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Essentials of Hand Surgery
Kevin C. Chung
SECTION 1: BASIC PRINCIPLES
CHAPTER 1:
Anatomy of the upper limb
INTRODUCTION
TERMINOLOGY
Palmar/volar surface
Dorsal surface
Radial and ulnar borders
Abduction and adduction
Flexion and extension
Pronosupination
EXTERNAL ANATOMY OF THE HAND
Skin and hand creases
Arches of the hand
Surface landmarks
INTERNAL ANATOMY OF THE HAND
Palmar aponeurosis (PA, Figure 1.5)
Carpal tunnel (Figure 1.7)
Guyon canal
Digital flexor sheath and pulley system
Extensor tendons
Intrinsic muscles (Figures 1.14 and 1.15)
Muscles supplied by the motor branch of the median nerve
Muscles supplied by the motor branch (deep branch) of the ulnar nerve
Skeletal framework of the hand
The metacarpophalangeal joint (MCP joint, Figure 1.16a and b )
The proximal interphalangeal joint (PIP joint, Figure 1.16a and b)
The distal interphalangeal joint (DIP joint, Figure 1.16a and b)
The wrist joint
Blood supply of the hand
Nerve supply of the hand
ANATOMY OF THE FOREARM
ANATOMY OF THE ARM
CHAPTER 2:
Objective evaluation of hand function
INTRODUCTION
INITIAL EVALUATION
Pain (0–10 ascending scale)
FUNCTIONAL LIMITATIONS (ACTIVITIES OF DAILY LIVING)
Michigan Hand Outcomes Questionnaire (MHQ)
OBJECTIVE
Sensory testing
Threshold tests
Objective tests
Range of motion (ROM)
Strength
Edema
Wound/Scar
Fine motor coordination
CHAPTER 3:
Radiologic studies used in evaluation of the upper extremity
INTRODUCTION
STANDARD RADIOGRAPHS
HAND VIEWS
AP/PA and lateral views (Figure 3.1)
Oblique view
WRIST VIEWS
PA view of the wrist (Figure 3.3)
AP view of the wrist
Lateral view of the wrist (Figure 3.6)
THUMB VIEWS
Roberts view
Lateral view
SPECIAL VIEWS
Brewerton view
Skyline view
Scaphoid view
Carpal tunnel view
DYNAMIC VIEWS
Wrist PA radial and ulnar deviation views
WRIST PA CLENCHED FIST VIEWS
DRUJ gap distance
THUMB STRESS VIEW
VIDEO FLUOROSCOPY
ULTRASOUND
Lesions of the hand and wrist
Tendon rupture
Tenosynovitis
Foreign bodies
Carpal tunnel syndrome
COMPUTED TOMOGRAPHY
CT SCAN PLANES
Axial plane
Coronal plane
Sagittal plane
Long sagittal axis of scaphoid plane
Three-dimensional CT
Scaphoid fracture
Distal radioulnar intra-articular fracture and instability
MAGNETIC RESONANCE IMAGING
Pathology
TFCC injury
Scaphoid nonunion (Figure 3.16)
Arthrography
Bone scintigraphy
Angiography
CHAPTER 4:
Electrodiagnostic studies and peripheral nerve ultrasound
ANATOMY OF THE PNS
PHYSIOLOGY
NERVE CONDUCTION STUDIES
Motor NCS
Sensory NCS
Mixed NCS
F waves
Parameters affecting NCS
Interpretation of NCS
ELECTROMYOGRAPHY
Interpretation of EMG
ELECTROPHYSIOLOGIC FINDINGS (NCS AND EMG)
Carpal tunnel syndrome
Ulnar neuropathy at the elbow
Radial nerve palsy at thespiral groove
PERIPHERAL NERVE US
US imaging technique
US findings
Carpal tunnel syndrome
Cubital tunnel syndrome
Radial neuropathy at the spiral groove
Nerve trauma
Nerve tumors
Nerve inflammation
Role of US in comparison with electrodiagnostic studies for assessing nerve diseases
CHAPTER 5:
Use of locoregional anesthesia and tourniquet in the upper limb
INTRODUCTION
INDICATIONS OF LOCOREGIONAL ANESTHESIA
