Hand and Foot Disorders

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Common Hand and Foot Disorders

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Hand and Foot Disorders

  1. 1. Common Hand and Foot Disorders
  2. 2. Common hand problems
  3. 3. Function of the hand Motor <ul><li>grasp </li></ul><ul><li>pinch - tip pressure </li></ul><ul><li> - pulp pressure </li></ul><ul><li> - lateral pressure </li></ul><ul><li>hook </li></ul>
  4. 4. Function of hand sensory <ul><li>stereognosis (position ,size, shape,etc.) </li></ul><ul><li>Pinprick </li></ul><ul><li>light touch </li></ul>
  5. 5. Rapid assessment of hand function <ul><li>space and stability </li></ul><ul><li>open and close </li></ul><ul><li>pinch and touch </li></ul>
  6. 6. Muscles of the hand <ul><li>Three group of muscles act on the fingers </li></ul><ul><li>long flexors </li></ul><ul><li>long extensors </li></ul><ul><li>intrinsic muscles </li></ul>
  7. 7. Ganglion <ul><ul><ul><ul><ul><li>cystic swelling in the neighbourhood of </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>tendon or joint </li></ul></ul></ul></ul></ul>
  8. 8. Ganglion pathology <ul><li>wall </li></ul><ul><li>lining </li></ul><ul><li>content </li></ul><ul><li>uni.. or multilocular cyst </li></ul>
  9. 9. Ganglion formation <ul><li>large no. of closely packed cells </li></ul><ul><li>formation of cavity </li></ul><ul><li>mucoid degeneration ? ischemia </li></ul>
  10. 10. Ganglion site <ul><li>60-70% dorsal wrist ganglion </li></ul><ul><li>(scapholunate joint) </li></ul><ul><li>18 -20% volar ganglion </li></ul><ul><li>10 - 20% in the flexor sheath </li></ul>
  11. 11. Ganglion treatment <ul><li>conservative </li></ul><ul><li>surgical </li></ul>
  12. 12. Carpal Tunnel Syndrome (CTS) <ul><ul><ul><ul><ul><li>The entrapment of the median </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>nerve at the fibro osseous </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>tunnel of the carpus . </li></ul></ul></ul></ul></ul>
  13. 13. CTS Aetiology <ul><li>Decrease in the size of the canal </li></ul><ul><li>osteoarthritis </li></ul><ul><li>trauma </li></ul><ul><li>acromegaly </li></ul>
  14. 14. CTS Aetiology 2 <ul><li>increase in the size of its contents </li></ul><ul><li>pregnancy </li></ul><ul><li>rheumatoid arthritis </li></ul><ul><li>alcoholism </li></ul><ul><li>tumour </li></ul><ul><li>idiopathic </li></ul>
  15. 15. CTS Clinical Picture <ul><li>patients in their 40s </li></ul><ul><li>female > male </li></ul><ul><li>pain (nocturnal) </li></ul><ul><li>numbness </li></ul><ul><li>clumsiness </li></ul>
  16. 16. CTS signs <ul><li>wasting of thener eminence </li></ul><ul><li>numbness </li></ul><ul><li>weakness </li></ul><ul><li>Tinnel sign </li></ul><ul><li>Phalen sign </li></ul>
  17. 17. CTS Treatment <ul><li>non operative </li></ul><ul><li>splint </li></ul><ul><li>steroid injection </li></ul><ul><li>surgical decompression </li></ul><ul><li>arthroscopic </li></ul><ul><li>open </li></ul>
  18. 18. De Quervains Disease <ul><li>Stenosing tenovaginitis of the first dorsal extensor compartment </li></ul>
  19. 19. De Quervain’s Treatment <ul><li>non operative </li></ul><ul><li>rest </li></ul><ul><li>steroid injection </li></ul><ul><li>anti-inflamatory </li></ul><ul><li>operative </li></ul>
  20. 20. Trigger Fingers <ul><li>stenosing tenovaginitis of the </li></ul><ul><li>flexor tendon sheath(A1 pulley) </li></ul>
  21. 21. Trigger Finger aetiology <ul><li>congenital (thumb) </li></ul><ul><ul><ul><li>often not recognised until toddlers </li></ul></ul></ul><ul><ul><ul><li>30% resolve spontaneously </li></ul></ul></ul><ul><li>acquired (middle aged) </li></ul><ul><ul><ul><li>idiopathic </li></ul></ul></ul><ul><ul><ul><li>traumatic </li></ul></ul></ul><ul><ul><ul><li>diabetes </li></ul></ul></ul><ul><ul><ul><li>rheumatoid </li></ul></ul></ul>
  22. 22. Trigger Finger treatment <ul><li>non operative </li></ul><ul><ul><ul><li>steroid injection </li></ul></ul></ul><ul><li>operative </li></ul><ul><ul><ul><li>release of A1 pulley </li></ul></ul></ul>
  23. 23. Dupuytren’s Contracture <ul><li>nodular hypertrophy and contracture </li></ul><ul><li>of the palmar fascia </li></ul>
  24. 24. Dupuytren’s Contracture aetiology <ul><li>genetic </li></ul><ul><li>geographical </li></ul><ul><li>smoking </li></ul><ul><li>alcohol </li></ul><ul><li>epilepsy </li></ul>
