In the absence of physical trauma, what appears to be a subungual hematoma might be a ___________ or __________ infection
Proteus or Pseudomonas infection
T/F?
When draining a subungual hematoma with any method you may have to repeat the procedure several times to provide a hole that is large enough to remain open for continued drainage
True
What do you advise the patient to do if the drainage hole made in a nail for a subungual hematoma closes up and pressure and pain reoccur?
- You may have to repeat this several times to provide a hole that is large enough to remain open for continued drainage
- If the hole clots shut then soak the digit in cold water; adding peroxide will help dissolve the clot
What are the 5 etiologies of onycholysis?
- Idiopathic
- Systemic (e.g., thyrotoxicosis)
- Congenital/hereditary
- Cutaneous diseases (e.g., psoriasis, drug-induced photo-onycholysis)
- Local causes (e.g., trauma, onychomycosis, chemicals)
What are the various causes of onychogryphosis?
- Acute injury – dropping something on toe
- Chronic injury – from ill-fitting shoes
- Infection
- Poor blood supply
- Diabetes
- Inadequate intake of nutrients
What are the four ways to help prevent onychogryphosis?
- Avoid footwear or stockings that gather at the toes.
- Keep nails trimmed.
- Avoid tight fitting foot wear.
- Avoid nail polish.
Tinea unguium (onychomycosis) is usually caused by one dermatophyte , either T. ____ or T. _____
trichophyton mentagrophytes or rubrum
What are thought to be the two likely causes of ganglion cysts?
- degenerative process in the mesoblastic tissues surrounding the joint
- herniation of a tendon sheath
What is the consistency of a ganglion cyst?
- Usually smooth and rounded; at other times multilocular
- Usually hard/firm – often misdiagnosed as a bony or cartilaginous lesion
- May be cystic and definitely fluctuant
T/F?
There may be an associated weakness of the area involved by the ganglion, such as weakness of the wrist, the finger, or the toe.
True
What are the three typical indications for treatment of ganglia?
- Relief of the pain/soreness
- Removal of the unsightly mass
- Relief of the feeling of weakness of the part
Know the “pros” and “cons” of the 4 types of treatments for a ganglion cyst.
- Rupture - striking with a heavy book or applying a sharp finger (no joke). pro- dramatic results. con- cure rate low, also considered malpractice
- Aspiration. con- contents are firm and jellylike so may be hard to aspirate, also may be difficult to ascertain that all content has been evacuated. Also, infection is a risk.
- Aspiration & Injection of sclerosing agent. con- injection produce moderate pain and local edema that lasts 1-2 days. Plus the sclerosing agent may damage surrounding structures. mixed results are obtained
- Excision. pro- most successful treatment but no guarantee of cure
*cure rate is only 50-80% for any of the above four methods.