ANESTHETIC AGENTS
MECHANISM OF ACTION
DRUGS AND DOSAGE
Role of adrenaline
Toxicity and adverse effects
LOCAL ANESTHESIA
Direct infiltration
Peripheral nerve block
Topical anesthesia (Table 5.2)
REGIONAL ANESTHESIA
Bier block
Plexus block
SEDATION
TOURNIQUET
Types of tourniquet
Finger tourniquet (Figure 5.5a–d)
Forearm tourniquet
Arm tourniquet
CHAPTER 6:
Surgical instrumentation and magnification
INTRODUCTION
BASIC SURGICAL INSTRUMENTS
Cutting and dissecting instruments
Retracting and exposing instruments
Clamping and occluding instruments
Grasping and holding instruments
Power instruments
MICROSURGICAL INSTRUMENTS
MAGNIFICATION
FLUOROSCOPY UNIT
Mini C-arm
TOURNIQUET
SUTURE MATERIAL
Absorbable sutures
Nonabsorbable sutures
Multifilament and monofilament sutures
Tendon repair
Nerve repair
Vascular repair
CHAPTER 7:
Rehabilitation
THERAPEUTIC INTERVENTIONS
Wound management
Edema control
Scar remodeling
Desensitization
Pain management
Sensory re-education
Range of motion (ROM) exercises
Strengthening
Psychological support
Orthoses
Thermal modalities
Electrical modalities
SECTION 2: EMERGENCY HAND SURGERY
CHAPTER 8:
Examination of the traumatized hand
INTRODUCTION
TYPES OF HAND INJURIES (FIGURE 8.1A–F)
EVALUATION OF HAND INJURIES
History taking
Physical examination
Wound inspection
Palpation
Sensory and motor function
Tendon function
Radiographic assessment
CHAPTER 9:
Compartment syndrome
DEFINITION
ETIOLOGY
PATHOPHYSIOLOGY
CLINICAL ASSESSMENT
INVESTIGATIONS
Objective measurements
TREATMENT
GENERAL PRINCIPLES OF SURGICAL DECOMPRESSION
The upper extremity
The forearm (Figure 9.1)
The hand
The upper arm
POSTOPERATIVE MANAGEMENT
OUTCOMES
CHAPTER 10:
Acute hand infections
OVERVIEW
CLASSIFICATION
ANATOMY
Bursa of the hand: (Figure 10.1)
Potential spaces of the hand (Figure 10.2)
Deep
Superficial
SPECIFIC TYPES OF INFECTIONS
Acute paronychia
Presentation
Diagnosis
Treatment
Prognosis
Chronic paronychia
Presentation
Diagnosis
Treatment
Prognosis
Felon
Presentation
Treatment
Prognosis
Abscess (stiles)
Presentation
Treatment
Flexor tenosynovitis
Presentation
Diagnosis
Treatment
Prognosis
Radial and ulnar bursa infections
Presentation
Treatment
Prognosis
Osteomyelitis
Presentation
Diagnosis
Treatment
Septic arthritis
Presentation
Diagnosis
Treatment
Cellulitis
Presentation
Treatment
Necrotizing infections
Presentation
Treatment
Prognosis
Herpetic whitlow
Presentation
Diagnosis
Treatment
Prognosis
Human bites
Presentation
Diagnosis
Treatment
Prognosis
Animal bites
Diagnosis
Treatment
Prognosis
Aquatic organisms
CHAPTER 11:
Nail bed injuries
ANATOMY
PHYSIOLOGY
FUNCTIONS
NAIL BED INJURIES
EVALUATION
TREATMENT
COMPLICATIONS
CHAPTER 12:
Tendon injuries
12.1 FLEXOR TENDON INJURIES
BACKGROUND AND EVALUATION
Anatomy
Flexor sheath and pulley system
Zones of flexor tendon injury
Evaluation
SURGICAL REPAIR
Timing of repair
Approach
Repair technique
Complications
Postoperative management
Tendon healing process
Secondary tendon reconstruction
FDP avulsion also known as ‘Jersey Finger’ or ‘Rugby Finger’
Treatment
12.2 EXTENSOR TENDON INJURIES
FUNCTIONAL ANATOMY
ZONES OF INJURY
Evaluation
Primary repair of extensor tendon injuries
