Hand Pathologies

Question 1

What is Duputren’s contracture?

Answer 1

1. A proliferative connective tissue disorder
2. Leads to the formation of nodules and cord
3. Progresses to contractures at the MCP and PIP joints

Question 2

What is the pathology behind Dupuytren’s contracture?

Answer 2

1. Proliferation of myofibroblast cells
2. Production of abnormal collagen (type 3 vs type 1)

Question 3

Dupuytren’s contracture most commonly affects which fingers?

Answer 3

1. Ring finger
2. Little finger

Question 4

What are the risk factors for developing Dupuytren’s contracture?

Answer 4

1. Male gender
2. North European/Scandinavian descent
3. Alcoholic cirrhosis
4. Phenytoin therapy
5. Diabetes
6. Other fibromatosis

Question 5

Besides Dupuytren’s contracture, name two other fibromatoses

Answer 5

1. Peyronie’s disease (penis)
2. Lederhose disease (plantar fibromatosis)

Question 6

What does surgery for Dupuytren’s contracture involve?

Answer 6

1. Removal of diseased tissue (fasciectomy)
2. Division of cords (fasciotomy)
3. Amputation (for the most severe cases)

Question 7

How is trigger finger caused?

Answer 7

1. Tendonitis of a flexor tendon can cause nodular enlargement
2. This can cause the tendon to get trapped under the fascial pulley
3. Usually the involved pulley is the A1 pulley

Question 8

Why may a patient who has trigger finger experience their finger becoming trapped in a flexed position?

Answer 8

The nodule of the flexor tendon (as a result of tendonitis) becomes trapped under the fascial pulley

Question 9

Which fingers are most commonly implicated in trigger finger?

Answer 9

Middle and ring fingers

Question 10

How can symptoms be quickly relieved in trigger finger?

Answer 10

Injection of steroid around the tendon

Question 11

If trigger finger is recurrent, what is the treatment?

Answer 11

Surgery to incise the affected pulley to allow free movemnt of the tendon

(division of just the A1 pulley does not affect function)

Question 12

Postmenopausal women are associayed with high rates of OA in which joints in the hand?

Answer 12

DIP joints

Question 13

How may mild-moderate OA in the hand be treated?

Answer 13

Removal of osteophytes and excision of associated mucous cysts

Question 14

How may severe OA in the hand be treated?

Answer 14

Arthrodesis

Question 15

In order to preserve pincer grip, which treatment is required for OA at the index finger?

Answer 15

Arthrodesis

(other fingers can have replacement arthroplasty)

Question 16

Which joints in the hand are least commonyl affected by OA?

Answer 16

MCP joints

Question 17

Which single joint in the hand is commonly affected by OA especially in women?

Answer 17

1st carpo-metacarpal joint

Question 18

How can OA in the 1st carpo-metacarpal joint be treated?

Answer 18

1. Injection of steroid aids an acute flare up
2. Excision arthroplasty (trapeziectomy) or fusion for chronic pain

Question 19

Which joints does RA avoid in the hand?

Answer 19

DIP joints

Question 20

What are the three stages of hand disease in RA?

Answer 20

1. Synovitis and tenosynovitis (swelling and pain)
2. Erosions of the joints (inflammatory pannus)
3. Joint instability and tendon rupture (subluxation and chronic tenosynovitis may cause extensor tendon ruptures)

Question 21

What are the common hand deformities of RA?

Answer 21

1. Volar MCP joint subluxation
2. Ulnar deviation
3. Swan neck deformity (hyperextension at PIPJ with flexion at DIPJ)
4. Boutonniere deformity (Flexion at PIPJ with hyperextension at DIPJ)
5. Z-shaped thumb

Question 22

Which procedure may prevent tendon rupture in RA?

Answer 22

Tenosynovectomy

Question 23

If extensor tendons to the wrist or fingers rupture in RA, which treatment is not suitable and which treatment is suitable for preserving function?

Answer 23

1. Direct surgical repair cannot be undertaken due to the diseased state of the tendon
2. Tendon transfers or joint fusions are required to preserve function

Question 24

How are

a) Contractures associated with RA treated
b) Affected joints with serve arthritic damage treated?

Answer 24

a) Soft tissue releases
b) Joint replacements or fusions