Introduction to Surgery of the Hand Flashcards
1
Q
Palmar fascia
- Tough layer anchoring skin to skeleton
- Extension of forearm fascia
- Tightened by palmaris longus (apes)
- … disease affects this
A
- Tough layer anchoring skin to skeleton
- Extension of forearm fascia
- Tightened by palmaris longus (apes)
- Dupuytren’s disease
2
Q
Palmar fascia
- … layer anchoring skin to skeleton
- … of forearm fascia
- Tightened by palmaris longus (apes)
- Dupuytren’s disease
A
- Tough layer anchoring skin to skeleton
- Extension of forearm fascia
- Tightened by palmaris longus (apes)
- Dupuytren’s disease
3
Q
Palmar fascia
- Tough layer anchoring skin to skeleton
- Extension of forearm fascia
- Tightened by … longus (apes)
- Dupuytren’s disease
A
- Tough layer anchoring skin to skeleton
- Extension of forearm fascia
- Tightened by palmaris longus (apes)
- Dupuytren’s disease
4
Q
In Dupuytren’s disease, what thickens?
A
thickening of palmar fascia
5
Q
Dupuytren’s disease
- … of fascia
- Contracture
- G..
- Smoking
- A…
- Diabetes/epilepsy
A
- Thickening of fascia
- Contracture
- Genetic
- Smoking
- Alcohol
- Diabetes/epilepsy
6
Q
Dupuytren’s disease
- What is the risk factor?
A
- genetic - mainly men (90%)
7
Q
Flexor tendons
- Superficial/deep
- Single/mass action & nerve supply
- Flexor …
- … muscles (unique)
- Traumatic rupture
- Trigger fingers
A
- Superficial/deep
- Single/mass action & nerve supply
- Flexor sheath
- Lumbrical muscles (unique)
- Traumatic rupture
- Trigger fingers
8
Q
Flexor tendons
A
- Superficial/deep
- Single/mass action & nerve supply
- Flexor sheath
- Lumbrical muscles (unique)
- Traumatic rupture
- Trigger fingers
9
Q
The flexor sheath can …
A
rupture - loss of grip function
10
Q
… muscles on the flexor tendons
A
Lumbrical muscles on the flexor tendons
11
Q
Trigger Fingers
- Catching of tendons at A1 pulley
- Usually due to degenerate nodule
- Thickening of sheath
- What causes it?(3)
A
- Catching of tendons at A1 pulley
- Usually due to degenerate nodule
- Thickening of sheath
- What causes it?
- Overuse
- Degeneration
- Change of direction of tendon
12
Q
Trigger Fingers
- Catching of tendons at A1 …
- Usually due to … nodule
- Thickening of sheath
A
- Catching of tendons at A1 pulley
- Usually due to degenerate nodule
- Thickening of sheath
13
Q
Nerve & tendon injury
A
- Neurovascular bundle
14
Q
Tendons
A
- Action of superficial flexor being pulled
- Work individually to muscle belly
15
Q
Nerve problems
- … & … nerves - both on palmar side
- … predominantly sensory with small motor component
- … predominantly motor with smaller sensory component
- Digital nerves to each finger/thumb
- Dermatomes
- What can go wrong?
- Injury can happen
- Compression neuropathies
A
-
Median & ulnar nerves - both on palmar side
- Median predominantly sensory with small motor component
- Ulnar predominantly motor with smaller sensory component
- Digital nerves to each finger/thumb
- Dermatomes
- What can go wrong?
- Injury can happen
- Compression neuropathies
16
Q
Nerve problems
- Median & ulnar nerves - both on palmar side
- Median predominantly … with small … component
- Ulnar predominantly … with smaller … component
- Digital nerves to each finger/thumb
- Dermatomes
- What can go wrong?
- Injury can happen
- Compression neuropathies
A
- Median & ulnar nerves - both on palmar side
- Median predominantly sensory with small motor component
- Ulnar predominantly motor with smaller sensory component
- Digital nerves to each finger/thumb
- Dermatomes
- What can go wrong?
- Injury can happen
- Compression neuropathies
17
Q
Nerve problems
- Median & ulnar nerves - both on palmar side
- Median predominantly sensory with small motor component
- Ulnar predominantly motor with smaller sensory component
- … nerves to each finger/thumb
- Dermatomes
- What can go wrong?
- Injury can happen
- … neuropathies
A
- Median & ulnar nerves - both on palmar side
- Median predominantly sensory with small motor component
- Ulnar predominantly motor with smaller sensory component
- Digital nerves to each finger/thumb
- Dermatomes
- What can go wrong?
