🔹
🔹Due to the contracture of the palmar fascia.
🔹
🔹
Common among men, Usually seen in the 50- to 70- age group.
Fixed flexion deformity. of the MCP & PIP joints
Dupuytren’s Contracture
🔹ItUsually seen in the ring or little finger.
is the contracture of the palmar aponeurosis which results in
the flexion deformity of the fingers, Ring and the little fingers are
commonly involved.
🔹
Treatment
Minor deformities are treated nonoperatively
and patients are advised to take care of the
predisposing factors, e.g. alcohol intake to be
🔹
reduced.
In those cases where the contracture is severe
and painful surgical excision of the contracted
tissue is advised.
🔹 Result of contracture of the intrinsic muscles, Often seen
The deep parts of the ulnar nerve may be compressed at the 🔹
after trauma or in patients with RA
Flexion of the MCP & DIP joints & extension of the PIP
joint
wrist as it enters the hand through the canal of Guyon beside
🔹
the pisiform. Swan-Neck Deformity
The condition is so excessively uncommon that for
practical purposes all ulnar nerve problems arise at the elbow Ulnar nerve compression at the
wrist
Treatment
If the symptoms are severe, which is unusual, and the lesion is
proven by electrical studies, surgical decompression is 🔹 Result of the rupture of the central tendinous slip of
required.
🔹
the extensor hood
🔹 Most common after trauma or in RA
🔹
Extension of the MCP & DIP joints & flexion of the
🔹 Intrinsic minus hand PIP joint
Boutonniere Deformity
Loss of intrinsic muscle action & the overaction of the extrinsic muscles on
🔹
the proximal phalanx of the fingers
🔹Combined median & ulnar nerve palsy
MCP joints are hyperextended & the PIP & DIP joints are flexed
Claw Fingers
2
🔹 🔹
🔹 Result of the rupture or avulsion of the extensor
🔹 Ulnar nerve palsy
Wasting of the hypothenar muscles of the
Bishop’s Hand or Benediction Hand
tendon where it inserts in the distal phalanx of the
hand, the interossei muscles, & the two
Deformity 🔹 Distal phalanx rests in a flexed position
finger
🔹 Flexion of the 4th & 5th fingers
lumbrical muscles
Mallet Finger
🔹
🔹 Median nerve palsy
🔹 Inability to oppose or flex the thumb
Wasting of the thenar eminence of the hand
Ape Hand Deformity
🔹 Caused by rupture of the flexor
🔹
digitorum profundus tendon
🔹 Common among football players
Jersey Finger 🔹Inability to flex the affected DIP joint
Occurs most often in the ring finger
which becomes apparent when the patient
🔹
🔹 Radial nerve palsy
Paralysis of the extensor muscles of the wrist Wrist Drop Deformity 🔹
is asked to make a fist
Positive sweater finger sign
🔹 Due to weakening of the capsuloligamentous
structures of the MCP joints & the
Osteochondritis of the lunate is described on. It accompanying bowstring effect if the extensor
Ulnar Drift
may cause pain in the wrist on gripping andat
the extremes of the range of movement. A firm Kienböck’s disease 🔹
communis tendons
🔹 Commonly seen in patients with RA
Ulnar deviation of the digits
splint is usually helpful and operation is seldom
needed.
It is known as trigger finger because a bent and
🔹
🔹 Infection in the hand is a serious matter.
The function of the hand depends upon smooth soft
locked finger opens with a snap,
i.e. like a trigger, on straightening
tissues sliding over each other and anything that causes
adhesions between the ‘moving parts’ has serious
consequences. 🔹 This is the result of inflammation of the tendon sheath of the
🔹
flexor tendon of the finger.
As the sheath gets thickened the canal for the gliding of the
tendon narrows and triggering develops.
Trigger Finger/Thumb
🔹
Etiology
🔹 More common in women than in men and in diabetics.
1 Those who are involved in manual labor which involves
grippng of a hard object are at a greater risk of developing
trigger finger.
🔹 Infections of the nail fold, or paronychia, is a common
wrist and hand
🔹
problem.
The infection begins with a break in the skin of the nail
conditions 🔹
Treatment
🔹 Begins with non-operative measures in mild and early cases.
fold and spreads from there to the subungual space, where 🔹 If symptoms are not relieved surgical release is done.
a. Nonoperatively treated by anti inflammatory drugs and
🔹
it causes severe pain by raising tissue tension.
