Hand disorders

Slide 1: Common Hand and Foot Disorders

Slide 2: Common hand problems

Slide 3: Function of the hand Motor grasp pinch - tip pressure - pulp pressure - lateral pressure hook

Slide 4: Function of hand sensory „ stereognosis (position ,size, shape,etc.) „ Pinprick „ light touch

Slide 5: Rapid assessment of hand function „ space and stability „ open and close „ pinch and touch

Slide 6: Muscles of the hand Three group of muscles act on the fingers „ long flexors „ long extensors „ intrinsic muscles

Slide 7: Ganglion cystic swelling in the neighbourhood of tendon or joint

Slide 8: Ganglion pathology wall „ lining „ content „ uni.. or multilocular cyst „

Slide 9: Ganglion formation „ large no. of closely packed cells „ formation of cavity „ mucoid degeneration ? ischemia

Slide 10: Ganglion site „ 60-70% dorsal wrist ganglion (scapholunate joint) „ 18 -20% volar ganglion „ 10 - 20% in the flexor sheath

Slide 11: Ganglion treatment „ conservative „ surgical

Slide 12: Carpal Tunnel Syndrome (CTS) The entrapment of the median nerve at the fibro osseous tunnel of the carpus.

Slide 13: CTS Aetiology Decrease in the size of the canal „ osteoarthritis „ trauma „ acromegaly

Slide 14: CTS Aetiology 2 increase in the size of its contents „ pregnancy „ rheumatoid arthritis „ alcoholism „ tumour „ idiopathic

Slide 15: CTS Clinical Picture patients in their 40s „ female > male „ pain (nocturnal) „ numbness „ clumsiness „

Slide 16: CTS signs wasting of thener eminence „ numbness „ weakness „ Tinnel sign „ Phalen sign „

Slide 17: CTS Treatment „ non operative splint steroid injection „ surgical decompression arthroscopic open

Slide 18: De Quervains Disease Stenosing tenovaginitis of the first dorsal extensor compartment

Slide 19: De Quervain’s Treatment „ non operative rest steroid injection anti-inflamatory „ operative

Slide 20: Trigger Fingers stenosing tenovaginitis of the flexor tendon sheath(A1 pulley)

Slide 21: Trigger Finger aetiology „ congenital (thumb) ‚ often not recognised until toddlers ‚ 30% resolve spontaneously „ acquired (middle aged) idiopathic ‚ traumatic ‚ diabetes ‚ rheumatoid ‚

Slide 22: Trigger Finger treatment „ non operative ‚ steroid injection „ operative ‚ release of A1 pulley

Slide 23: Dupuytren’s Contracture nodular hypertrophy and contracture of the palmar fascia

Slide 24: Dupuytren’s Contracture aetiology genetic „ geographical „ smoking „ alcohol „ epilepsy „

Slide 25: Dupuytren’s Contracture clinical middle aged „ male 10 x female „ nodular thickening in the palm „ contracture of the ring and little finger „ MCPJ and/or IPJ not DIPJ „

Slide 26: Dupuytren’s Contracture treatment Surgery if:- ‚ rapidly progressive contracture ‚ inconvenience „ fasciotomy „ fasciectomy „ amputation

Slide 27: Foot Disorders „ deformities „ arthritis „ pain

Slide 28: Deformities Pes Planus physiological „ congenital (vertical talus) „ joint hypermobility „ paralytic „ compensatory „ spasmodic (peroneal muscle spasm) „

Slide 29: Pes Planus Peroneal muscle spasm tarsal coalition ‚ infection ‚ inflammatory arthritis ‚ fractures ‚

Slide 30: Deformities Pes Cavus „ idiopathic „ neurological abnormality eg • spinal dysraphism • peroneal muscular atrophy • Friedrich’s ataxia

Slide 31: Deformities Hallux Valgus „ female > male „ adolescent (familial) „ middle aged

Slide 32: Hallux Valgus symptoms „ deformity „ pain pbunion o metatarsalgia nMT-P OA mhammer toe

Slide 33: Hallux Valgus treatment Soft tissue balancing „ distal osteotomy „ proximal osteotomy „ excision „ fusion „

Slide 34: Deformities Lesser toes curly toes „ claw toes (neurological) „ hammer toes „ mallet toes „ overlapping „

Slide 35: Lesser toe deformities treatment „ modify footwear „ tendon release / transfer „ excision „ arthrodesis

Slide 36: Osteoarthritis Hallux Rigidus „ male > female „ repeated trauma „ loss of dorsiflexion

Slide 37: Hallux Rigidus treatment rocker sole „ dorsal cheilectomy „ extension osteotomy „ arthrodesis „ excision „ replacement „

Slide 38: Rheumatoid arthritis hindfoot „ Ankle pain and swelling ‚ tenosynovitis ‚ ankle or sub-talar joint „ Ankle and tarsal joint erosion and deformity

Slide 39: Rheumatoid arthritis forefoot „ hallux valgus „ claw toes „ MT-P dislocation

Slide 40: Foot pain „ Mechanical pressure • foot-shoe mismatch joint inflammation „ bone lesion „ peripheral vascular disease „ muscle strain „

Slide 41: Heel pain Sever’s disease „ heel bumps „ peritendonitis „ plantar fasciitis „ • idiopathic • ankylosing spondylitis • Reiter’s disease • gonorrhoea

Slide 42: Midfoot pain „ Köhler’s disease „ tarsal boss „ osteoarthritis „ tarsal tunnel syndrome

Slide 43: Forefoot pain hallux valgus „ hammer toe „ Freiberg’s disease „ stress fracture „ Morton’s neuroma „