  25. 25. Dupuytren’s Contracture clinical <ul><li>middle aged </li></ul><ul><li>male 10 x female </li></ul><ul><li>nodular thickening in the palm </li></ul><ul><li>contracture of the ring and little finger </li></ul><ul><li>MCPJ and/or IPJ not DIPJ </li></ul>
  26. 26. Dupuytren’s Contracture treatment <ul><li>Surgery if:- </li></ul><ul><ul><ul><li>rapidly progressive contracture </li></ul></ul></ul><ul><ul><ul><li>inconvenience </li></ul></ul></ul><ul><li>fasciotomy </li></ul><ul><li>fasciectomy </li></ul><ul><li>amputation </li></ul>
  27. 27. Foot Disorders <ul><li>deformities </li></ul><ul><li>arthritis </li></ul><ul><li>pain </li></ul>
  28. 28. Deformities Pes Planus <ul><li>physiological </li></ul><ul><li>congenital (vertical talus) </li></ul><ul><li>joint hypermobility </li></ul><ul><li>paralytic </li></ul><ul><li>compensatory </li></ul><ul><li>spasmodic (peroneal muscle spasm) </li></ul>
  29. 29. Pes Planus Peroneal muscle spasm <ul><ul><ul><li>tarsal coalition </li></ul></ul></ul><ul><ul><ul><li>infection </li></ul></ul></ul><ul><ul><ul><li>inflammatory arthritis </li></ul></ul></ul><ul><ul><ul><li>fractures </li></ul></ul></ul>
  30. 30. Deformities Pes Cavus <ul><li>idiopathic </li></ul><ul><li>neurological abnormality eg </li></ul><ul><ul><ul><ul><li>spinal dysraphism </li></ul></ul></ul></ul><ul><ul><ul><ul><li>peroneal muscular atrophy </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Friedrich’s ataxia </li></ul></ul></ul></ul>
  31. 31. Deformities Hallux Valgus <ul><li>female > male </li></ul><ul><li>adolescent (familial) </li></ul><ul><li>middle aged </li></ul>
  32. 32. Hallux Valgus symptoms <ul><li>deformity </li></ul><ul><li>pain </li></ul><ul><ul><ul><li>bunion </li></ul></ul></ul><ul><ul><ul><li>metatarsalgia </li></ul></ul></ul><ul><ul><ul><li>MT-P OA </li></ul></ul></ul><ul><ul><ul><li>hammer toe </li></ul></ul></ul>
  33. 33. Hallux Valgus treatment <ul><li>Soft tissue balancing </li></ul><ul><li>distal osteotomy </li></ul><ul><li>proximal osteotomy </li></ul><ul><li>excision </li></ul><ul><li>fusion </li></ul>
  34. 34. Deformities Lesser toes <ul><li>curly toes </li></ul><ul><li>claw toes (neurological) </li></ul><ul><li>hammer toes </li></ul><ul><li>mallet toes </li></ul><ul><li>overlapping </li></ul>
  35. 35. Lesser toe deformities treatment <ul><li>modify footwear </li></ul><ul><li>tendon release / transfer </li></ul><ul><li>excision </li></ul><ul><li>arthrodesis </li></ul>
  36. 36. Osteoarthritis Hallux Rigidus <ul><li>male > female </li></ul><ul><li>repeated trauma </li></ul><ul><li>loss of dorsiflexion </li></ul>
  37. 37. Hallux Rigidus treatment <ul><li>rocker sole </li></ul><ul><li>dorsal cheilectomy </li></ul><ul><li>extension osteotomy </li></ul><ul><li>arthrodesis </li></ul><ul><li>excision </li></ul><ul><li>replacement </li></ul>
  38. 38. Rheumatoid arthritis hindfoot <ul><li>Ankle pain and swelling </li></ul><ul><ul><ul><li>tenosynovitis </li></ul></ul></ul><ul><ul><ul><li>ankle or sub-talar joint </li></ul></ul></ul><ul><li>Ankle and tarsal joint erosion and deformity </li></ul>
  39. 39. Rheumatoid arthritis forefoot <ul><li>hallux valgus </li></ul><ul><li>claw toes </li></ul><ul><li>MT-P dislocation </li></ul>
  40. 40. Foot pain <ul><li>Mechanical pressure </li></ul><ul><ul><ul><ul><li>foot-shoe mismatch </li></ul></ul></ul></ul><ul><li>joint inflammation </li></ul><ul><li>bone lesion </li></ul><ul><li>peripheral vascular disease </li></ul><ul><li>muscle strain </li></ul>
  41. 41. Heel pain <ul><li>Sever’s disease </li></ul><ul><li>heel bumps </li></ul><ul><li>peritendonitis </li></ul><ul><li>plantar fasciitis </li></ul><ul><ul><ul><ul><li>idiopathic </li></ul></ul></ul></ul><ul><ul><ul><ul><li>ankylosing spondylitis </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Reiter’s disease </li></ul></ul></ul></ul><ul><ul><ul><ul><li>gonorrhoea </li></ul></ul></ul></ul>
  42. 42. Midfoot pain <ul><li>Köhler’s disease </li></ul><ul><li>tarsal boss </li></ul><ul><li>osteoarthritis </li></ul><ul><li>tarsal tunnel syndrome </li></ul>
  43. 43. Forefoot pain <ul><li>hallux valgus </li></ul><ul><li>hammer toe </li></ul><ul><li>Freiberg’s disease </li></ul><ul><li>stress fracture </li></ul><ul><li>Morton’s neuroma </li></ul>

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