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Common Hand andFoot Disorders

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Common handproblems

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Function of the hand

Motor

grasp

pinch - tip pressure

- pulp pressure

- lateral pressure

hook

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Function of hand

sensory

stereognosis (position ,size, shape,etc.)

Pinprick

light touch

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Rapid assessment of hand

function

space and stability

open and close

pinch and touch

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Muscles of the hand

Three group of muscles act on the fingers

long flexors

long extensors

intrinsic muscles

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Ganglion

cystic swelling in theneighbourhood of

tendon or joint

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Ganglion

pathology

wall

lining

content

uni.. or multilocular cyst

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Ganglion

formation

large no. of closely packed cells

formation of cavity

mucoid degeneration ? ischemia

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Ganglion

site

60-70% dorsal wrist ganglion

(scapholunate joint)

18 -20% volar ganglion

10 - 20% in the flexorsheath

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Ganglion

treatment

conservative

surgical

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Carpal Tunnel Syndrome

(CTS)

The entrapment of the median

nerve at the fibro osseous

tunnel of the carpus.

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CTS

Aetiology

Decrease in the size of the canal

osteoarthritis

trauma

acromegaly

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CTS

Aetiology 2

increase in the size of its contents

pregnancy

rheumatoid arthritis

alcoholism

tumour

idiopathic

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CTS

Clinical Picture

patients in their 40s

female > male

pain (nocturnal)

numbness

clumsiness

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CTS

signs

wasting of thener eminence

numbness

weakness

Tinnel sign

Phalen sign

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CTS

Treatment

non operative

splint

steroid injection

surgical decompression

arthroscopic

open

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De Quervains Disease

Stenosing tenovaginitis of the firstdorsal extensor compartment

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De Quervains

Treatment

non operative

rest

steroid injection

anti-inflamatory

operative

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Trigger Fingers

stenosing tenovaginitis of the

flexor tendon sheath(A1 pulley)

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Trigger Finger

aetiology

congenital (thumb)often not recognised until toddlers

30% resolve spontaneously

acquired (middle aged)idiopathic

traumaticdiabetes

rheumatoid

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Trigger Finger

treatment

non operative

steroid injection

operative

release of A1 pulley

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Dupuytrens Contracture

nodular hypertrophy and contracture

of the palmar fascia

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Dupuytrens Contracture

aetiology

genetic

geographical

smoking

alcohol

epilepsy

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Dupuytrens 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

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Dupuytrens Contracture

treatment

Surgery if:-rapidly progressive contracture

inconvenience

fasciotomy

fasciectomyamputation

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Foot Disorders

deformities

arthritis

pain

D f iti

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Deformities

Pes Planus

physiological

congenital (vertical talus)

joint hypermobility

paralytic

compensatory

spasmodic (peroneal muscle spasm)

P Pl

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Pes Planus

Peroneal muscle spasm

tarsal coalition

infectioninflammatory arthritis

fractures

D f iti

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Deformities

Pes Cavus

idiopathic

neurological abnormality eg spinal dysraphism

peroneal muscular atrophy

Friedrichs ataxia

D f iti

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Deformities

Hallux Valgus

female > male

adolescent (familial)

middle aged

H ll V l

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Hallux Valgus

symptoms

deformity

painbunion

metatarsalgia

MT-P OAhammer toe

H ll V l

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Hallux Valgus

treatment

Soft tissue balancing

distal osteotomy

proximal osteotomy

excision

fusion

D f iti

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Deformities

Lesser toes

curly toes

claw toes (neurological)

hammer toes

mallet toes

overlapping

L t d f iti

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Lesser toe deformities

treatment

modify footwear

tendon release / transfer

excision

arthrodesis

O t th iti

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Osteoarthritis

Hallux Rigidus

male > female

repeated trauma

loss of dorsiflexion

H ll Ri id

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Hallux Rigidus

treatment

rocker sole

dorsal cheilectomy

extension osteotomy

arthrodesis

excision

replacement

Rh t id th iti

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Rheumatoid arthritis

hindfoot

Ankle pain and swelling

tenosynovitisankle or sub-talar joint

Ankle and tarsal joint erosion anddeformity

Rhe matoid arthritis

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Rheumatoid arthritis

forefoot

hallux valgus

claw toes

MT-P dislocation

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Foot pain

Mechanical pressure

foot-shoe mismatch

joint inflammation

bone lesion

peripheral vascular disease

muscle strain

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Heel pain

Severs disease

heel bumps

peritendonitisplantar fasciitis

idiopathic

ankylosing spondylitis Reiters disease

gonorrhoea

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Midfoot pain

Khlers disease

tarsal boss

osteoarthritis

tarsal tunnel syndrome

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Forefoot pain

hallux valgus

hammer toeFreibergs disease

stress fracture

Mortons neuroma