Orthopaedic Problems on the Hand

Question 1

Which gender is more prevalent of dupytrens disease and when does this occur?

Answer 1

M > F

occurs earlier in males

Question 2

Genetics of dupytrens disease

Answer 2

autosomal dominant - variable penetrance

sporadic 30% of cases

Question 3

Associations of dupytrens contracture

Answer 3

Diabetic 
alcohol 
tobacco 
HIV
epilepsy

Question 4

What is dupytren’s diathesis?

Answer 4

A more aggressive dupytrens

Question 5

Features of dupytrens diathesis

Answer 5

Early onset disease
Bilateral disease
FH
Ectopic disease

Question 6

Pathology of dupytrens

Answer 6

myofibroblast

• intracellular contractile elements
• regulated by growth factors
• production of collagen

Question 7

Presentation of dupytrens

Answer 7

Not painful usually
Loss of finger extension (active or passive)
Hand in pocket
gripping things problems
curse of the macrrimmonds

Question 8

treatment of dupytrens

Answer 8

observe
radiotherapy
partial fasciectomy
dermo-fasiectomy
arthrodesis
amputation 
percutanoues needle fasciotomy 
collagenase

Question 9

What is trigger finger?

Answer 9

A condition in which tendons of the hand become swollen and inflamed and “catch” in the pulley it runs through in the tendon sheath

Question 10

Who gets trigger finger?

Answer 10

W > M

40-60s

Question 11

Which finger are mostly affected in trigger finger?

Answer 11

Ring > thumb > middle

Question 12

Associations of trigger finger

Answer 12

repetitive use of the hand
local trauma
RA
DM
Gout

Question 13

Presentation of trigger finger

Answer 13

Clicking sensation of movement of digit
Lump on palm under pully
may have to use the other hand to ‘unlock’
‘clicking’ may progress to ‘locking’

Question 14

Treatment of trigger finger

Answer 14

splintage
Steriod
percutaneous release
open surgery

Question 15

What is De Quervians syndrome?

Answer 15

Painful inflammation of the tendons of your wrist and lower thumb - the sheath of containing the extensor pollicus brevis and abductor pollicus longus tendons are inflamed

Question 16

Presentation of De Quervians syndrome

Answer 16

Several weeks pain localised to the radial side of the wrist
Tenderness over radial styloid process
Aggravated pain by movement of the thumb
Abduction of thumb against resistance is painful
localised swelling
localised tenderness over tunnel

Question 17

Who gets de Quervians syndrome?

Answer 17

F > M

30-50s y/o

Question 18

assosiations of de quervians syndrome

Answer 18

post partum
lactating females
activities with frequent thumb abduction and ulnar deviation
washerwomans sprain

Question 19

Pathology of de quervians syndrome

Answer 19

1st dorsal extensor compartment
fibro-osseous tunnel at distal radius
30% 1st compartment divided by septum

Question 20

investigations of de quervians syndrome

Answer 20

examine thumb joints
Friklesteins tests
resistricted thumb extension

Question 21

Treatment of de quervian syndrome

Answer 21

non operative = splints, steroid injections, analgesia

Operative decompression

Question 22

What is a ganglia?

Answer 22

A myxoid degeneration from joint synovia

Question 23

Where can ganglions arise from?

Answer 23

joint capsule
tendon sheath
ligament

Question 24

Who gets ganglias?

Answer 24

F > M
20 - 40 y/o
dorsal > volar

Question 25

What can a ganglia be associated with?

Answer 25

Recurrent injury around the wrist

Question 26

Presentation of a ganglia

Answer 26

``` lump firm non tender change in size smooth occasionally lobulated not normally fixed to any underlying tissues never fixed to the skin ```

Question 27

treatment of ganglia

Answer 27

reassure and observe aspiration excision; including the 'root'

Question 28

Presentation of OA of the thumb

Answer 28

``` pain stiffness swelling deformity loss of function pain opening jars/pinching ```

Question 29

Pathology of OA of the thumb

Answer 29

dorsal sublaxation metacarpal adduction MCPJ extension

Question 30

Treatment of OA of the thumb

Answer 30

``` Life style modifications NSAIDs splint steroid injections operative - trapeziectomy - fusion - replacement ```

Question 31

What is the gold standard operative treatment for OA of the thumb?

Answer 31

Trapeziectomy

Question 32

What drug treatment can dupytrens contracture be a S/E for?

Answer 32

Phenytoin treatment

Question 33

What is friklestones test used for and how does it work?

Answer 33

De Quervians tenosynovitis Pull thumb in ulnar deviation and longitudinal traction. This action (if have the condition) causes pain over the radial styloid process and along the length of the extensor pollicus brevis and abductor pollicus longus

Question 34

What is a common cause of bilateral carpal tunnel syndrome?

Answer 34

Rheumatoid arthritis