Postoperative rehabilitation after extensor tendon repairs
CHRONIC EXTENSOR TENDON PATHOLOGIES
Chronic mallet deformity
Chronic swan neck deformity
Chronic boutonnière deformity
12.3 REHABILITATION OF TENDON INJURIES
INTRODUCTION
SCIENTIFIC BASIS FOR REHABILITATION PROTOCOLS
FLEXOR TENDON REHABILITATION
Immobilization
Early passive motion
Early active motion
EXTENSOR TENDON REHABILITATION
Immobilization
Early motion protocols
OUTCOME EVALUATION
CHAPTER 13:
Fractures and dislocations
13.1 PRINCIPLES OF SKELETAL FIXATION FOR THE HAND
INTRODUCTION
TECHNICAL OPTIONS
INDICATIONS AND GOALS OF FRACTURE FIXATION
Restoration of anatomical parameters
Restoration of stability
Techniques for anatomical restoration
Application and principles of lag screw fixation
13.2 PHALANGEAL FRACTURES AND INTERPHALANGEAL JOINT DISLOCATIONS
INTRODUCTION
SURGICAL ANATOMY
CLINICAL FEATURES
IMAGING
EMERGENCY DEPARTMENT MANAGEMENT
Definitive management
CLASSIFICATION AND SPECIFIC FRACTURES
Distal phalanx
Middle and proximal phalangeal shaft fractures
Base fracture
Condylar fractures
DISLOCATIONS
13.3 METACARPAL FRACTURES
INTRODUCTION
RELEVANT ANATOMY
EVALUATION
HISTORY
Patient age
Occupation
IMAGING
CLINICAL SYMPTOMS AND DECISION MAKING
Closed fractures
Open fractures
TREATMENT
Indications of nonoperative and surgical management
METACARPAL HEAD FRACTURES
METACARPAL NECK FRACTURES
Conservative treatment
Metacarpal shaft fractures
Metacarpal base fractures
13.4 LIGAMENTOUS INSTABILITY AND CARPAL FRACTURES
ANATOMY
EXTRINSIC AND INTRINSIC LIGAMENTS
BIOMECHANICS
Wrist kinematics (carpal motion)
Wrist kinetics (force transmission)
Mechanism of carpal ligament injuries
Clinical examination and imaging
CARPAL INSTABILITY
Classification
Scapholunate dissociation
Lunotriquetral dissociation
Perilunate injuries
CARPAL FRACTURES
Scaphoid fractures
Triquetral fractures
Capitate fractures
Hamate fractures
Pisiform fractures
Trapezium fractures
Lunate fractures
Trapezoid fractures
13.5 FRACTURES AND DISLOCATIONS OF THE DISTAL RADIUS AND THE DISTAL RADIOULNAR JOINT
DISTAL RADIUS FRACTURES AND DISLOCATIONS
Anatomy of the distal radius and ulna
Classification and pathomechanics of the fracture
History and clinical examination
DRUJ INJURIES
Anatomy and biomechanics
13.6 THERAPY FOR FRACTURES AND DISLOCATIONS IN THE HAND
KEY THERAPY TECHNIQUES/EXERCISES FOR HAND INJURIES
Distal radius fractures
Carpal fractures
Metacarpal fractures
Proximal phalanx (P1) fractures
Middle phalanx (P2) fractures
Distal phalanx (P3) fractures
Interphalangeal joint dislocations and collateral ligament injuries
THERAPY MANAGEMENT OF COMPLICATIONS AFTER A FRACTURE/SOFT TISSUE INJURY
Stiffness
Complex regional pain syndrome
CHAPTER 14:
Burns
SURGICAL CARE AND MANAGEMENT OF HAND BURNS
EPIDEMIOLOGY
THERMAL BURNS
PATHOLOGY
CLASSIFICATION
INITIAL MANAGEMENT
Nonoperative treatment
Local wound care
TREATMENT OF VARIOUS DEGREES OF BURN INJURY
Treatment of first-degree and superficial thickness second-degree hand burns
Treatment of deep thickness second-degree and third-degree hand burns
Treatment of fourth-degree hand burns
Hand therapy
COMPLICATIONS
Infection
