Disorders of the Hand 2024-2025 PDF

Disorders of the hand Dr Ayman Mansour Introduction  Functions of the hand Motor Pinch: - Tip pinch - Pulp pinch - Lateral pinch - Five finger pinch Grip: - Power grip - Diagonal grip - Transverse grip...

Disorders of the hand Dr Ayman Mansour Introduction  Functions of the hand Motor Pinch: - Tip pinch - Pulp pinch - Lateral pinch - Five finger pinch Grip: - Power grip - Diagonal grip - Transverse grip - Extension grip Hook  Functions of hand Sensory Stereognosis (position ,size, shape, etc.) Pinprick Light touch  Muscles of the hand Three group of muscles act on the fingers long flexors long extensors intrinsic muscles Hand disorders  1. Ganglion 58pj A ganglion cyst is a mucous-filled synovial cyst caused by either: trauma mucoid degeneration synovial herniation Arises from a joint or tendon sheath No true epithelial lining  1. Ganglion 60-70% dorsal wrist ganglion (scapholunate joint) - 18 -20% volar ganglion 10 -20% in the flexor sheath  1. Ganglion Dorsal Volar Tendon sheath ganglion ganglion ganglion  1. Ganglion Treatment: Conservative: watch and wait, aspiration Surgical: excision ↳ pan or appearance  2. De Quervain’s tenosynovitis Stenosing tenosynovitis of the first dorsal extensor compartment  2. De Quervain’s tenosynovitis Very common 1:1000 0F>M shormone Risk factors: retchedwond common birth) - Overuse Giving - Post-traumatic - Post-partum on radial opain Diagnosis is made clinically with radial aspect of wrish sided wrist pain made worse with the Finkelstein maneuver (ulnar deviation of a closed fist)  2. De Quervain’s tenosynovitis othumb Slab/Splint Treatment: Conservative rest steroid injection anti-inflammatory Surgical compartment release - remove "roof" of Compartic  3. Trigger Finger is the inhibition of smooth tendon gliding due to turn a mechanical impingement at the level of the A1 pulley that causes progressive pain, clicking, catching, and locking of the digit tendon enlarges & · inflammation stuck in pulley  3. Trigger Finger Congenital (thumb) developmental - Growth mismatch to leading A - often not recognised until toddlers - 30% resolve spontaneously our terdon Acquired (middle aged) - idiopathic - traumatic - diabetes - rheumatoid  3. Trigger Finger Conservative steroid injection Surgical release of A1 pulley  4. Congenital hand anomalies An estimate of 1 in 600 live births A very wide range of anomalies exist Common anomalies include Polydactyly Presence of an extra digit or part of a digit According to functional disability treatment may range from reassurance to surgical excision of the extra digit  4. Congenital hand anomalies Syndactyly Fusion of two or more digits, due to failure of segmentation or separation during embryo formation According to functional disability and complexity treatment may range from simple stretching and rehabilitation to surgical separation of the fused digits  4. Congenital hand anomalies Congenital trigger thumb Constriction or narrowing of the A1 pulley of the thumb According to patient presentation treatment may range from simple stretching and rehabilitation to surgical release of the pulley  5. Dupuytren’s disease Dupuytren's Disease is a benign proliferative disorder characterized by decreased hand function caused by hand contractures and painful fascial nodules. of the Palmar Fascia ~ Condensation  5. Dupuytren’s disease M:F 2:1 Anatomic location:000E ring > small > middle > index MCPJ and/or PIPJ not DIPJ Risk factors: Genetic Geographical: most commonly in caucasian males Alcohol >  5. Dupuytren’s disease Symptoms decreased ROM affecting ADL Activities of daily living painful nodules Hueston's tabletop test: ask patient to place palm flat on table look for MCPJ or PIPJ contracture  5. Dupuytren’s disease exercises early Stretching : * -> Surgery if:- rapidly progressive contracture or inconvenience Palmar fasciectomy: excision of diseased palmar fascia Amputation: in severe cases  6. Pulp space infection (Felon) reach it , blood supply t AB doesn't has no direct to necrosis liable -diaphysis more Pulp space contains fat partioned by fibrous septae Septae: from periosteom to skin Closed compartment Pressure on blood vessels can result in necrosis of diaphysis Epiphesis is saved because blood supply proximal to space -immediate Treatment: incision - and drainage must be * all Septe drained -  7. Pyogenic flexor tenosynovitis into Redid) Spread · very Fast wrist-Mid - bursa > - Unar forezim Infection of the synovial sheath that surrounds the flexor tendon Staph Aureus (most common) Presentation (Kanavel’s signs): flexed posture tenderness pain with passive extension fusiform swelling drainage push water > & - immediate inscision - with B  8.Finger extensor tendon injuries outh comp- 4 tendons calSlipmidepana philant · extend p - can · p 8.Finger extensor tendon injuries Mallet finger: Rupture or avulsion of distal tendon insertion - - Treatment with Mallet splint undet & Soft in tissue not bury - need sugy 8.Finger extensor tendon injuries extend Boutonniere deformity: · Can't middle phalant Rupture of the central slip Finger is flexed at the proximal interphalangeal joint (PIP) and hyperextended at the distal interphalangeal joint (DIP) Boutonniere - splint gyy de to soft tissue pathology)  9. Carpal tunnel syndrome Carpal tunnel contains 9 tendons + Median nerve Median nerve entrapment neuropathy Thenar weakness or atrophy Dec pu epet Numbness and tingling in radial 3 ½ digits >  9. Carpal tunnel syndrome Aetiology: Decrease in the size of the canal: osteoarthritis trauma acromegaly Increase in the size of its contents: pregnancy rheumatoid arthritis alcoholism tumor idiopathic  9. Carpal tunnel syndrome Clinically: Tinel sign Tapping on the median nerve to unevue hypersensiting pressure Phalen’s test wrist volar flexion against gravity for 60 sec produces symptoms  9. Carpal tunnel syndrome Conservative it at night splint > - wear steroid injection Medications Surgical decompression: Release of the transverse carpal ligament  10. Volkmann L Ischemic Contracture -ot acte ischemia Deformity of the hand and wrist, that is caused by contracture of forearm muscles (2-3 was) to muscle contracture prolonged to blood supply leading ~ The condition may be caused by either Increased forearm compartment pressure Following fractures Burns Bleeding disorders Vascular injury that leads to muscle ischemia  10. Volkmann Ischemic Contracture Clinical picture Hand, wrist and sometimes forearm deformity (claw like) => Loss of hand functions - Flexors take Diminished sensation - Upperhand Curre Treatment > - No = According to severity, the following modalities may be utilized Mild cases – stretching, rehabilitation. May require surgery to lengthen tendons Moderate cases – multiple soft tissue procedures may be required. E.g Tendon lengthening, tendon transfer, bone shortening. Severe cases – in addition to above procedures, tendon grafts may be required. Ischemic, contractured muscles, fascia, tendons are excised. Thank you