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Flashcards in Wrist and hand Deck (24)
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What is Dupuytren's contracture?

Progressive, painless fibrotic thickening of the palmar fascia with the skin puckering and tethering.


Describe the clinical features of Dupuytren's contracture

Mainly affects the ring and little fingers
Often bilateral (45%) and symmetrical
1. Pitting and thickening of palmar skin and SC tissue
2. Nodule forms: firm, painless, fixed
3. Cord develops and begins to contract over months/years
MCP joint flexion
Involvement of interphalangeal joints: disabling


Name 3 risk factors for Dupuytren's contracture

Increasing age
North European descent
Positive family history
Smoking (3:1)
Alcoholic liver disease
HIV or cancer
Diabetes mellitus (20%)
Occupational exposure to hand-transmitted vibration
Epilepsy/anticonvulsant drugs: e.g. Phenytoin
Peyronie's disease (rare): penile fibromatosis


Name 2 differential diagnoses for Dupuytren's contracture

Skin contracture
Trigger finger
Ulnar nerve palsy


Outline the management of Dupuytren's contracture

Surgery offered for significantly compromised hand function or positive Hueston table-top test.

Non-surgical: injectable collagenase, radiotherapy
Closed fasciotomy

Post-op splintage and physiotherapy


What is a ganglion cyst?

A smooth fluid-filled swelling associated with a joint capsule or tendon sheath.


Describe the treatment options for ganglion cysts

May disappear spontaneously or with local pressure.
Aspiration via wide-bore needle
Surgical dissection


Define De Quervain's tenosynovitis

Stenosing tenosynovitis of the abductor policies longus and extensor policies brevis tendons as they cross the distal radial styloid.


Describe the clinical features of De Quervain's tenosynovitis

Pain on radial side of wrist
Tenderness over radial styloid process
Abduction of thumb against resistance is painful

Finkelstein's test: with thumb flexed across palm, pain on wrist flexion and ulnar deviation


Outline the management options for De Quervain's tenosynovitis

Rest, thumb splint, ice
Hydrocortisone injection
Decompression of tendons sheath


What is trigger finger?

Entrapment of a flexor tendon nodule at the sheath, preventing smooth gliding. On forced extension, the nodule passes the constriction with a snap.


Describe the clinical features of trigger finger

Most commonly affects ring and middle fingers
Sudden extension of finger after initial locking
Tender nodule palpable in front of affected sheath


What are the treatment options for trigger finger?

Simple immobilisation
Steroid injection
Percutaneous trigger finger release


Define Volkmann's ischaemic contracture

Permanent flexion deformity due to muscle necrosis and fibrosis after ischaemic injury.


What hand deformities are seen with osteoarthritis

Bouchard's nodes (PIP)
Heberden's nodes (DIP)
Squaring of the thumb base


What hand deformities are seen with rheumatoid arthritis

Z thumb
Ulnar deviation of MCPJ
Swan-neck: DIP hyperflexion, PIP hyperextension
Boutonniere: DIP hyperextension, PIP hyperflexion

Rheumatoid nodules


Define mallet finger

Flexion deformity of distal phalanx, with normal passive movement. Due to injury to extensor tendon of distal phalanx.


What is the treatment for mallet finger?

Distal phalanx hyperextension splint for 6-8 weeks


Define carpal tunnel syndrome

Compression of the median nerve as it passes under hte flexor retinaculum


Describe the clinical features of carpal tunnel syndrome

Affects the median nerve distribution of the hand

Pain or paraesthesia: typically localised to median innervated fingers, but may involve entire hand or radiate into the forearm
Common at night and after repetitive movement
Relieved by hanging arm or shaking*
Late: clumsiness and weakness

Wasting of thenar eminence
Sensory deficit of lateral 3.5 digits
Sparing of lateral palmar sensation


Explain the pattern of sensory deficit with carpal tunnel syndrome

Sensory deficit in lateral 3.5 digits: median nerve
Sparing of lateral palmar sensation: palmar cutaneous branch of median nerve does not travel within tunnel


List 3 risk factors for carpal tunnel syndrome

Genetic: FHx, wrist anatomy
Post-Colles' fracture, wrist injury
Diabetes, obesity
Menopause or pregnancy
Rheumatoid arthritis
Thyroid: myxoedema
Gout and CPPD


Describe 2 tests used to assess carpal tunnel syndrome

Phalen's test: hyperflexion of wrist for 1 minute
Tinel's test: tapping over the carpal tunnel


What is the treatment for carpal tunnel syndrome?

Treat any treatable associated diseases
Rest, activity modification
Wrist splints: esp at night
Carpal injection
Carpal tunnel release