Skin and soft tissue contractures
Hypertrophic burn scars
Web space contracture
Z-plasty
Trapeze-flap plasty
Flaps
OUTCOMES
ELECTRICAL BURNS
EPIDEMIOLOGY
PATHOLOGY
Voltage effects
INITIAL MANAGEMENT
History
Examination
Early treatment
SURGICAL PROCEDURES
Indications of surgical treatment
Timing of surgical procedure
Surgical treatment options
COMPLICATIONS
CHEMICAL BURNS
EPIDEMIOLOGY
CLASSIFICATION
Severity
INITIAL MANAGEMENT
History
Physical examination
Initial treatment
Treatment
COMPLICATIONS
Compartment syndrome
Systemic intoxication
CHAPTER 15:
High-pressure jet injection injuries
INTRODUCTION
EPIDEMIOLOGY
Injectable materials
PATHOPHYSIOLOGY
Symptoms
Evaluation
TREATMENT
Initial management
Surgical intervention
Postoperative care
COMPLICATIONS
OUTCOMES
CHAPTER 16:
Fundamental principles of microsurgery and replantation
INTRODUCTION
FUNDAMENTAL PRINCIPLES OF MICROSURGERY
INDICATIONS AND CONTRAINDICATIONS
CLASSIFICATION
Levels
Type of injury
PREOPERATIVE MANAGEMENT
Resuscitate
Assess
Prepare for surgery
For major replantation
OPERATIVE TREATMENT
Sequence of replantation
Two-team approach
TREATMENT OF HAND/DIGITAL REPLANTATION
Preoperative management
Sequence of replantation
Strategies for managing the lack of veins for anastomosis
POSTOPERATIVE MANAGEMENT
IMMEDIATE AND EARLY COMPLICATIONS
Symptoms
Action
Symptoms
Action
CHAPTER 17:
Soft tissue coverage and thumb reconstruction
SOFT TISSUE
INTRODUCTION
PREOPERATIVE EVALUATION
History
SURGICAL OPTIONS
Skin grafts
Postoperative care and complications
Local flaps
Bilateral V–Y advancement flap
Volar V–Y advancement flap
Oblique triangular flap
Cross-finger pedicle flap
Thenar flap
Regional flaps
Reverse digital artery flap
Dorsal metacarpal artery perforator flap
Radial forearm flap
Radial artery perforator flap
Reverse posterior interosseous flap
Surgical technique
Postoperative care and complications
Distal ulnar artery flap
Surgical technique
Postoperative care and complications
DISTANT FLAPS
Lateral arm flap
Surgical technique
Postoperative care
Groin flap
Surgical technique
Postoperative care
Pedicled intercostal perforator flap
Surgical technique
Postoperative care
Anterolateral thigh flap
Surgical technique
TRAUMATIC THUMB RECONSTRUCTION
INTRODUCTION
VASCULAR ANATOMY OF THE THUMB
RECONSTRUCTION CONCEPTS
Distal third
Middle third
Toe-to-thumb transfer
Proximal third
SURGICAL TECHNIQUE
Distal third loss of the thumb
Moberg flap
Kite flap (the FDMA flap)
Middle third loss of the thumb
Second-toe transfer
Surgical technique
Proximal third loss of the thumb
Pollicization of index or injured finger stump
Surgical technique
Postoperative care
CHAPTER 18:
Approach to complex hand trauma
INTRODUCTION
PATIENT ASSESSMENT
History
ANTIBIOTIC AND TETANUS PROPHYLAXIS
ASSESSMENT OF THE INJURED HAND
Visual assessment of the hand (Figure 18.1)
Radiographic examination
Wound evaluation
SURGICAL MANAGEMENT OF COMPLEX HAND INJURIES (FIGURE 18.2)
Emergency surgery
Surgical planning
Timing of surgery
Goals of reconstruction
Surgical preparation and sources of tissues
THE FIRST STAGE OF RECONSTRUCTION (EMERGENCY SURGERY)
Adequate debridement (Figure 18.3)
