THE HAND'S NEW

8/12/2019 THE HAND'S NEW

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Clinical Assesment On TheHand

Pain: localized orreferedDeformity: suddenly

or slowlySwelling: localized ormany jointssimultantlyLoss of functions:handling tools,holding glass,etcSensory symptomsand motor weaknes:neurolgical deficit

Look: posture,colour, hair, scarred,wasting, deformity,

lumpFeel: temperature,texture, pulse,tendernessMove: active andpassive movements

Symptoms Sign


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Finger and ThumbMovements


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Congenital VariationsHand and foot aremuch the commonestsites of congenitalvariations in themusculoskeletalsystemCause:

Inherited genetic defect Chromosome disorder Viral infection,

radiation, drug

administration duringfirst 2 month of

There are sevengroups clinicaldisorderEarly recogniton anddefinitive treatment assoon as feasible andpreferable before the

age of 3 years.Psycological supportis important


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ACQUIRED DEFORMITIES


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ACQUIRED DEFORMITIES

SKIN CONTRACTUREMUSCLE CONTRACTURETENDON LESSIONJOINT DISORDERBONE DISORDERNEUROMUSCULAR DISORDER


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SKIN CONTRACTURE


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MUSCLE CONTRACTURE

Volkmanns Ischemic Contracture Shortening Of The Intrinsic Muscle


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A. MALLET FINGERB. RUPTURED EXTENSOR

POLLICIS LONGUSC. SWAN NECK DEFORMITY

A

EC

B

D

D. BOUTONIERE DEFORMITYE. DROPPED FINGER

TENDON LESSION


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JOINT DISORDER

JUVENILLE CHRONIC ARTHRITSSYSTEMIC LUPUSERYTHEMATOUSTRAUMA


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NEUROMUSCULARDISORDER

PERIPHERAL NERVE LESION


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DUPUYTRENS CONTRACTURE


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INTRODUCTION

DUPUYTRENS CONTRACTURE is anodular hypertrophy and contractureof the superficial palmar fascia.

It is inhereted as an autosomaldominant traitMore common in male, increase with

age, at an early stage meansaggressive disease.


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PATHOLOGY

Proliferation of myofibroblasts infibrous tissue within the palmar fasciaand fascial bands within the fingers

contract flexion deformities ofthe MCP and PIP joints.Fibrous attachments to the skin lead

to puckering. The digital nerve isdisplaced or enveloped, but notinvaded, by fibrous tissue.


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CLINICAL FEATURES

The palm is puckered, nodular andthickPainflexion deformities


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TREATMENT

Operation


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STENOSING TENOVAGINITIS(TRIGGER FINGER)


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INTRODUCTION

A flexor tendon may become trappedat the entrance to its sheath. Onforced extension it passes the

constriction with a snap (triggering).The usual cause is thickening of thefibrous tendon sheath ( often following

local trauma or unaccustomedactivity).


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TREATMENT

Early cases injection ofmethylprednisolone carefully placedinto the tendon sheath.

Refractory cases need operation.


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INTRODUCTION

The hand, more than any other region, iswhere rheumatoid arthritis carves itsstoryRheumatoid arthritis consist of 3 stage:o Stage 1 synovitis of joints and of

tendon sheaths.o Stage 2 joint & tendon erosions

prepare the ground for mechanicalderangement.o Stage 3 joint instability & tendon

ruptur cause progressive deformity andloss of function.


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CLINICAL FEATURESSTAGE 1 STAGE 2 STAGE 3

Stiffness, painfull,swellingof the fingers, the MCP joints, the PIP joints or thewrist.

slight radial deviation ofthe wrist and ulnardeviation of the fingers

Deformitiesare the rule

Carpal tunnelcompression

correctable swan-neck-ing

rheumatoidnodules

Symmetric weakness

Swelling of tendon sheaths a drop finger or malletthumb (from extensor

tendon rupture)The joints are tender andcrepitus

An isolated boutonniere

Joint mobility and grip

strength are diminished.


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Osteoarthritis

80% of people over the age of 65have radiological signs ofosteoarthritis in one or more joints of

the hand, include DIP, PIP, MCP, andCarpo-metacarpal joints,most of them are asymptomatic.


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OA IN PROXIMAL INTERPHALANGEALJOINTS

Not infrequently some of the PIP jointsare involved (Bouchards nodes).The joints are swollen and tend to

deviate ulnarwards due to mechanicalpressure in daily activities.


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Treatment is usually symptomaticNon-operative

Analgesic Appropriate rest

Operative

TREATMENT


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RAYNAUDS DISEASE


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RAYNAUDS DISEASE

Raynauds syndrome is produced by avasospastic disorder which affectsmainly the hands and fingers.

precipitated by cold; the fingers gopale and icy, then dusky blue (orcyanotic) and finally red. Between

attacks the hands look normal.


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RAYNAUDS DISEASE

Raynauds phenomenon is the termapplied when these changes areassociated with an underlying diseasesuch as scleroderma or arteriosclerosis.

Treatment :The hands must be kept warm.Calcium channel blockade,iloprost infusions or digitalsympathectomy (surgical removal of thesympathetic plexus around the digitalarteries)


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ACUTE INFECTIONS OF

THE HAND


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Acute Infections Of The Hand

Infection of the hand is frequentlylimited to one of generalcompartments

Usually the cause is a staphylococcuswhich has been implanted by fairlytrivial injury.

The response to infection is an acuteinflammatory reaction with oedema,suppuration and increased tissuetension.


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Clinical features

History of trauma (a superficialabrasion, laceration or penetratingwound)

Painfull, swollen, feversExamination: the finger or hand redand swollen, exquisitely ten over the

site of tension, examined forlymphangitis and swollen gland, signof septicaemia.

X-Ray: Osteomyelitis or septic


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A B C

(a) Acute nail-fold infection (paronychia)

(b) Chronic paronychia

(c) Pulp-space infection (felon or whitlow) of the thumbdue to a prick- injury on the patients own denture


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(a) Septic arthritis of the terminal interphalangeal(b) Infected insect bite.


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Principles of treatment

AntibioticsRest,

splintage and

elevation

Drainase Rehabilitation


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The position of the immobilization

This position in which the ligaments are at their

longest and splintage is least likely to result instiffness


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Thank

THE HAND'S NEW

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