Hand Disorders and Ganglion Cysts

Hand Disorders

• Hand disorders are a common medical issue
• Hand function is complex; encompassing motor and sensory aspects
• There are three main groups of muscles acting on the fingers: long flexors, long extensors, and intrinsic muscles.
• There are various types of hand disorders
• The lecture covers Ganglion, De Quervain's tenosynovitis, Trigger finger, Congenital hand anomalies, Dupuytren's disease, Pulp space infection, Pyogenic flexor tenosynovitis, Finger extensor tendon injuries, and Carpal tunnel syndrome, Volkmann Ischemic Contracture.

Ganglion

• A ganglion cyst is a mucus-filled synovial cyst
• It is caused by trauma, mucoid degeneration, or synovial herniation
• It originates from a joint or tendon sheath
• It lacks a true epithelial lining
• Dorsal wrist ganglion is the most common type (60-70%)
• Volar ganglion accounts for 18-20%
• The remaining 10-20% are in the flexor sheath
• Treatment options for ganglion cysts include conservative management like observation and aspiration as well as surgical excision

De Quervain's Tenosynovitis

• A very common condition (1:1000) more prevalent in females
• Risk factors include overuse, post-traumatic injuries, and post-partum conditions
• Diagnosis is confirmed clinically with a positive Finkelstein maneuver (ulnar deviation of a closed fist) causing radial-sided wrist pain
• Treatment includes conservative measures like rest, steroid injections, and anti-inflammatory medications
• Surgical compartment release is an option if conservative treatments do not resolve the condition

Trigger Finger

• Trigger finger is the inhibition of smooth tendon gliding due to mechanical impingement at the A1 pulley level
• It leads to progressive pain, clicking, catching, and locking of the digit.
• Trigger finger can be congenital (developmental) or acquired (middle-aged related)
• Congenital cases are often not recognized until toddlers, with 30% spontaneously resolving
• Acquired trigger finger is associated with idiopathic conditions, trauma, diabetes, and rheumatoid arthritis
• Treatment options include steroid injections and surgical release of the A1 pulley

Congenital Hand Anomalies

• A wide range of anomalies are estimated to occur in approximately 1 in 600 live births
• Common anomalies include polydactyly (extra digits), syndactyly (fused digits), and congenital trigger thumb
• Treatment varies widely according to specific type and functional disability and ranges from simple stretching to surgical intervention

Dupuytren's Disease

• A benign proliferative disorder characterized by decreased hand function due to contractures, and painful fascial nodules.
• It tends to affect ring, small, middle, and index fingers mostly in Caucasian males over time.
• M:F ratio is 2:1
• Associated risks include genetics, geographical factors like Caucasian ethnicity, and alcohol consumption
• Symptoms include decreased range of motion affecting ADLs and painful nodules. Diagnosis is supported by the Hueston tabletop test placing palm flat on table looking for contractures
• Treatment involves stretching exercises and potentially surgical palmar fasciectomy or amputation (in severe cases)

Pulp Space Infection (Felon)

• Pulp space infections are localized to the pulp space, a fat-filled area partitioned by fibrous septae.
• Infection is a common problem within the pulp
• Pressure on blood vessels can lead to necrosis of the diaphysis but not the epiphysis which is supplied by proximal blood vessels
• Treatment involves incision and drainage.

Pyogenic Flexor Tenosynovitis

• An infection of the synovial sheath surrounding flexor tendons common for cases of Staph Aureus infections.
• Diagnosis is clinically supported by Kanavel's signs: flexed posture, tenderness, pain with passive extension, and fusiform swelling.
• Treatment typically involves immediate incision and drainage along with irrigation.

Finger Extensor Tendon Injuries

• Injuries to these tendons can affect the extensor hood, leading to conditions like mallet finger (rupture or avulsion of distal tendon insertion) and boutonniere deformity (rupture of the central slip).
• Treatment varies, and often involve splints or surgery depending on condition severity.

Carpal Tunnel Syndrome

• The carpal tunnel contains nine tendons and the median nerve.
• Median nerve entrapment neuropathy can lead to thenar weakness or atrophy.
• Numbness and tingling are common symptoms, specifically in the radial 3.5 digits.
• Causes of carpal tunnel syndrome include: decrease in canal size such as osteoarthritis, trauma, and acromegaly as well as increased content size such as pregnancy, rheumatoid arthritis, tumors, and idiopathic conditions
• Clinically supported by Tinel sign (tapping the median nerve) and Phalen's test (volar wrist flexion for 60 seconds)
• Conservative treatment includes splints, steroid injections, and medications. Surgical decompression involves releasing the transverse carpal ligament.

Volkmans Ischemic Contracture

• A deformity of the hand and wrist that is caused by the prolonged decrease in blood supply leading to muscle contracture (2-3 weeks)
• The condition may be caused by increased forearm compartment pressure, following fractures, burns, or bleeding disorders, and vascular injuries leading to muscle ischemia
• Characterized by hand, wrist, and possibly forearm deformity with claw-like appearance, loss of hand function, decreased sensation.
• Treatment varies based on the severity: mild cases involve exercises and rehabilitation; moderate cases may require multiple soft tissue interventions (e.g., tendon lengthening, tendon transfers, bone shortening); surgery (tendon grafts, excision) in severe cases.

This quiz covers various hand disorders, focusing on their complexities, underlying mechanics, and specific conditions such as Ganglion cysts. Participants will learn about different types of hand ailments, their causes, and treatment options, enhancing their understanding of hand functionality and associated medical issues.