Skeletal stabilization
Vascular reconstruction
Nerve, tendon, and soft tissue reconstruction
Prioritizing salvage during surgery (intraoperative ‘triage’)
Spare-parts concept
THE EARLY SECOND STAGE OF RECONSTRUCTION
REHABILITATION: ACTIVE AND PASSIVE MOBILIZATION (FIGURE 18.6)
THE LATE STAGE OF RECONSTRUCTION (PERFORMED 3–6 MONTHS AFTER THE RECONSTRUCTION)
SECTION 3: ELECTIVE HAND SURGERY
CHAPTER 19:
System-specific examination of the hand
INTRODUCTION
HAND EXAMINATION
HAND INSPECTION
SYSTEM-SPECIFIC EXAMINATION
Assessment of muscle and tendon function
Assessment of motor and sensory function
Median nerve
Ulnar nerve
Radial nerve
Assessment of hand vascularity
Assessment of bone and joint stability
Bone injuries
Specific joint injuries
CHAPTER 20:
Congenital disorders
EMBRYOLOGY
AXIS DEVELOPMENT
INTERNATIONAL FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND (IFSSH) CLASSIFICATION
Key features
Criticisms of IFSSH classification
RADIAL LONGITUDINAL DEFICIENCY
Assessment
Treatment
THUMB HYPOPLASIA
SYNDACTYLY
Treatment
THUMB DUPLICATION/POLYDACTYLY
Treatment
CAMPTODACTYLY
Clinical assessment
Treatment
CLINODACTYLY
Treatment
MACRODACTYLY
Treatment
TRIGGER THUMB
Treatment
TRIGGER DIGITS (OTHER THAN THUMB)
Treatment
CONSTRICTION RING SYNDROME
CLEFT HAND
Symbrachydactyly
Symbrachydactyly classification
Types
RADIOULNAR SYNOSTOSIS
Treatment
Surgical options
CHAPTER 21:
Chronic infections of the hand and upper extremity
GENERAL PRINCIPLES
BACTERIAL INFECTIONS
Actinomycosis
Epidemiology/biology
Presentation/appearance
Diagnosis/workup
Treatment
Mycetoma (actinomycetoma and eumycetoma)
Epidemiology/biology
Presentation/appearance
Diagnosis/workup
Treatment
Syphilis
Epidemiology/biology
Presentation/appearance
Diagnosis/workup
Treatment
FUNGAL INFECTIONS
General
Chronic paronychia
Epidemiology/biology
Presentation/appearance
Diagnosis/workup
Treatment
Sporotrichosis
Epidemiology/biology
Presentation/appearance
Diagnosis/workup
Treatment
Extracutaneous sporotrichosis
Epidemiology/biology
Presentation/appearance
Diagnosis/workup
Treatment
Aspergillosis
Epidemiology/biology
Presentation/appearance
Diagnosis/workup
Treatment
Mucormycosis
Epidemiology/biology
Presentation/appearance
Diagnosis/workup
Treatment
PROTOZOAL INFECTIONS
Leishmaniasis
Epidemiology/biology
Presentation/appearance
Diagnosis/workup
Treatment
VIRAL INFECTIONS
Human orf (ecthyma contagiosum)
Epidemiology/biology
Presentation/appearance
Diagnosis/workup
Treatment
CHAPTER 22:
Tendinopathy and work-related upper-limb disorders
INTRODUCTION
TRIGGER FINGER
Adult trigger digit
Pertinent anatomy and pathology
Clinical appearance and diagnosis
Treatment
Pediatric trigger digit
Etiology
Diagnosis
Treatment
de QUERVAIN SYNDROME
Pertinent anatomy and pathology
Diagnosis
Treatment
INTERSECTION SYNDROME
Pertinent anatomy and pathology
Diagnosis
Treatment
EXTENSOR POLLICIS LONGUS TENOSYNOVITIS
Pertinent anatomy
Clinical appearance and diagnosis
Treatment
EXTENSOR CARPI ULNARIS TENDONITIS
Pertinent anatomy
Clinical appearance
Diagnosis
Treatment
FLEXOR CARPI RADIALIS TENDONITIS
Anatomy
Pathology
Clinical appearance and diagnosis
Treatment
MISCELLANEOUS
