Look
Palms up
Scars / Dimples / pits
Nodules - palm, proximal to distal palmar crease
Cords - extend into fingers & cause contracture
Thumb
Fingers - contracture of MCPJ, PIPJ
Palms down
Garrod knuckle pads
Hueston Table Top Test
- contracture MCPJ
- contracure PIPJ
Feel
Nodules / Cords / Webspaces (Natatory cords)
Sensation
Move
Deformities
- stiff or flexible
PIPJ
- true v apparent FFD
- spiral cord crossing MCPJ and PIPJ may contract both
- flex MCPJ
- assess PIPJ
Concepts
MCPJ Contracture
- Always correctable by removal of pretendinous bands
- Collateral ligaments are tightest in flexion
- Flexion deformity does not lead to collateral shortening
- Resection central cord restores extension
PIPJ
Contracture due to 4 cords
1.Central
2.Spiral
- pushes NV bundle volar and midline
- from spiral band and Grayson's ligaments
3.Lateral
- lateral digital sheath
4.Retrovascular
Not always correctable unless release volar plate & accessory collateral ligaments
- Collateral ligaments tightest in extension
- Flexion deformity leads to collateral shortening