- Injury can happen
- Compression neuropathies
18
Q
Nerve problems
- Median & ulnar nerves - both on palmar side
- Median predominantly sensory with small motor component
- Ulnar predominantly motor with smaller sensory component
- Digital nerves to each finger/thumb
- Dermatomes
- What can go wrong?
- … can happen
- Compression …
A
- Median & ulnar nerves - both on palmar side
- Median predominantly sensory with small motor component
- Ulnar predominantly motor with smaller sensory component
- Digital nerves to each finger/thumb
- Dermatomes
- What can go wrong?
- Injury can happen
- Compression neuropathies
19
Q
Label the palmar and dorsal surfaces of the hand
A
20
Q
Label the palmar and dorsal surfaces of the hand
A
21
Q
Label the palmar and dorsal surfaces of the hand
A
22
Q
Carpal tunnel
- … nerve compression at wrist (compression neuropathy)
- In the Osseous/… tunnel
- Tendons and nerves here
- Nerve function -> 3 of thenar muscles & sensory symptoms in the … half of the hand.
A
-
Median nerve compression at wrist (compression neuropathy)
- In the Osseous/ligamentous tunnel
- Tendons and nerves here
- Nerve function -> 3 of thenar muscles & sensory symptoms in the radial half of the hand.
23
Q
… … syndrome is the most common type of nerve compression syndrome
A
Carpal tunnel syndrome is the most common type of nerve compression syndrome
24
Q
… nerve compression at the hand and wrist is called carpal tunnel syndrome.
A
Median nerve compression at the hand and wrist is called carpal tunnel syndrome.
25
Q
Carpal tunnel
- Median nerve compression at wrist (compression neuropathy)
- In the Osseous/ligamentous tunnel
- Tendons and nerves here
- Nerve function -> 3 of … muscles & … symptoms in the radial half of the hand.
A
- Median nerve compression at wrist (compression neuropathy)
- In the Osseous/ligamentous tunnel
- Tendons and nerves here
- Nerve function -> 3 of thenar muscles & sensory symptoms in the radial half of the hand.
26
Q
Thenar muscles
- The thenar musculature consists of four short muscles located on the lateral (…) aspect of the hand.
- These muscles include the:
- … pollicis
- abductor pollicis brevis
- flexor pollicis brevis
- … pollicis.
- Responsible for fine control of the thumb
- Species advantage (ability to oppose the thumb)
A
- The thenar musculature consists of four short muscles located on the lateral (radial) aspect of the hand.
- These muscles include the:
- adductor pollicis
- abductor pollicis brevis
- flexor pollicis brevis
- opponens pollicis.
- Responsible for fine control of the thumb
- Species advantage (ability to oppose the thumb)
27
Q
Thenar muscles
- The thenar musculature consists of four short muscles located on the lateral (radial) aspect of the hand.
- These muscles include the:
- adductor pollicis
- … pollicis …
- … pollicis …
- opponens pollicis.
- Responsible for fine control of the thumb
- Species advantage (ability to oppose the thumb)
A
- The thenar musculature consists of four short muscles located on the lateral (radial) aspect of the hand.
- These muscles include the:
- adductor pollicis
- abductor pollicis brevis
- flexor pollicis brevis
- opponens pollicis.
- Responsible for fine control of the thumb
- Species advantage (ability to oppose the thumb)
28
Q
Thenar muscles
- The thenar musculature consists of four short muscles located on the … (radial) aspect of the hand.
- These muscles include the:
- adductor pollicis
- abductor pollicis brevis
- flexor pollicis brevis
- opponens pollicis.
- Responsible for … … of the thumb
- Species advantage (ability to oppose the thumb)
A
- The thenar musculature consists of four short muscles located on the lateral (radial) aspect of the hand.
- These muscles include the:
- adductor pollicis
- abductor pollicis brevis
- flexor pollicis brevis
- opponens pollicis.
- Responsible for fine control of the thumb
- Species advantage (ability to oppose the thumb)
29
Q
Thenar muscles
- The thenar musculature consists of four short muscles located on the lateral (radial) aspect of the hand.
- These muscles include the:
- adductor pollicis
- … … brevis
- flexor pollicis brevis
- opponens pollicis.
- Responsible for … control of the thumb
- Species advantage (ability to … the thumb)
A
- The thenar musculature consists of four short muscles located on the lateral (radial) aspect of the hand.
- These muscles include the:
- adductor pollicis
- abductor pollicis brevis
- flexor pollicis brevis
- opponens pollicis.