Saddle syndrome
Anatomy and pathology
Clinical appearance
Treatment
SECRETAN DISEASE
Clinical appearance
Treatment
WORK-RELATED UPPER-LIMB DISORDERS
Risk factors
Approach to WRULD patients
CHAPTER 23:
Nerve disorders
23.1 NERVE INJURY AND REPAIR
NERVE ANATOMY
Macroanatomy
PHYSICAL EXAMINATION
Assessment of motor function
Assessment of sensory function
NERVE INJURY
Myelin sheath
Axon
TREATMENT OF NERVE INJURIES
Nonsurgical treatment
Surgical treatment
Timing
Principles of nerve repair
Nerve grafting
Nerve transfer
Neurolysis
PROGNOSIS AND REHABILITATION OF NERVE INJURIES
23.2 NERVE COMPRESSION SYNDROMES
PATHOLOGY
CLINICAL PRESENTATION
MEDIAN NERVE
Pronator tunnel syndrome
Symptoms/signs
Investigations
Provocative tests
Management
AIN syndrome
Symptoms/signs
Management
Carpal tunnel syndrome
Symptoms/signs
Provocative tests
Investigations
Management
ULNAR NERVE
Cubital tunnel syndrome
Symptoms/signs
Provocative tests
Investigations
Management
Guyon canal compression or ulnar tunnel syndrome
Symptoms/signs
Provocative tests
Investigations
Management
RADIAL NERVE
Compression in the spiral groove
Symptoms/signs
Provocative tests
Investigations
Management
Radial tunnel syndrome
Symptoms/signs
Provocative tests
Investigations
Management
Posterior interosseous nerve syndrome
Symptoms/signs
Provocative tests
Investigations
Management
Superficial radial nerve compression or Wartenberg syndrome
Symptoms/signs
Provocative tests
Investigations
Management
Digital nerve (Bowler’s thumb)
Symptoms/signs
Provocative tests
Investigations
Management
23.3 NERVE PALSY
NERVE TRANSFER
Indications
Principles
Technique
TENDON TRANSFER
Indications
Principles
Technique
Management of individual nerve palsies
Radial nerve palsy
Median nerve palsy
Ulnar nerve palsy
Combined nerve palsies
Ulnar and median deficit
23.4 NEONATAL BRACHIAL PLEXUS PALSY
EARLY NBPP
Risk factors
Classification
Natural history
Clinical evaluation
History
Examination
Investigations
Treatment
LATE NBPP
Etiology
Pathogenesis
Clinical evaluation
Investigations
Treatment
23.5 THE SPASTIC UPPER LIMB AND TETRAPLEGIA
THE SPASTIC UPPER LIMB
Incidence
Traumatic brain injury
Stroke
Cerebral palsy
Pathophysiology
Clinical presentation in the upper limb
History taking
Physical examination
Multidisciplinary team management
Outcomes and results
TETRAPLEGIA
Definition
History and evolution
Epidemiology and etiology of SCI
Concept of the injured metamere
Assessment of the tetraplegic patient
Assessment of the tetraplegic hand (tangible evidence)
Other considerations (intangible evidence)
Key questions in the assessment of the tetraplegic patient
Treatment preferably based on a dedicated team
Indication of surgery
Surgical reconstruction
Functional neuromuscular stimulation
23.6 THORACIC OUTLET SYNDROME (TOS)
CLASSIFICATION
PERTINENT ANATOMY
ETIOLOGY
CLINICAL PRESENTATION
Neurogenic TOS
Venous TOS
Arterial TOS
Clinical evaluation
History taking
Physical examination
Electrodiagnostic evaluation
Radiologic evaluation
DIFFERENTIAL DIAGNOSIS
Complications of surgery
Postoperative rehabilitation
Treatment outcomes
Recurrent TOS
CHAPTER 24:
Vascular disorders of the hand
