What cysts commonly appear at the DIP joint?
Mucous cyst
What causes mucous cysts?
Outpouching of synovial fluid secondary to joint damage in OA
What are some symptoms associated with mucous cysts?
Pain
Discharge
Nail deformity
How are mucous cysts treated surgically?
Excision
Are mucous cysts the same as ganglion cysts?
No
What is a ganglion (cyst)?
Outpouching of synovial CAVITY
Are ganglion cysts painful?
No
If a ganglion cyst is fluctuating and causing functional problems, how may it be treated?
Aspiration (will probably recur)
Excision
Which artery may be damaged during aspiration of a ganglion cyst?
Radial artery
What stops flexor tendons from bowstringing by holding them to the bone?
Flexor tendon sheathes
What structures, found on the flexor tendon sheath, can catch inflamed tendons and cause trigger finger?
Pulleys
Which particular pulley is involved in trigger finger?
A1 pulley
What are the symptoms of trigger finger?
Pain
Flexion > LOCKING > Forced extension to unlock it
What gets caught on the A1 pulley in trigger finger?
Inflamed nodule of tendon
If trigger finger doesn’t resolve itself, how can it be treated?
Steroid injections into tendon sheath
Steroid injections often ___ trigger finger.
cure
How many steroid injections should be given for trigger finger before considering alternative therapy?
3
What surgical options exist for trigger finger?
Division of A1 pulley
What may be damaged in trigger finger surgery?
Digital arteries
Digital nerves
Why can the A1 pulley be sacrificed without causing functional issues in the hand?
There aren’t any pulleys distal to it
What does DeQuervain’s tenosynovitis affect?
Extensor tendons of the thumb
What test is done on examination for DeQuervain’s tenosynovitis?
Finklestein test
Thumb into fist, adduct fist
Will be painful
How is DeQuervain’s tenosynovitis treated?
NSAIDs
Splint
Rest
Steroid injections
Decompression
What is Dupuytren’s contracture?
Contraction/fibrosis of PALMAR FASCIA
What sort of deformity occurs due to Dupuytren’s contracture?
Fixed flexion deformity of fingers
What particular aspect of the palmar fascia fixes the palmar skin to the hand?
Palmar aponeurosis
What pathological process occurs in the specific cells of the palmar fascia implicated in Dupuytren’s contracture?
Metaplasia
Fibroblast > Myofibroblast (muscle - CONTRACTILE)
Is Dupuytren’s painful?
No
Dupuytren’s contracture has a gradual onset. How does it initially present?
Palmar pit / nodule
What are some possible causes of Dupuytren’s?
Genetics
Diabetes
Alcohol
Smoking
What are the two offshoots of Dupuytren’s which you should know about?
Ledderhose disease - plantar fascia
Peyronie’s disease - penis
What movement of the MCP joints is lost in Dupuytren’s contracture?
Hyperextension
but patients don’t usually notice as we don’t hyperextend very much
Can the deformity of
a) MCP joints
b) PIP joints
be corrected following Dupuytren’s contracture?
a) Yes
b) No
Dupuyren’s contracture may be treated ___ or ___.
conservatively
surgically
Why are zig-zag incisions made in Dupuytren’s contracture surgery?
Incisions PERPENDICULAR to the the flexor creases of skin will always heal with a contracture
Why are nerves always at risk in finger surgery?
Tendons often pull nerves into unusual positions
Contractile ___ cause symptoms of Dupuytren’s.
cords
Why is the skin overlying cords also removed in Dupuytren’s surgery?
Skin also contains myofibroblasts which may allow for recurrence
Why is revision surgery for Dupuytren’s highly risky?
Digital nerve displacement
What are alternative surgeries for Dupuytren’s?
Needle fasciectomy
Collagenase injections (dissolves cords)
The recurrence rate of Dupuytren’s is (low / high).
high recurrence rate
What is an infection of the nail fold called?
Paronychia
Who tends to get paronychia?
Why?
Children
Nail biting
How is paronychia treated?
Antibiotics
Drain pus
What is an important hand infection which must be treated immediately to prevent deformity?
Flexor tendon sheath infection
What are the features of flexor tendon sheath infection?
Extreme pain; tracking up palm and arm
Tracking lymphangitis
How is flexor tendon sheath infection treated?
Fluroscopically