The lesion is seen less often now than in the past,
perhaps because people keep their hands cleaner.
🔹
steroid infiltration into the flexor tendon sheath.
b. Surgically treated by the release of the flexor tendon sheath
🔹This relieves the symptoms permanently.
A1.
Treatment
🔹 The lesion should be cleaned, antibiotics administered and
🔹
the hand elevated.
Unless there is a rapid improvement, the edge of the nail
should be raised and the pus evacuated, or the proximal half Nail fold infections
🔹
of the nail removed.
This must be done under general or regional Anaesthesia, 🔹 A ganglion is a collection of thick fluid, similar to synovial fluid, surrounded by a
no local anesthesia
🔹
thin layer of synovium in the soft tissues around joints and tendons.
Although these cysts are called ganglia they have no connection with the nervous
🔹
system.
Synovial fluid is produced by synovial cells, which normally secrete synovial fluid
🔹
into the joint space.
If the cells secrete fluid into the soft tissues rather than the joint cavity then a
🔹
ganglion results.
The lesions can form around any joint or tendon sheath but do not communicate
Ganglion
🔹
with the joint space.
Some extend inside the sheaths of peripheral nerves and cause peripheral nerve
damage. Others extend deep to periosteum and involve bone
🔹 Pulp space infections, often referred to by the ancient name of
🔹
‘whitlow’, usually begin with a penetrating injury .
🔹 The pulp has many stout, fibrous septa, which
make the pulp of the finger firm but also prevent soft tissue
Clinical features
🔹 Ganglia usually appear in early adult life and are particularly noticeable on the
🔹
swelling.
This in turn means that even a small collection of pus causes
🔹
back of the wrist, associated with the scapholunate ligament.
They also occur on the front of the wrist, where they emerge between the
🔹 if the digit is accidentally knocked.
severe pain, particularly 🔹 Ganglia vary in size, ache after the hand is used, and interfere with its function.
flexor tendons and the radial artery.
Treatment
Treatment
🔹 🔹 Ganglia sometimes rupture or disappear spontaneously after an
🔹 Treatment is similar to that of paronychia.
If rest, antibiotics and elevation do not bring rapid relief, the Pulp space infections 🔹
accidental blow.
If they do not disappear spontaneously and interfere with function,
🔹
pus should be released through a transverse or oblique incision excision is required.
in the side of the pulp If the ganglion is causing neurological problems, early excision is
🔹 If not, operation is best deferred for as long as possible.
indicated.
🔹 Seen in patients who perform activities requiring forceful
gripping with radial deviation of the wrist, or repetitive use of
De Quervain’s Syndrome 🔹
the thumb
Insidious onset of pain & tenderness over the dorsal radial
Infection 🔹Positive Finkelstein’s test
aspect of the wrist
🔹 The web space between adjacent fingers 🔹 It is the compression of the median nerve in the carpal tunnel causing
contains loose tissue, and quite large abscesses
🔹
numbness in the hand.
If left untreated paralysis of the thenar muscles takes place over a period of
🔹
can form with little local pain or tissue tension .
Penetrating injury is the usual cause.
🔹Rarely severe sensory disturbance and trophic ulcers can develop
time.
Treatment
If elevation and adequate antibiotics do not
bring rapid relief, a short incision is needed to
Web space infections
Etiology
For a compression to occur either the
🔹
Attachment of Flexor retinaculum:
Medially
i. Pisiform
drain the pus.
volume of the contents in the canal should
increase Or the amount of space in the canal
should decrease.
🔹
ii. Hook of hamate
Laterally
i. Tubercle of scaphoid
ii. Crest of trapezium.
🔹 a. Space occupying lesions in the canal such as ganglion,
tenosynovitis, lipoma, etc. increase the volume of the contents in the
🔹
canal and cause compression.
b. Malunited Colles’ fracture, degenerative and inflammatory
arthritis of the wrist decrease the amount of space in the canal and
🔹 Tendon sheaths infected by spread from the pulp or by
🔹
cause the compression.
c. Physiological cause is pregnancy. The compression is transitory. It
🔹
penetrating injuries provide an easy route for bacterial spread.
The finger quickly becomes painful and is held in slight flexion becomes normal after delivery
🔹
because the volume of the sheath is greatest in this position.
