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Musculoskeletal > Orthopaedic Problems of the Hand > Flashcards

Orthopaedic Problems of the Hand Flashcards

1
Q

What are some common conditions of the hand?

A
  • Dupuytren’s disease
  • Trigger finger
  • De Quervain’s tenovaginitis
  • Nerve entrapments
    • Carpal tunnel syndrome
    • Cubital tunnel syndrome
  • Ganglion
  • OA base of thumb
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2
Q

What sex and ethnicity does Dupuytren’s disease affect more?

A

Males > females

Almost exclusively white

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3
Q

Are there any genetic factors to Dupuytren’s disease?

A

Autosomal dominant

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4
Q

What are some risk factors for Dupuytren’s disease?

A
  • Diabetes
  • Alcohol
  • Tobacco
  • HIV
  • Epilepsy
  • Genetics
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5
Q

Describe the pathology of Dupuytren’s disease?

A
  • Contraction of pretendinous bands and palmar aponeurosis (fascia) causes disease
  • Myofibroblast
    • Intracellular contractile elements
    • Regulated by growth factors
    • Production of collagen
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6
Q

What are some functional problems of dupuytren’s disease?

A
  • Usually not painful
  • Loss of finger extension
  • Problems gripping things, putting hands in pockets or washing face
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7
Q

What is the treatment of dupuytren’s disease?

A
  • Non operative
    • Observe
    • Splints don’t work
    • Radiotherapy
  • Operative
    • Partial fasciotomy
      • Most common procedure in UK
      • Doesn’t get rid of all fascia
      • Recurrence 50% at 5 years
    • Dermo-fasciectomy
      • More radical procedure, gets rid of all fascia and removes some skin
      • Requires intensive physiotherapy
    • Arthrodesis
    • Amputation
    • Percutaneous needle fasciotomy
      • Quick and no wounds
      • Higher reoccurrence rate
      • Risk of nerve injury
    • Collagenase
      • Dissolves collagen in the band
      • Major problem is the flexor tendon may rupture
      • Expensive procedure
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8
Q

What causes trigger finger?

A
  • 2 tendons to each finger that sits in sheath
  • Thickenings in sheaths known as pulley, keep tendon close to bone
  • Swelling in tendon catches the pulley
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9
Q

What age group and sex is more affected by trigger finger?

A
  • Woman more than men
  • 40-60 years
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10
Q

Which fingers does trigger finger affect most commonly?

A

ring>thumb>middle

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11
Q

Describe the clinical features of trigger finger?

A
  • Patient history
    • Clicking sensation, may progress to locking
  • Examination
    • Palpable lump over A1 pulley
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12
Q

What is the treatment of trigger finger?

A
  • Non operative
    • Splintage
    • Steroid
  • Operative
    • Percutaneous release
    • Open surgery
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13
Q

What does De Quervain’s Tenovaginitis occur due to?

A

Occurs in 1st dorsal extensor compartment due to thickening of localised segment

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14
Q

What is the presentation of de quervain’s tenovaginitis?

A
  • Pain
    • Localised to radial side of wrist
    • Aggravated by movement of thumb
  • Localised swelling
  • Tenderness over tunnel
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15
Q

What sex and age group is most affected by de quervain’s tenovaginitis?

A
  • Females more than males
  • 50-60 years
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16
Q

How is de quervain’s tenovaginitis diagnosed?

A
  • Examination of joints
  • Finkelstein’s test
  • Resisted thumb extension
17
Q

What is the treatment of de quervain’s tenovaginitis?

A
  • Non operative
    • Splints
    • Steroid injection
  • Operative
    • Decompression
18
Q

What is a ganglion?

A

Ganglion = a myxoid degeneration from joint synovial

19
Q

What can a ganglion arise from?

A

Arise from joint capsule, tendon sheath or ligaments

20
Q

What age group and sex are most affected by ganglion?

A
  • More common in females
  • 20-40 years
21
Q

What are the clinical features of ganglion?

A
  • Present with lump
  • Firm, non-tender
  • Change in size
  • Smooth
  • Normally not fixed to underlying tissues and never fixed to skin
22
Q

What is the treatment of ganglion?

A
  • Non operative
    • Reassure and observe
    • Aspiration
  • Operative
    • Excision
      • Make sure also excise the ‘root’
23
Q

What does OA stand for?

A

Osteoarthritis

24
Q

What is the presentation of osteoarthritis of base of thumb?

A
  • Pain
    • At base of thumb
    • Worse on activity
  • Stiffness
  • Swelling
  • Deformity
  • Loss of function
25
Q

Which sex does OA of the base of thumb affect more?

A

Females > males

26
Q

What is the treatment of OA of the base of the thumb?

A
  • Non-operative
    • Life style modifications
    • NSAIDs
    • Splint
    • Steroid injection
  • Operative
    • Trapeziectomy
      • Gold standard
      • Good pain relief
    • Fusion
    • Replacement

Musculoskeletal (40 decks)

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