INTRODUCTION
ASSESSMENT
History
Clinical examination
Symptoms
Evaluation
Investigation
VASCULAR OCCLUSIONS
Hypothenar hammer syndrome
Physiology
Diagnostic criteria
Treatment
Aneurysm
Physiology
Presentation
Diagnosis
Treatment
Embolism
Sources
Presentation
Diagnosis
Treatment
VASOSPASTIC DISEASE
Raynaud disease
Secondary Raynaud phenomenon
Diagnosis
Treatment
Hand-arm vibration syndrome
Symptoms
Investigation
Treatment
ACUTE VASCULAR INJURIES
VASCULAR ANOMALIES OF THE UPPER EXTREMITY
Hemangiomas
Presentation
Investigation
Treatment
Venous malformation (VM)
Presentation
Investigation
Treatment
Capillary malformations
Presentation
Investigation
Treatment
Arteriovenous malformations (AVM)
Presentation
Investigation
Treatment
CHAPTER 25:
Degenerative osteoarthritis and inflammatory arthritis of the hand and wrist
DEGENERATIVE OSTEOARTHRITIS
Overview
Pathophysiology
Digital osteoarthritis
Clinical presentation
Anatomy
Treatment options
Thumb basal joint osteoarthritis
Pathogenesis
Clinical presentation
Radiographic staging
Anatomy
Treatment
Wrist osteoarthritis
Pathogenesis
Clinical presentation
Treatment options
RHEUMATOID ARTHRITIS
Treatment options
Medical treatment
Surgical treatment
OTHER ARTHROPATHIES
Systemic lupus erythematoses (SLE)
Wrist
Digital deformities
Scleroderma
Digital deformities
Psoriatic arthritis
CHAPTER 26:
Hand tumors
INTRODUCTION
BENIGN TUMORS
Ganglions
Soft tissue tumors
Pigmented villonodular synovitis (PVNS)
Epidermal cysts
Lipomas
Vascular tumors (described in Chapter 24)
Nerve tumors
Bone and cartilage tumors
Enchondroma
Giant cell tumor
Aneurysmal bone cyst
Osteoid osteoma
MALIGNANT TUMORS
Skin tumors
Squamous cell carcinomas
Basal cell carcinoma
Melanomas
Soft tissue sarcomas
Bone and cartilage tumors
Chondrosarcoma
Osteogenic sarcoma
Ewing sarcoma
Hand metastases
CHAPTER 27:
Contracture
27.1 THE STIFF DIGIT
TERMINOLOGY
ETIOLOGY
PATHOGENESIS
Edema
Skin contractures
Tenosynovitis
Boutonnière deformity (Figure 27.3)
Swan-neck deformity (Figure 27.4)
Mallet deformity
CLINICAL EXAMINATION
INVESTIGATIONS
Laboratory
Radiological
TREATMENT
Nonoperative
Operative treatment
Scar release
Tenolysis
Intrinsic release
Correction of boutonnière and swan-neck deformities
Joint release
External traction device (Ex-fix)
27.2 VOLKMANN ISCHEMIC CONTRACTURE
PATHOGENESIS
Effect on muscles
Effect on nerves
PATHOLOGY
EVALUATION
CLASSIFICATION
Holden classification (1979)
Type I
Type II
Tsuge classification (1975) [modification of Seddon classification (1964)]
Mild type
Moderate type ‘classic or typical type’
Severe type
Zancolli classification (1979)
MANAGEMENT
Timing of intervention
Treatment options
Mild type
Moderate type ‘classic or typical type’
Severe type
Intrinsic function
EXPECTED OUTCOMES
27.3 DUPUYTREN CONTRACTURE
ETIOPATHOGENESIS
PATHOANATOMY
CLASSIFICATION
CLINICAL PRESENTATION
EVALUATION
TREATMENT OPTIONS
CHAPTER 28:
Complex regional pain syndrome
DEFINITION
KEY MILESTONES
INCIDENCE
PATHOPHYSIOLOGY
DIAGNOSTIC CRITERIA
STAGING
APPROACH TO A PATIENT WITH CRPS
History
Physical examination
Investigations
Treatment
INDEX
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