Common Hand and Foot Disorders
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Transcript of Common Hand and Foot Disorders
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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