Common Hand and Foot Disorders

Common hand problems

Function of the handMotor

grasp pinch - tip pressure

- pulp pressure - lateral pressure

hook

Function of handsensory

stereognosis (position ,size, shape,etc.)

Pinprick

light touch

Rapid assessment of hand function

space and stability

open and close

pinch and touch

Muscles of the hand

Three group of muscles act on the fingers

long flexors long extensorsintrinsic muscles

Ganglion

cystic swelling in the neighbourhood of

tendon or joint

Ganglionpathology

wallliningcontentuni.. or multilocular cyst

Ganglionformation

large no. of closely packed cells

formation of cavity

mucoid degeneration ? ischemia

Ganglionsite

60-70% dorsal wrist ganglion (scapholunate joint)

18 -20% volar ganglion

10 - 20% in the flexor sheath

Gangliontreatment

conservative

surgical

Carpal Tunnel Syndrome (CTS)

The entrapment of the mediannerve at the fibro osseous

tunnel of the carpus.

CTSAetiology

Decrease in the size of the canal

osteoarthritistraumaacromegaly

CTSAetiology 2

increase in the size of its contentspregnancyrheumatoid arthritis alcoholismtumour idiopathic

CTSClinical Picture

patients in their 40s female > malepain (nocturnal)numbnessclumsiness

CTSsigns

wasting of thener eminencenumbnessweaknessTinnel signPhalen sign

CTSTreatment

non operative splint steroid injection

surgical decompression arthroscopic open

De Quervains Disease

Stenosing tenovaginitis of the first dorsal extensor compartment

De Quervain’sTreatment

non operative rest steroid injection anti-inflamatory

operative

Trigger Fingers

stenosing tenovaginitis of theflexor tendon sheath(A1 pulley)

Trigger Fingeraetiology

congenital (thumb)often not recognised until toddlers30% resolve spontaneously

acquired (middle aged)idiopathictraumaticdiabetesrheumatoid

Trigger Fingertreatment

non operativesteroid injection

operativerelease of A1 pulley

Dupuytren’s Contracture

nodular hypertrophy and contracture

of the palmar fascia

Dupuytren’s Contracture aetiology

genetic geographicalsmokingalcohol epilepsy

Dupuytren’s Contracture clinical

middle agedmale 10 x femalenodular thickening in the palmcontracture of the ring and little

fingerMCPJ and/or IPJ not DIPJ

Dupuytren’s Contracturetreatment

Surgery if:-rapidly progressive contractureinconvenience

fasciotomyfasciectomyamputation

Foot Disordersdeformities

arthritis

pain

DeformitiesPes Planus

physiologicalcongenital (vertical talus)joint hypermobilityparalyticcompensatoryspasmodic (peroneal muscle spasm)

Pes PlanusPeroneal muscle spasm

tarsal coalitioninfectioninflammatory arthritisfractures

DeformitiesPes Cavus

idiopathic

neurological abnormality eg•spinal dysraphism•peroneal muscular atrophy•Friedrich’s ataxia

DeformitiesHallux Valgus

female > male

adolescent (familial)

middle aged

Hallux Valgussymptoms

deformity

painbunionmetatarsalgiaMT-P OAhammer toe

Hallux Valgustreatment

Soft tissue balancingdistal osteotomyproximal osteotomyexcisionfusion

DeformitiesLesser toes

curly toesclaw toes (neurological)hammer toesmallet toesoverlapping

Lesser toe deformitiestreatment

modify footwear

tendon release / transfer

excision

arthrodesis

OsteoarthritisHallux Rigidus

male > female

repeated trauma

loss of dorsiflexion

Hallux Rigidustreatment

rocker soledorsal cheilectomyextension osteotomyarthrodesisexcisionreplacement

Rheumatoid arthritishindfoot

Ankle pain and swellingtenosynovitisankle or sub-talar joint

Ankle and tarsal joint erosion and deformity

Rheumatoid arthritisforefoot

hallux valgus

claw toes

MT-P dislocation

Foot pain

Mechanical pressure•foot-shoe mismatch

joint inflammationbone lesionperipheral vascular diseasemuscle strain

Heel pain

Sever’s diseaseheel bumpsperitendonitisplantar fasciitis

•idiopathic•ankylosing spondylitis•Reiter’s disease•gonorrhoea

Midfoot pain

Köhler’s disease

tarsal boss

osteoarthritis

tarsal tunnel syndrome

Forefoot pain

hallux valgushammer toeFreiberg’s diseasestress fractureMorton’s neuroma