2 - Hand And Wrist (2)

Question 1

Which portion of the flexor sheath is most involved in triggering?

Answer 1

A1 (first annular pulley)

Question 2

Describe trigger finger:

Answer 2

Stenotic or inflamed annular ligament resulting in limited movement of the tendon under the pulley

Finger may snap or lock during flexion of the finger or thumb

Question 3

MC affected fingers for trigger finger?

Answer 3

3rd and 4th digits

Question 4

Tx for trigger finger:

Answer 4

Steroid injection at tendon sheath (do NOT inject directly into tendon!)

Splinting, therapy

60% “curative”

Question 5

Stenosing tenosynovitis is AKA:

Answer 5

Trigger finger

Question 6

About half of the patients presenting with trigger finger also have:

Answer 6

Carpal tunnel syndrome

Question 7

Nerve distribution in the hand for median nerve:

Answer 7

Palmar

1st through 3rd digits AND lateral half of 4th digit

Question 8

What is the MC compression neuropathy in the upper extremity?

Answer 8

Carpal tunnel syndrome

Question 9

What are the structures in the carpal tunnel?

Answer 9

Median nerve

Flexor pollicis longus

Flexor digitorum profundus tendons (4)

Flexor digitorum superficialis tendons (4)

Question 10

Thenar atrophy may be suggestive of:

Answer 10

Carpal tunnel syndrome

Question 11

Two tests for carpal tunnel?

Answer 11

Durkan’s

Phalen’s

Question 12

What is the most useful confirmatory test for carpal tunnel (though rarely required for Dx)

Answer 12

Nerve Conduction Velocity testing

Question 13

Tx for carpal tunnel:

Answer 13

Wrist splint worn especially at night

Short-term course of NSAIDs

Question 14

Injections for carpal tunnel?

Answer 14

Has diagnostic and therapeutic benefits, but improvement may be temporary

Question 15

Surgery for carpal tunnel?

Answer 15

If other stuff fails

Cut that transverse carpal ligament

Very fast and easy surgery, but not without risks

Question 16

What is the MC soft tissue tumor of the hand?

Answer 16

Ganglion Cyst

Question 17

Common locations for ganglion cysts?

Answer 17

Dorsum of the wrist (MC)

Volar radial aspect of the wrist

Base of the finger

Question 18

Volar radial ganglion cysts?

Answer 18

Can adhere to radial artery - don’t fuck with them

Question 19

Tx for ganglion cysts:

Answer 19

Conservative management - immobilize the wrist

You can aspirate, but it’s just gonna come back, maybe worse

Excision is optional, but again, they come back sometimes

Overall, best to leave it alone as long as it’s not causing significant impairment

Question 20

The ulnar collateral ligament (UCL) of the thumb is required for:

Answer 20

Pinching

Question 21

Acute UCL injury is AKA:

Answer 21

Skier’s thumb

Question 22

Chronic UCL injury is AKA:

Answer 22

Gamekeeper’s thumb

Question 23

How are thumb UCL injuries treated?

Answer 23

Cast or splint

Immobilization for 4 weeks

Question 24

What is the MC carpal fracture?

Answer 24

Scaphoid fx

Question 25

Scaphoid fx’s are prone to:

Answer 25

Proximal osseous necrosis and poor healing

Question 26

The majority of scaphoid fx’s occur in:

Answer 26

The middle of the bone (or waist)

Question 27

Displaced scaphoid fx’s of more than ___mm have a high rate of nonunion

Answer 27

1

Question 28

Clinical presentation of scaphoid fx:

Answer 28

Pain in the scaphoid

Question 29

Scaphoid fx’s are uncommon in which age groups?

Answer 29

Young children and older adults

Question 30

MC cause of scaphoid fx?

Answer 30

FOOSH

Question 31

If you have a high suspicion for scaphoid fx but the radiograph is negative, you can order:

Answer 31

MRI (not CT)

Question 32

Which type of scaphoid fx’s need surgical management to mitigate risk of malunion / necrosis?

Answer 32

Waist and proximal

Question 33

Kienbock’s Disease is:

Answer 33

Osteonecrosis of the carpal lunate

Question 34

Kienbock disease MC affects:

Answer 34

Men age 20 to40

Question 35

Examination for Keinbock reveals:

Answer 35

Tenderness over the lunate bone Decreased grip strength Dorsal swelling Limited wrist motion

Question 36

X-rays for Keinbock reveals:

Answer 36

Increased opacity of the lunate (early) Collapse of the lunate bone, degenerative arthritis (late)

Question 37

What is a Bennet’s Fx?

Answer 37

First metacarpal fracture

Question 38

What is a Rolando fracture?

Answer 38

First metacarpal fracture

Question 39

Which is worse, Bennet or Rolando?

Answer 39

Bennet

Question 40

What muscles cause the deforming force in a Bennet’s fx?

Answer 40

Abductor Pollicis Longus and Adductor Pollicis Longus

Question 41

Presentation of first metacarpal fx?

Answer 41

Swelling and ecchymosis about the base of the thumb are common Base of thumb painful to palpation Pt unable to move thumb actively without pain

Question 42

Tx for first metacarpal fx?

Answer 42

Pin it

Question 43

What is the mallet finger surgery?

Answer 43

Open reduction internal fixation and percutaneous pinning

Question 44

Which mallet finger patients get surgery?

Answer 44

Those seen >12 post injury | Those w >50% of the articular surface damaged

Question 45

Adverse outcomes of first metacarpal fxs?

Answer 45

Posttraumatic arthritis CMC joint Chronic pain Loss of motion Loss of pinch strength

Question 46

Dont you hate it when someone answers their own questions?

Answer 46

I do