Deformities of the Hand

Heberden’s is DJD of

DIPs, calcified spurs on articular cartilage of bone; thickening of jt capsule

Bouchard’s nodes is DJD of

PIP joints, less common

Dupuytren’s contracture is a contracture of the palmar fascia. Causes

flexion deformity in 4th & 5th digits (also 3rd in severe cases)

Dupuytren’s contracture prevalence/population

Usually occurs >40 y/o

Men > women

Genetic Component

Surgical manipulation: Collagenase clostridium histolyticum

Swan neck deformity includes hypermobility of

PIP & volar plate injury

Swan neck deformity shows a bow stringing of lateral bands due to

contracture of intrinsic muscles: Palmar interossei

Swan neck deformity presentation is

PIP hyperextended

DIP & MCP flexed

Swan neck deformity etiology

RA, neurovascular lesion

Boutonnière deformity is due to rupture of the

central slip of extensor hood, seen w/ Trauma or RA

Boutonnière deformity presentation

Extension of MCP & DIP

Flexion of PIP

Mallet finger is an avulsion fx of the

extensor tendon

mallet finger presents w/ no active extension of

DIP joint is possible

Mallet finger MOI:

jamming a finger in bball or volleyball (Iceman Jason)

De Quervain’s Tenosynovitis definition

Stenosing tenosynovitis of 1st dorsal extensor compartment

De Quervain’s Tenosynovitis anatomy involved

APL/EPB: share 1st dorsal ext compartment (apple & peanut butter)

De Quervain’s Tenosynovitis clinical presentation

Thumb activity produces ↑ pain

Tenderness & edema over/distal to radial styloid

Pain produced w/ resisted thumb ext & abduction

Pain w/ active or passive ulnar deviation w/ thumb flexed ((+) Finkelstein test)

De Quervain’s Tenosynovitis differential diagnosises

radial nerve entrapment

ligamentous

scaphoid/lunate jt dysfunction

C-spine

De Quervain’s Tenosynovitis diagnostic techniques

Finkelstein Test (+)

ULTT - assess for involvmnt of superficial radial n: It passes over snuff box, examine for sensory changes

Trigger Finger pathology of Flexor tenosynovitis presents w/ a thickening/fibrosis of a tendon, synovial sheath, &/or annular pulley. Flexor tendon can’t glide normally w/in sheath due to a thickening or nodule that catches at the

1st annular pulley (A-1). Nodule may be palpable

The finger may locked in a flexed position

Differential Diagnosis of Wrist & Hand. 1st Rule out proximal contributions (C-spine). Additionally investigate the

MOI: Traumatic Vs atraumatic

Neurology: Altered Sensation, Isolated weakness in myotomal or peripheral nerve patterns, reflexes

Pain location: What structures live in the area

Lifestyle & occupations considerations