Common hand conditions - 01/11/18

Question 1

What is a mucous cyst?

Answer 1

Outpouching of synovial fluid from DIPjt OA

Question 2

What are the characteristics of a mucous cyst?

Answer 2

May be painful
May fluctuate/discharge
May deform nail/cause ridge

Question 3

How is a mucous cyst managed?

Answer 3

May be left alone

Excision

Question 4

What are ganglions?

Answer 4

Outpouchings of synovial cavity

Question 5

Where are ganglions common?

Answer 5

Wrist

Question 6

What are the characteristics of ganglions?

Answer 6

Filled with synovial fluid
Fluctuate
Usually painless
May feel tight
Usually resolve with time

Question 7

How are ganglions managed?

Answer 7

Benign neglect
Family bible
Aspiration
Excision

Question 8

What do tendons run within?

Answer 8

Flexor tendon sheath

Question 9

What does any swelling on a tendon lead to?

Answer 9

More swelling

Tendon gets caught on edge on A1 pulley

Question 10

What is pain over an A1 pulley known as?

Answer 10

Triggering

Sticking of finger

Question 11

What is trigger finger?

Answer 11

Small nodule on the tendon
As it passes through the edge of the tendon sheath, it catches and gets irritated
Leading to palm soreness
Keeps getting irritated and catches more, becoming bigger

Question 12

What is found on examination of trigger finger?

Answer 12

Demonstrate triggering
Tender over A1 pulley
Feel nodule pass beneath pulley
Distinguish from dupuytrens

Question 13

How is trigger finger managed?

Answer 13

Can resolve spontaneously
Splint to prevent flexion
Tendon sheath injection
(Steroid and LA) 
Can be repeated up to 3x
Surgery
Under GA or LA
Divide A1 pulley

Question 14

What is DeQuervain’s tenosynovitis and What are the characteristics of it?

Answer 14

Pain at base of thumb on extension
Spontaneous
Painful
Swollen
Red
Finklestein's test

Question 15

What is the management of DeQuervains tenosynovitis?

Answer 15

NSAIDs
Splint
Rest
Steroid injection
Decompression surgery

Question 16

Where does dupuytrens contracture lie?

Answer 16

Palmar fascia

Question 17

What is dupuytrens contracture?

Answer 17

Thickening and contracture of subdermal fascia leading to fixed flexion deformity of fingers

Question 18

What are the characteristics of dupuytrens contracture?

Answer 18

Painless
Gradual progression
Palmar/pit nodule
Unknown cause

Question 19

What are some risk factors for Dupuytrens?

Answer 19

Genetics
DM
Alcohol/Cirrhosis
Smoking
Epilepsy
Trauma
Lederhosens feet

Question 20

What is found on examination of Dupuytrens contracture?

Answer 20

Feel cords
MCP/PIP joint involvement
Measure angles
Table top test

Question 21

Which joints should be managed urgently if affected in dupuytrens?

Answer 21

PIPs

Question 22

How is dupuytrens managed?

Answer 22

Stretches
Activity modifcation
Surgery
-Segmental fasciectomy
-Fasciectomy
-Dermofasciectomy
-Amputation
Collegenase injection
Percutaneous needle fasciotomy

Question 23

What is paronychia?

Answer 23

Infection within nail fold

Question 24

Who gets paronychia?

Answer 24

Mostly children

Question 25

What is a risk factor for paronychia?

Answer 25

Nail biting

Question 26

What is the management of paronychia?

Answer 26

Elevate
Antibiotics
Incise and drain collection

Question 27

What is a flexor tendon sheath infection?

Answer 27

Infection within sheath tracking up palm and arm

Question 28

What are the characteristics of flexor tendon sheath infection?

Answer 28

Rare
Surgical emergency
Extremely painful
Limited extension due to pain
May have tracking lymphangitis

Question 29

What is the management of flexor tendon sheath infections?

Answer 29

Wash out tendon sheath