🔹 Any movement is excruciating.
Carpal Tunnel Syndrome
Diagnosis
The extent of the infection is dictated by the anatomy of the
tendon sheaths. 🔹 a. Patient presents with diminished sensation and pain along the
🔹
distribution of the median nerve in the hand.
Starts initially at night and then becomes more constant. Interferes with
🔹
Treatment
The consequences of adhesions in the tendon sheath are 🔹
daily activities.
🔹 b. Phalen’s test positive.
worse than paronychia or pulp space infections and more
🔹d.c. Nerve
Tinel’s sign positive.
🔹
energetic treatment is needed. conduction velocity shows delay in conduction.
The patient must be admitted, the arm elevated and antibiotics Infection of the tendon sheaths
🔹
given in adequate doses.
🔹 Intravenous antibiotics are advisable.
Unless there is a response within 6 h, the tendon sheath should
be opened at each end and then irrigated.
Treatment
🔹 Nonoperative treatment is indicated if the compression is not due to
🔹 There are two spaces in the hand, the thenar and hypothenar spaces,
🔹
space occupying lesions.
Measures undertaken are rest to the part, supportive splints and
bounded by fascial sheaths that act as bulkheads to prevent the spread of 🔹
anti-inflammatory drug therapy.
🔹 Infiltration of the tunnel with steroids can also be tried.
🔹
infection.
Infection can follow spread from infection in adjacent structures, penetrating
If no relief is obtained surgical decompression is undertaken by
dividing the flexor retinaculum at the wrist.
🔹
injury,or spread from the web space by way of the lumbricals.
The pain and clinical signs are less dramatic than in the infections described
previously because the infection is deeper and there is more room for the
🔹
infection to spread.
The hand is diffusely swollen, finger movement is restricted, and deep
pressure over the infected space is painful.
by fatema okoff Infection of the deep spaces
🔹
Treatment
The patient should be admitted, the arm elevated and antibiotics given
🔹
intravenously.
Unless there is a rapid response, the appropriate space should be
decompressed by an experienced hand surgeon who is familiar with the
detailed anatomy of these spaces.
🔹Due to the contracture of the palmar fascia.
🔹
🔹
Common among men, Usually seen in the 50- to 70- age group.
Fixed flexion deformity. of the MCP & PIP joints
Dupuytren’s Contracture
🔹ItUsually seen in the ring or little finger.
is the contracture of the palmar aponeurosis which results in
the flexion deformity of the fingers, Ring and the little fingers are
commonly involved.
🔹
Treatment
Minor deformities are treated nonoperatively
and patients are advised to take care of the
predisposing factors, e.g. alcohol intake to be
🔹
reduced.
In those cases where the contracture is severe
and painful surgical excision of the contracted
tissue is advised.
🔹 Result of contracture of the intrinsic muscles, Often seen
The deep parts of the ulnar nerve may be compressed at the 🔹
after trauma or in patients with RA
Flexion of the MCP & DIP joints & extension of the PIP
joint
wrist as it enters the hand through the canal of Guyon beside
🔹
the pisiform. Swan-Neck Deformity
The condition is so excessively uncommon that for
practical purposes all ulnar nerve problems arise at the elbow Ulnar nerve compression at the
wrist
Treatment
If the symptoms are severe, which is unusual, and the lesion is
proven by electrical studies, surgical decompression is 🔹 Result of the rupture of the central tendinous slip of
required.
