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Flashcards in Wrist and hand Deck (24)
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1
Q

What is Dupuytren’s contracture?

A

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

2
Q

Describe the clinical features of Dupuytren’s contracture

A

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

3
Q

Name 3 risk factors for Dupuytren’s contracture

A

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

4
Q

Name 2 differential diagnoses for Dupuytren’s contracture

A
Callus
Ganglion
Skin contracture
Trigger finger
Ulnar nerve palsy
5
Q

Outline the management of Dupuytren’s contracture

A

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

Non-surgical: injectable collagenase, radiotherapy
Closed fasciotomy
Fasciectomy

Post-op splintage and physiotherapy

6
Q

What is a ganglion cyst?

A

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

7
Q

Describe the treatment options for ganglion cysts

A

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

8
Q

Define De Quervain’s tenosynovitis

A

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

9
Q

Describe the clinical features of De Quervain’s tenosynovitis

A

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

10
Q

Outline the management options for De Quervain’s tenosynovitis

A

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

11
Q

What is trigger finger?

A

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

12
Q

Describe the clinical features of trigger finger

A

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

13
Q

What are the treatment options for trigger finger?

A

Simple immobilisation
Steroid injection
Percutaneous trigger finger release

14
Q

Define Volkmann’s ischaemic contracture

A

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

15
Q

What hand deformities are seen with osteoarthritis

A

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

16
Q

What hand deformities are seen with rheumatoid arthritis

A

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

Rheumatoid nodules

17
Q

Define mallet finger

A

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

18
Q

What is the treatment for mallet finger?

A

Distal phalanx hyperextension splint for 6-8 weeks

19
Q

Define carpal tunnel syndrome

A

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

20
Q

Describe the clinical features of carpal tunnel syndrome

A

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

21
Q

Explain the pattern of sensory deficit with carpal tunnel syndrome

A

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

22
Q

List 3 risk factors for carpal tunnel syndrome

A
Occupation/activities
Genetic: FHx, wrist anatomy
Post-Colles' fracture, wrist injury
Diabetes, obesity
Menopause or pregnancy
Rheumatoid arthritis
Acromegaly
Thyroid: myxoedema
Amyloidosis
Gout and CPPD
23
Q

Describe 2 tests used to assess carpal tunnel syndrome

A

Phalen’s test: hyperflexion of wrist for 1 minute

Tinel’s test: tapping over the carpal tunnel

24
Q

What is the treatment for carpal tunnel syndrome?

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