 30

You need to repair the nail bed in order for nail injuries to heal - true or false

Answer 30

TRUE | The condition of the nail bed determines how the nail grows back

Question 31

What do joint fractures increase risk of

Answer 31

post-traumatic arthritis

Question 32

What is a boxers fracture

Answer 32

Break in the neck of finger - usually little | Often occurs after punching someone/something

Question 33

How would you treat a boxer's fracture

Answer 33

Buddy strap = secure to neighbouring finger | Early mobilisation

Question 34

What is mallet finger

Answer 34

Injury commonly caused by finger getting hit from front Ligament is torn off finger and may cause avulsion fracture Won't be able to extend finger

Question 35

How do you manage mallet finger

Answer 35

Splint straight for 6 weeks | Occasionally fix avulsion fracture with wire if displaced

Question 36

How do you treat a PIP joint dislocation

Answer 36

Has to be treated urgently Pull to reduce and then buddy strap Will be very stiff

Question 37

What type of injury tends to cause PIP joint dislocation

Answer 37

Twisting

Question 38

What is a Bennett's fracture

Answer 38

Fracture at base of thumb that goes into joint alongside dislocation

Question 39

How do you examine the FDP

Answer 39

Hold the PIP joint straight and bend the tip of the finger

Question 40

How do you examine the FDS

Answer 40

Hold index, ring and pinkie fingers straight and get patient to bend middle finger up

Question 41

What are the principles of treatment for mutilating injuries

Answer 41

``` Preserve amputed parts on ice Early debridement Establish bony support and vascularity Repair tissues Establish skin cover Prevent/treat infection Mobilise ```

Question 42

What is Eschar

Answer 42

Thick, leathery, inelastic skin which can form after burns | May need to be surgically released

Question 43

Describe the standard treatment for burns

Answer 43

Pain relief Rehydrate - fluid loss is a big issue | Prevent/treat infection

Question 44

Describe how RA can affect the extensor tendon

Answer 44

Autoimmune attacks leads to tendon degeneration and rupture Leads to weakness or dropped finger Can only treat with tendon transfer

Question 45

What is the most common hand tendon rupture

Answer 45

EPL

Question 46

What causes an EPL rupture

Answer 46

Often occurs a few weeks after an undisplaced radial fracture May be caused by ischaemia

Question 47

How does EPL rupture present

Answer 47

Loss of function of thumb extension

Question 48

What makes up the extensor mechanism of the knee

Answer 48

Quadriceps muscle Quadriceps tendon Patella Patellar tendon

Question 49

What are the signs of damage to the quads or patellar tendon

Answer 49

Palpable gap Unable to do straight leg raise | Patella may sit high or low on X-ray

Question 50

How do you diagnose quad or patellar tendon rupture

Answer 50

Imaging - x-ray, US or MRI

Question 51

How do you treat quad or patellar tendon rupture

Answer 51

Surgical repair

Question 52

What is Osgood-Schlatter's disease

Answer 52

Pain at insertion of patellar tendon | Leaves a prominent bony lump below knee

Question 53

Who gets Osgood-Schlatter's disease

Answer 53

Active, adolescent boys

Question 54

What are the clinical findings of an Achilles tendon rupture

Answer 54

Palpable gap Unable to stand on tiptoes Simmonds test positive

Question 55

Who commonly presents with Achilles tendon rupture

Answer 55

Middle aged | During sudden acceleration/deceleration

Question 56

How do you treat an Achilles tendon rupture

Answer 56

Serial casts to bring foot to neutral position Surgical repair Both work and have equal outcomes

Question 57

What is Simmonds Test

Answer 57

Get patient to lie on their front with feet hanging off the bed Squeeze calf - normally foot should plantar flex, if Achilles is ruptured there will be no movement