🔹
the extensor hood
🔹 Most common after trauma or in RA
🔹
Extension of the MCP & DIP joints & flexion of the
🔹 Intrinsic minus hand PIP joint
Boutonniere Deformity
Loss of intrinsic muscle action & the overaction of the extrinsic muscles on
🔹
the proximal phalanx of the fingers
🔹Combined median & ulnar nerve palsy
MCP joints are hyperextended & the PIP & DIP joints are flexed
Claw Fingers
2
🔹 🔹
🔹 Result of the rupture or avulsion of the extensor
🔹 Ulnar nerve palsy
Wasting of the hypothenar muscles of the
Bishop’s Hand or Benediction Hand
tendon where it inserts in the distal phalanx of the
hand, the interossei muscles, & the two
Deformity 🔹 Distal phalanx rests in a flexed position
finger
🔹 Flexion of the 4th & 5th fingers
lumbrical muscles
Mallet Finger
🔹
🔹 Median nerve palsy
🔹 Inability to oppose or flex the thumb
Wasting of the thenar eminence of the hand
Ape Hand Deformity
🔹 Caused by rupture of the flexor
🔹
digitorum profundus tendon
🔹 Common among football players
Jersey Finger 🔹Inability to flex the affected DIP joint
Occurs most often in the ring finger
which becomes apparent when the patient
🔹
🔹 Radial nerve palsy
Paralysis of the extensor muscles of the wrist Wrist Drop Deformity 🔹
is asked to make a fist
Positive sweater finger sign
🔹 Due to weakening of the capsuloligamentous
structures of the MCP joints & the
Osteochondritis of the lunate is described on. It accompanying bowstring effect if the extensor
Ulnar Drift
may cause pain in the wrist on gripping andat
the extremes of the range of movement. A firm Kienböck’s disease 🔹
communis tendons
🔹 Commonly seen in patients with RA
Ulnar deviation of the digits
splint is usually helpful and operation is seldom
needed.
It is known as trigger finger because a bent and
🔹
🔹 Infection in the hand is a serious matter.
The function of the hand depends upon smooth soft
locked finger opens with a snap,
i.e. like a trigger, on straightening
tissues sliding over each other and anything that causes
adhesions between the ‘moving parts’ has serious
consequences. 🔹 This is the result of inflammation of the tendon sheath of the
🔹
flexor tendon of the finger.
As the sheath gets thickened the canal for the gliding of the
tendon narrows and triggering develops.
Trigger Finger/Thumb
🔹
Etiology
🔹 More common in women than in men and in diabetics.
1 Those who are involved in manual labor which involves
grippng of a hard object are at a greater risk of developing
trigger finger.
🔹 Infections of the nail fold, or paronychia, is a common
wrist and hand
🔹
problem.
The infection begins with a break in the skin of the nail
conditions 🔹
Treatment
🔹 Begins with non-operative measures in mild and early cases.
fold and spreads from there to the subungual space, where 🔹 If symptoms are not relieved surgical release is done.
a. Nonoperatively treated by anti inflammatory drugs and
🔹
it causes severe pain by raising tissue tension.
The lesion is seen less often now than in the past,
perhaps because people keep their hands cleaner.
🔹
steroid infiltration into the flexor tendon sheath.
b. Surgically treated by the release of the flexor tendon sheath
🔹This relieves the symptoms permanently.
A1.
Treatment
🔹 The lesion should be cleaned, antibiotics administered and
🔹
the hand elevated.
Unless there is a rapid improvement, the edge of the nail
should be raised and the pus evacuated, or the proximal half Nail fold infections
🔹
of the nail removed.
This must be done under general or regional Anaesthesia, 🔹 A ganglion is a collection of thick fluid, similar to synovial fluid, surrounded by a
no local anesthesia
🔹
thin layer of synovium in the soft tissues around joints and tendons.
Although these cysts are called ganglia they have no connection with the nervous
🔹
system.
Synovial fluid is produced by synovial cells, which normally secrete synovial fluid
🔹
into the joint space.
If the cells secrete fluid into the soft tissues rather than the joint cavity then a
🔹
ganglion results.
The lesions can form around any joint or tendon sheath but do not communicate
Ganglion
🔹
with the joint space.
Some extend inside the sheaths of peripheral nerves and cause peripheral nerve
damage. Others extend deep to periosteum and involve bone
🔹 Pulp space infections, often referred to by the ancient name of
🔹
‘whitlow’, usually begin with a penetrating injury .
🔹 The pulp has many stout, fibrous septa, which
make the pulp of the finger firm but also prevent soft tissue
Clinical features
🔹 Ganglia usually appear in early adult life and are particularly noticeable on the
🔹
swelling.
This in turn means that even a small collection of pus causes
🔹
back of the wrist, associated with the scapholunate ligament.
They also occur on the front of the wrist, where they emerge between the
🔹 if the digit is accidentally knocked.
severe pain, particularly 🔹 Ganglia vary in size, ache after the hand is used, and interfere with its function.
flexor tendons and the radial artery.
Treatment
Treatment
🔹 🔹 Ganglia sometimes rupture or disappear spontaneously after an
🔹 Treatment is similar to that of paronychia.
