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30 Cards in this Set
- Front
- Back
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a ganglion cysts
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-most common tissues found in the hand/wrist -arises from the synovial lining of either a joint or tendon sheath -etiology is uncertain -3 types: -dorsal wrist ganglion -volar wrist ganglion -dorsal retinacular ganglion |
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dorsal wrist ganglion
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-most common ganglion cyst |
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volar wrist ganglion
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-second most common ganglion cyst |
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dorsal retinacular ganglion |
*base of the thumb* -attached to first extensor compartment -causes symptoms of Dequarvain's tenosynovitis -inflammation along that tendon sheath |
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occult dorsal carpal ganglion
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-small and difficult to palpate- differentiates it from a dorsal wrist ganglion -may be very painful |
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mucous cyst
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-DIPS are the most common site |
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DIP joint
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carpometacarpal boss
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-(2nd and 3rd fingers where carpal and metacarpals meet) |
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CMC joint
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between the carpals (1st wrist bones) and metacarpals (the long bones distal to them)
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conservative treatment of ganglions
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-splinting -aspiration of cyst (OTs won't do) |
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operative management of ganglions
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-may also have stiffness, pain, scarring, and nerve entrapment -post-op therapy protocols vary based on the type of cysts removed |
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timeline, interventions, and therapy ______ by type of tumor? |
vary |
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Dupuytren's Disease |
*ring finger and pinkie= tendon sheath is thickening ----> finger is pulled into flexion -exact etiology is unknown -causes: manual work, hand injury, epilepsy, HIV, alcoholism, and DM |
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diagnosis and pathology of Dupuytren's Disease
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-more prominent in: males, older than 60, in the ring finger -causes shortening of an increased tension in the longitudinal fascial bands |
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operative treatment
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-surgical excision of the diseased palmer fascia (most successful approach) -indication for surgery: flexion contractures >30 degrees -surgery does not mean full recovery (thumb may be restricted) |
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surgical approaches
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-fasciectomy -limited (selective) fasciectomy -dermofasciectomy |
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fasciotomy |
-divide the disease fascia through ha Z-plasty incision |
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fasciectomy
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excision of fascia and palmar aponeurosis |
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limited (selective) fasciectomy
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-usually used when only palm and/or ulnar-side digits are involved |
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dermofasciectomy
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-requires use of skin graft or healing by secondary intention |
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surgical complications
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-most often seen in cases of severe, extensive preoperative deformity and disease -infection/skin loss/ hematoma/ dehiscence/ injury of digital artery or nerve/ gangrene/ loss of flexion/ complex regional pain syndrome |
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preoperative evaluation
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-asses baseline functional level -postop course of care -expectations and realistic outcomes from surgery -requirements for therapy post surgery |
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(postoperative treatment) communicate with surgeon |
-discuss with them how they want the wound taken care of -type of splinting -ex: just worn at night and during some parts of the day |
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early postoperative treatment |
- maintain surgical gains (don't just let hand be stagnant after) -protect incision and structures (limit activates after) -splinting |
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(postoperative treatment) Edema Control |
-light compression (coban): wrap distal to proximal to push fluid in arm back towards body -gentle motion |
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(postoperative treatment) exercise |
*be sure to not overstress the structure |
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postoperative treatment weeks two to three
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-monitor for losses of flexion -wound care and scar management -exercise |
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postoperative treatment weeks three to six
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-scar management -exercise (more intense) |
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hands after surgery? |
-may be extremely sensitive (not use to touch/ new skin) |
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postoperative treatment weeks eight and later |
-need to monitor extension for up to six months post-surgery (normally only 4-8 weeks for OT) |
