Hand & Wrist Conditions Dr. Gavin Nimon Head of Upper Limb - - PowerPoint PPT Presentation

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Hand & Wrist Conditions

• Dr. Gavin Nimon

Head of Upper Limb Surgery- QEH

Senior Lecturer- University of Adelaide

MBBS FRACS (Orth) FRCS (Ed)

www.glenelgorthopaedics.com.au Gavin Anthony Nimon University of Adelaide-intern 1990 bst 91-93 Edinburgh/ Newcastle –Orthopaedic Registrar 1994 Advanced Trainee –Orthopaedics 1995-1998 Senior Registrar Year 1999 QEH Senior Registrar/ Consultant PMR Edinburgh Consultant DGRI 2000-2005 Senior Lecturer University of Adelaide- QEH Head of Upper Limb Specialty- The Queen Elizabeth Hospital

Profile

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My Approach to Assessing and treating Orthopaedic Issues

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Metacarpal fracture Distal metacarpal (5th= boxers fracture) Bennet’s fracture (unstable) Rolando’s fracture

www.glenelgorthopaedics.com.au Acute:-

• Undsiplaced-Splint
• Displaced-screw Fixation

Chronic:- ORIF and Bone Graft

Scaphoid fractures

Important not to miss diagnosis

• I see 1-2/year missed diagnosis
• Can occur after Torquing injury
• Futuro splint option if concern
• CT scan very good for diagnosis
• MRI

www.glenelgorthopaedics.com.au Wrist Fractures

• Very Common
• Many Osteoporotic- thus treatment later
• Not all benign
• Can cause significant functional problems
• CT – great for work up

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Wrist Dislocations ( perilunate )

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Mallet Finger (extensor tendon Rupture)

• Hit end of finger ( spiking ball/ making bed)
• Tendon avulses/ tears
• Stack finger splint 6 weeks

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Wrist Pain- some common diagnoses

Global- OA (x-ray changes) Tendinitis ( crepitus ) Radial- Radial styloid oa (xray) scaphoid fracture / Scapho-lunate (xray) deQuervains (u/s) CMC OA (xray) Ulnar-ECU tendinitis (u/s) TFCC (clinical) pisiform / triquetral oa (xray/ ct/ bone scan) Neurological - Carpal tunnel (ncs) Cubital tunnel (ncs) Referred from neck ( spurling’s test )

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Wrist Arthroscopy- Investigative tool

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Carpal Tunnel Syndrome

• Very Common
• Performed Under Local Anaesthesia
• Wide awake no tourniquet surgery
• Self- funded - cheaper as no assistant nor

anaethetist required

• Safe
• Quick recovery

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Trigger Finger DeQuervain’s Tenosynovitis

Stenosing Tenovaginitis

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OA and myxoid cysts

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Ganglions

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– Very common – Degenerative (female> male) – Grind test +ve – Tx

• Splint/ physiotherapy
• Steroid Injection
• Trapezectomy +/- suspensoplasty vs fusion
• K wire and plaster 4-6 weeks

CMC Osteoarthritis

CMC Fusion performed for arthritis

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CMC Fusion

www.glenelgorthopaedics.com.au Scaphoid fracture/ scapho-lunate dissociation- oa

Arthritis and scaphoid Non-union can be treated with scaphoid excision and partial fusion of wrist

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Keinboch’s disease

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– Very common in United Kingdom – Nordic Genes (Vikings) – Requires committed patient, for splinting, physiotherapy and wound care – High risk of recurrence – But results very good from surgery

• Risks
• Nerve damage
• Infection

Dupuytren’s Contracture