If rest, antibiotics and elevation do not bring rapid relief, the Pulp space infections 🔹
accidental blow.
If they do not disappear spontaneously and interfere with function,
🔹
pus should be released through a transverse or oblique incision excision is required.
in the side of the pulp If the ganglion is causing neurological problems, early excision is
🔹 If not, operation is best deferred for as long as possible.
indicated.
🔹 Seen in patients who perform activities requiring forceful
gripping with radial deviation of the wrist, or repetitive use of
De Quervain’s Syndrome 🔹
the thumb
Insidious onset of pain & tenderness over the dorsal radial
Infection 🔹Positive Finkelstein’s test
aspect of the wrist
🔹 The web space between adjacent fingers 🔹 It is the compression of the median nerve in the carpal tunnel causing
contains loose tissue, and quite large abscesses
🔹
numbness in the hand.
If left untreated paralysis of the thenar muscles takes place over a period of
🔹
can form with little local pain or tissue tension .
Penetrating injury is the usual cause.
🔹Rarely severe sensory disturbance and trophic ulcers can develop
time.
Treatment
If elevation and adequate antibiotics do not
bring rapid relief, a short incision is needed to
Web space infections
Etiology
For a compression to occur either the
🔹
Attachment of Flexor retinaculum:
Medially
i. Pisiform
drain the pus.
volume of the contents in the canal should
increase Or the amount of space in the canal
should decrease.
🔹
ii. Hook of hamate
Laterally
i. Tubercle of scaphoid
ii. Crest of trapezium.
🔹 a. Space occupying lesions in the canal such as ganglion,
tenosynovitis, lipoma, etc. increase the volume of the contents in the
🔹
canal and cause compression.
b. Malunited Colles’ fracture, degenerative and inflammatory
arthritis of the wrist decrease the amount of space in the canal and
🔹 Tendon sheaths infected by spread from the pulp or by
🔹
cause the compression.
c. Physiological cause is pregnancy. The compression is transitory. It
🔹
penetrating injuries provide an easy route for bacterial spread.
The finger quickly becomes painful and is held in slight flexion becomes normal after delivery
🔹
because the volume of the sheath is greatest in this position.
🔹 Any movement is excruciating.
Carpal Tunnel Syndrome
Diagnosis
The extent of the infection is dictated by the anatomy of the
tendon sheaths. 🔹 a. Patient presents with diminished sensation and pain along the
🔹
distribution of the median nerve in the hand.
Starts initially at night and then becomes more constant. Interferes with
🔹
Treatment
The consequences of adhesions in the tendon sheath are 🔹
daily activities.
🔹 b. Phalen’s test positive.
worse than paronychia or pulp space infections and more
🔹d.c. Nerve
Tinel’s sign positive.
🔹
energetic treatment is needed. conduction velocity shows delay in conduction.
The patient must be admitted, the arm elevated and antibiotics Infection of the tendon sheaths
🔹
given in adequate doses.
🔹 Intravenous antibiotics are advisable.
Unless there is a response within 6 h, the tendon sheath should
be opened at each end and then irrigated.
Treatment
🔹 Nonoperative treatment is indicated if the compression is not due to
🔹 There are two spaces in the hand, the thenar and hypothenar spaces,
🔹
space occupying lesions.
Measures undertaken are rest to the part, supportive splints and
bounded by fascial sheaths that act as bulkheads to prevent the spread of 🔹
anti-inflammatory drug therapy.
🔹 Infiltration of the tunnel with steroids can also be tried.
🔹
infection.
Infection can follow spread from infection in adjacent structures, penetrating
If no relief is obtained surgical decompression is undertaken by
dividing the flexor retinaculum at the wrist.
🔹
injury,or spread from the web space by way of the lumbricals.
The pain and clinical signs are less dramatic than in the infections described
previously because the infection is deeper and there is more room for the
🔹
infection to spread.
The hand is diffusely swollen, finger movement is restricted, and deep
pressure over the infected space is painful.
by fatema okoff Infection of the deep spaces
🔹
Treatment
The patient should be admitted, the arm elevated and antibiotics given
🔹
intravenously.
Unless there is a rapid response, the appropriate space should be
decompressed by an experienced hand surgeon who is familiar with the
detailed anatomy of these spaces.
