Surgery of the hand

Question 1

What is the palmar fascia?

Answer 1

• tough layer anchoring skin to skeleton
• extension of forearm fascia
• tightened by palmaris lognus

Question 2

What is the disease of the palmar fascia called?

What is it?
What causes it?

Answer 2

• Dupuytrens disease (contracture)
• Thickening (fibrosis) of fascia which leads to contracture
• Genetics, smoking, alcohol, diabetes/epilepsy

Question 3

State the flexor tendons of the hand

What pathologies can occur

Answer 3

Flexor digitorum profundus
Flexor digitorum superficialis
Flexor pollicis longus

Susceptible to traumatic rupture (violent pulling), trigger fingers

Question 4

What are trigger fingers

Causes

Answer 4

• catching of tendons at A1 pulley
• degenerate nodule thickening of sheath
• overuse, degeneration, change of direction of tendon

Question 5

What nerves supply the fingers?

Answer 5

Common/proper digital nerves coming from median nerve and ulnar nerve (1/2 d4 and d5)

Question 6

CARPAL TUNNEL

1. What is it
   2, Which structures are involved. What are the implications of this?
2. Symptoms
3. Signs

Answer 6

1. Median nerve compression at wrist
2. Tendons and nerves affected
   - Thenar muscles (abductor pollicis brevis, opponens pollicis, flexor pollicis brevis) which are required for fine movement
3. Pins and needles in periphery, waking up at night
4. Thenar wasting, loss of abduction, loss of opposition

Question 7

CUBITAL TUNNEL

1. What is it
   2, Which structures are involved. What are the implications of this?
2. Signs

Answer 7

1. Ulnar nerve compression at elbow, fascial compression at 3 sites
2. Nerve only
   - physiologically innervates hypothenar muscles, medial 2 lumbicals, sensory to 1/2 d4 + d5 + FCU + FDP
3. Wasted hypothenar web spaces, paradoxical wasting thenar, forearm wasting, clawing of digits

Question 8

What are the long extensor tendons?

What is the function of the extensor tendons?

Answer 8

Extensor digitorum, indicis and digiti minimi
Extensor pollicis longus, brevis and abductor pollicis longus

• Extend MCP joints of fingers
• From extensor retinaculum to extensor hoods

Question 9

DE QUERVAIN DISEASE

1. What is it?
2. What is it caused by?

Answer 9

1. Triggering and pain of thumb extensors

2. Degeneration, overuse, Ciprofloxacin (severe bacterial infections), Anastrazole (anti-cancer)

Question 10

TENDON RUPTURE

1. Causes
2. Presentation

Answer 10

1. Lacerations, fractures, synovitis, arthritis

2. No triggering

Question 11

Which muscles insert into the digital extensor hood?

Answer 11

• Long extensor tendons
• Dorsal interossei
• Lumbricals

Question 12

What common bone problems occur?

Answer 12

• Radial fracture
• Scaphoid fracture
• 1st CMC osteoarthritis
• RA