- Responsible for fine control of the thumb
- Species advantage (ability to oppose the thumb)
30
Q
Proximal to carpal tunnel
A
38
Q
Interosseous muscles
- Palmar/dorsal sets
- Dual Insertion to proximal …
- Adduction/abduction
- …. Insertion to extensor hood
- Interphalangeal …
- Lose function of ulnar nerve - lose ability to fully straighten proximal interphalangeal joints
A
- Palmar/dorsal sets
- Dual Insertion to proximal phalanx
- Adduction/abduction
-
Tendonous Insertion to extensor hood
- Interphalangeal extension
- Lose function of ulnar nerve - lose ability to fully straighten proximal interphalangeal joints
39
Q
Interosseous muscles
- Palmar/dorsal set
- Dual Insertion to proximal phalanx
- Adduction/abduction
- Tendonous Insertion to … hood
- … extension
- Lose function of … nerve - lose ability to fully straighten proximal interphalangeal joints
A
- Palmar/dorsal sets
- Dual Insertion to proximal phalanx
- Adduction/abduction
- Tendonous Insertion to extensor hood
- Interphalangeal extension
- Lose function of ulnar nerve - lose ability to fully straighten proximal interphalangeal joints
40
Q
Interosseous muscles
- Palmar/dorsal set
- Dual Insertion to proximal phalanx
- Adduction/abduction
- Tendonous Insertion to extensor hood
- Interphalangeal extension
- Lose function of ulnar nerve - lose ability to fully straighten proximal interphalangeal joints
A
- Palmar/dorsal sets
- Dual Insertion to proximal phalanx
- Adduction/abduction
- Tendonous Insertion to extensor hood
- Interphalangeal extension
- Lose function of ulnar nerve - lose ability to fully straighten proximal interphalangeal joints
41
Q
Inter-osseous muscles
- Label hypothenar, thenar and lumbricals
A
51
Q
de Quervain,s disease
- Triggering and pain of thumb …
- Causes:
- Degeneration
- …
- Ciprofloxacin
- Anastrazole
A
- Triggering and pain of thumb extensors
- Causes:
- Degeneration
- Overuse
- Ciprofloxacin
- Anastrazole
52
Q
de Quervain,s disease
- Triggering and pain of thumb extensors
- Causes:
- Degeneration
- Overuse
- What 2 drugs can cause it?
A
- Triggering and pain of thumb extensors
- Causes:
- Degeneration
- Overuse
- Ciprofloxacin
- Anastrazole
54
Q
Dorsal extensors
A
57
Q
Digital extensor hood
- Long extensors
- … either side
- Lumbrical
- Finely balanced
- Complex … flat tendon
A
- Long extensors
- Interossei either side
- Lumbrical
- Finely balanced
- Complex multibundle flat tendon
59
Q
What is mallet finger?
A
It is caused by damage to the extensor tendon complex as it inserts onto the distal phalanx of any of the digits. The distal phalanx therefore lies in permanent flexion, and has the appearance of a mallet.
60
Q
Osteology - hand
- 3 phalanges in …
- 2 phalanges in …
- 5 metacarpals
- 2 sesamoids in thumb
- 8 carpal bones
A
- 3 phalanges in fingers
- 2 phalanges in thumb
- 5 metacarpals
- 2 sesamoids in thumb
- 8 carpal bones
61
Q
Osteology - hand
- 3 phalanges in fingers
- 2 phalanges in thumb
- 5 …
- 2 … in thumb
- 8 carpal bones
A
- 3 phalanges in fingers
- 2 phalanges in thumb
- 5 metacarpals
- 2 sesamoids in thumb
- 8 carpal bones
62
Q
Osteology - hand
- 3 phalanges in fingers
- 2 phalanges in thumb
- 5 metacarpals
- 2 … in thumb
- 8 … bones
A
- 3 phalanges in fingers
- 2 phalanges in thumb
- 5 metacarpals
- 2 sesamoids in thumb
- 8 carpal bones
63
Q
Osteology - hand
- … phalanges in fingers
- … phalanges in thumb
- 5 metacarpals
- … sesamoids in thumb
- 8 carpal bones
A
- 3 phalanges in fingers
- 2 phalanges in thumb
- 5 metacarpals
- 2 sesamoids in thumb
- 8 carpal bones
64
Q
Carpal bones - MNEMONIC
- Some Lovers Try Positions, That They Cannot Handle
A
69
Q
What is shown?
A
thumb base arthritis (osteoarthritis) - very common, predominantly women, not too painful, seen on X-ray incidentally
71
Q
Whats shown here?
A
Rheumatoid arthritis
