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46 Cards in this Set
- Front
- Back
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Which two fingers are commonly affected in Dupuytren's contracture disease? |
Little finger and ring finger |
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Which sex is more commonly affected in Dupuytren's contracture disease? |
Males (at a ratio of 8:1) |
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What are the three common contributing factors? |
Alcoholism, Genetics and Diabetes |
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What type of cells invade the palmar apernurosis (flat broad tendons) in the hand to cause Dupuytren's contracture? |
Myofibroblasts are related to Dupuytren's contracture. They invade the tendons causing thickening and rigidity. |
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What are the symptoms and functional problems associated with Dupuytren's contracture? |
Symptoms: Usually not painful. Gradual thinking of the skin under the little and ring finger. Functional issues: Loss of finger extension Difficult to grip things Washing face ect. |
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What is the non-surgical treatment for Dupuytren's contracture? |
Radiotherapy - destroys the growth of the fibroblasts Collagenase injection - contains special proteins that can weaken the cord |
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What is the most common surgical management for Dupuytren's contracture? |
Partial fasciectomy - thickened connective tissue is cut and then divided up. |
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What is the pathology behind trigger finger? |
Thickening of the sheath which surround the extensor tendons of the hand. |
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Which sex is more commonly affected in trigger finger? and what age group? |
Women Typically 40-60s, towards the end of a career where it has maybe been caused by repetitive use of the hand as part of their occupation. |
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Which fingers are most commonly affected in trigger finger? |
Ring finger is the most commonly affected. It can also affect the thumb and middle finger. |
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What disease is trigger finger associated with? |
RA Diabetes Gout |
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What are the clinical signs a patient may have trigger finger? |
Clicking sensation with the movement of the digit. Lump in palm under pulley Clicking may progress to locking of the digit |
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What is the non-operative treatment for trigger finger? |
Splinting - to stop it popping and clicking NSAIDs Corticosteroid injections |
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What is the operative treatment for trigger finger? |
Percutaneous trigger release - needle is inserted at the base of the tendon and sliced through Open trigger release - cut through the tendon sheath to make it wider |
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What are the two tendons surrounding the thumb that become thickened in De Quervain Syndrome? |
Extensor pollicis brevis & Abductor pollicis longus |
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What are the clinical signs of De Quervain syndrome? |
Main symptom is pain involving the thumb - i.e if patient presents with pain around the thumb think De Quervain syndrome. Also.. Several weeks pain localised to the side of the wrist. Pain aggravated by thumb movement May have localised swelling and tenderness over tunnel. |
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What sex is De Quervain syndrome more common in? |
Females - aged 50s to 60s. Like trigger finger it occurs often towards the end of a working career and is associated with occupational damage. |
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What type of activity is associated with De Quervain syndrome? |
Associated with activities that involve frequent thumb abduction. e.g gaming, texting and so it gets the nick name Texting thumb, gamers thumb or washerwomen thumb |
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What are the two examination tests you can perform to test for De Quervain syndrome? |
Finklestein’s Test - thumb is tucked under knuckles and then deviated towards the ulnar sharply to test for pain & Resisted thumb extension |
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What is the non-operative treatment for De Quervain Syndrome? |
Splints Steroid injetion |
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What is the operative treatment for De Quervain syndrome? |
Decrompression surgery - general term to relieve symptoms caused by pressure or compression |
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Carpal tunnel syndrome (CTS) is caused by the compression of which nerve? |
Median nerve at the wrist |
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What type of peripheral nerve disease is carpal tunnel syndrome? |
CTS is a mononeuropathy - meaning it involves only a single nerve |
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Carpal tunnel syndrome can cause sensory and motor loss in what parts of the palmar and dorsal side of the hand? |
Causes sensory loss in all the fingers except the little finger on the palmar side. Sensory loss in the three middle fingers on the dorsal side (back of hand) |
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What conditions is carpal tunnel often associated with? |
3rd trimester of Pregnancy Rheumatoid arthritis Fractures Hypothyroidism |
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What sex is carpal tunnel syndrome more commonly found in? |
Females |
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What would be expected in the history of somebody with carpal tunnel syndrome? |
Painful tingling in hand and forearm Worse at night Pain is usually poorly localised Wasting of the thenar muscles Loss of power in thenar muscles Loss of thumb abduction |
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What are the Thenar muscles that often become weak due to lack of nerve innervation in carpal tunnel syndrome? *use the acronym LOAF* |
L - Lumbricals O - Opponenspollicis A - AbductorPoll Brevis F - FlexorPoll Brevis |
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What is the clinical examination test and sign which are specific to carpal tunnel syndrome? |
Phalen's test - Dorsal aspect of both hands pressed against each other then compressed for a minute. Positive result = onset of tingling in hand Tinel's sign - tapping over dorsal wrist and proximal part of palm. Positive result = numbness in first three and half digits |
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What is the non-operative treatment for carpal tunnel syndrome? |
Wrist splint at night Steroid injection |
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What is the surgical treatment for carpal tunnel syndrome? |
Decompression surgery |
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What nerve is compressed in cubital tunnel syndrome and what is the site of entrapment? |
Ulnar nerve is compressed in cubital tunnel syndrome. The elbow is the site of entrapment. |
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What is the common cause of onset for cubital tunnel syndrome? |
Prolonged and recurrent pressure on ulnar nerve due to pressure from elbow fracture. |
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What fingers become numb and tingly in cubital tunnel syndrome? |
Cubital tunnel causes compression of the ulnar nerve. This is the nerve that lies over the funny bone. When you bash your funny bone the little finger and ring finger are tingly. Therefore it is the little finger and ring finger that are affected in carpal tunnel syndrome. |
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What is the clinical presentation of somebody with cubital tunnel syndrome? |
Numbness/tingling in little finger/ring finger Increased tingling with activity Worse on bending the elbow Pain around elbow Clawing of hand Wasting of interossei and hypothenar muscles History of elbow fracture History of occupation that involves bending elbow or leaning on elbow (e.g desk work) |
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What is the non-operative treatment for cubital tunnel syndrome? |
Activity modification Extension splint |
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What is the operative treatment for cubital tunnel syndrome? |
Surgical decompression |
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What type of tissue do ganglion cysts arise from and in what part of the body do they commonly present? |
Ganglion cysts are fluid filled swellings arising from a joint capsule, tendon sheath or ligament. Can occur alongside any joint but most commonly the wrist. |
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What is the most common area of the body for a ganglion cyst to arise? |
The back of the wrist joint |
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What sex and age group commonly get ganglia? |
Females Age 20-40 *may be associated with recurrent injury around the wrist* |
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How do ganglia clinically present? |
Present with smooth lump usually on hand or wrist Firm, non-tender Normally not fixed to any underlying tissue Often painless but can cause discomfort |
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What is the non-operative and operative treatment of a ganglia? |
Non-operative = Aspiration Operative = Excision, |
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What are the symptoms of osteoarthritis in the base of the thumb? |
Pain Stiffness Swelling Deformity Loss of function - pain opening jars and pinching *mum has it* |
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How common is osteoarthtirs in the base of the thumb? |
V common! 1 in 3 women. |
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What is the operative and non-operative treatment for OA at the base of the thumb? |
Non-operatvie = NSAIDs, splint, steroid injection Operative = Trapeziectomy - removal of the trapezium which is a small bone at the base of the thumb. GOLD STANDARD TREATMENT |
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What is the gold standard treatment for receiving the symptoms of OA at the base of the thumb? |
Trapeziectomy +/- ligament reconstruction |
