6 - Hand Deformities, Fractures, and Palsy

6 - Hand Deformities, Fractures, and Palsy -...

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Hand Deformities, Fractures,  and palsy By Adnan AL-Maaitah
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NOTE The following subjects are NOT mentioned in the guidelines Dupuytren contracture (slides 28-31) Hand fractures (32-45) Hand palsy (46-57) Sry, but I got the guidelines after finishing the seminar
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- Mallet deformity - Trigger Finger - Boutonniere Deformity - Swan – Neck deformity - Dupuytren contracture
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Mallet Finger  Aka: baseball finger Deformity in which the fingertip is curled in and cannot straighten itself Due to injury to extensor digitorium tendons at DIPJ
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Mallet Finger/Causes Forced flexion of the finger when finger is extended: . Sport Injury: Finger struck by volleyball, basketball or baseball when it is in extension . Other common mechanisms of injury include forcefully tucking in a bedspread or slipcover or pushing off a sock with extended fingers.
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Mallet Finger/Presentation After DIPJ forced flexion: inability to actively extend the distal joint, intact full passive extension Often injury is painless or nearly painless Dorsum of joint may be slightly tender and swollen Order X-ray to make sure there are no fractures
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Despite active extension effort, the distal interphalangeal joint of the index finger rests in flexion, characteristic of a mallet finger
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This x-ray depicts a large, dorsal-lip avulsion fracture from the distal phalanx, a bony mallet injury.
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Mallet Finger/Managment Mallet finger splint (6- 10 weeks) Surgery: In case of volar sublaxation of distal phalanx or avulsion fracture K-wire (Kirschner wire)
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Anteroposterior radiographic view of finger after 4 weeks. The longitudinal K-wire is blocking the distal interphalangeal joint from flexion to protect the repair
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Trigger Finger Trigger finger is the popular name of stenosing tenosynovitis, a painful condition in which a finger or thumb locks when it is bent (flexed) or straightened (extended).
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Trigger Tension Due to narrowing of the sheath that surrounds the tendon in the affected finger, or a nodule forms on the tendon. Trigger finger is often an overuse injury because of repetitive or frequent movement of the fingers (ex. hobbies as playing a musical instrument or crocheting) Trigger finger may also result from trauma or accident It is called trigger finger because when the finger unlocks , it pops back suddenly, as if releasing a trigger on a gun.
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Trigger Tension Clinical Picture: Affected digits may become painful to straighten once bent May make a soft crackling sound when moved. It props back suddenly when straightened Symptoms are usually worse in the morning and improve during the day Treatment: local steroid injections and splinting (weeks to months) Surgery: cut the sheath that is restricting the tendon.
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Trigger Tension
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Introduction of the needle into the tendon sheath at 45° to the palm for injection treatment.
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Boutonniere Deformity Aka: Buttonhole Deformity Hyperflexion at the PIP joint with hyperextension at the DIP Passive extension of the PIP joint is easy.
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6 - Hand Deformities, Fractures, and Palsy -...

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