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1
Q

Immediate treatment in AnE for perilunate dislocation

A

MAnipulation and reduction
Carpal tunnel release if median nerve compression
Needs definitive fixation

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2
Q

Origin of ulnar nerve?

A

Medial cords C8 - T1

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3
Q

Types of ulnar nerve palsy?

A

Wrist - Guyon Canal syndrome
Above wrist - Cubital tunnel syndrome, Tardy ulnar nerve palsy

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4
Q

Borders of Guyon’s Canal?

A

Medial = Pisiform
Lateral = Hook of hamate
Roof = Palmar carpal lig
Floor = Flexor retinaculum

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5
Q

Causes of Guyon’s canal syndrome?

Only the more common ones

A

Ganglion cyst compression [80% of nontraumatic causes]
Hypothenar hammer syndrome
Hook of hamate fracture

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6
Q

Symptoms of Guyon Canal syndrome?

A

Motor = Opponens Digiti Minimi
Dorsal Interosseous, Palmar interosseoust
Sensory = Palmar 1.5 medial digits

Froment sign, Wartenberg sign, ulnar claw

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7
Q

Borders of cubital tunnel?

A

Medial = olecranon
Lateral = Medial epicondyle
Roof = FCU
Floor = MCL

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8
Q

Location of cubital tunnel syndrome lesion?

A

Lesion at medial epicondyle of humerus

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9
Q

Symptoms of cubital tunnel syndrome?

A

Referred pain in forearm
Sensory loss in hand [UN dermatomes]
Muscle atrophy and weakness [UN myotomes]
Intrinsic muscle wasting - guttering
Slight clawing

Wartenberg’s sign

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10
Q

Etiology of Saturday night palsy?

A

Humeral shaft fracture
Prolonged RN compression along humerus

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11
Q

Symptoms of saturday night palsy?

A

Sensory: 1sst dorsal webspace
Motor:
Low - IPJ extension of thumb + MCPJ 2-5 extension
High - Wrist extension drop+ elbow drop

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12
Q

Source of Median Nerve?

A

Medial and lateral cords.
C5-T1

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13
Q

Tests in Median nerve lesion?

A

Clench fist & test power - Benedict hand
Ant Intero Nerve
Test FDS
Test FPL
Test FDP
Test APB (Carpal tunnel syndrome)

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14
Q

Special tests in Median Nerve lesion?

A

Tinel’s sign
Phalen’s sign
Durkan’s compression test

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15
Q

What relieves pain in carpal tunnel syndrome?

A

Shaking hand of hanging arm over side of the bed

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16
Q

What to take note of for diabetics in nerve injuries?

A

DM can cause peripheral nerves to be more sensitive to compression. Not all numbness in diabetics are peripheral neuropathy

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17
Q

Does Carpal tunnel syndrome have Benediction sign?

A

No. Only higher lesions like AIN

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18
Q

Common site of AIN entrapment?

Median nerve

A

Deep head of pronator teres

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19
Q

Conservative Mx of ganglion cysts?

A

Leave alone - favoured, resolve after months
Aspiration (50% recurs)
Rupture
OR CONSERVATIVE EXCISION

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20
Q

What are the hand tendinopathies?

A

Stenosing Tenosynovitis
De Quervain’s Tenosynovitis
Suppurative Tenosynovitis

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21
Q

What is Stenosing Tenosynovitis?

A

Tenosynovitis of flexor tendons at level of A1 pulley.
Diagnosed clinically

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22
Q

RF for Stenosing Tenosynovitis?

A

Women >50
Tendon overuse
PMH = DM, HypoT, Gout, RA, pregnancy, Acromegaly

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23
Q

Green classification for Trigger finger?

A

Grade 1 = Palm pain + tenderness at A1 pulley
2 = Catching of digit
3 = Locking of digit, passively correctable
4 = Fixed, locked digit

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24
Q

Presentation of Stenosing Tenosynovitis?

A

Clicking, catching and locking of digit - 엄지, 중지, 약지
Progressive pain over distal palm
FFD

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25
What happens in Stenosing Tenosynovitis if A2, A4 pulley is involved instead of A1?
Bowstringing of the finger
26
What is DeQuervain's Tenosynovitis?
Entrapment tendinitis of dorsal first extensor compartment affecting EPB & APL ## Footnote The tendons run along the thumb side of the wrist and attach to the base of the thumb
27
Signs of DeQuervain's Tenosynovitis in PE?
Swelling and palpable sheath thickening over course of tendons **Radial sided wrist pain**, worse with Finkelstein maneuver (thumb extension)
28
What are Kanavel's signs in suppurative tenosynovitis?
Pain on passive extension (earliest) Fusiform swelling of finger Digit held in flexion Pain along distribution of flexor sheath
29
Signs of paronychia?
Nail fold tenderness Fluctuance -> abscess Nail bed motility -> tracking under nail Chronic paronychia - nail plate hypertrophy, nail fold blunting/retraction, prominent transverse ridges
30
Conditions a/w Dupuytren's contracture? DEAFEST PAIL
DM Epilepsy Age Family Hx/fibromatoses Epileptic meds Smoking Trauma/Manual labour Peyronie's disease AIDS Idiopathic Liver disease
31
What is Dupuytren's Contracture?
Nodular hypertrophy and contracture of palmar aponeurosis, causing tendons attached to finger to be unable to move properly
32
Hand manifestations of RA?
Bilaterally deforming arthropathy with MCPJ, PIPJ and DIPJ or all fingers Swan neck - flexion of DIPJ, hyperextension of PIPJ Boutonniere's - Hyperextension of DIPJ, flexion of PIPJ
33
Mallet finger which tendon/muscle affected?
Disruption of terminal extensor tendon distal to DIP joint. Diagnosed with distal phalanx about 45° of flexion with lack of active DIP extension
34
Median nerve supplies more in ____, almost all ____ except the medial few ones
Median nerve supplies more in arm, almost all flexors except medial few ones. Ulnar nerve supplies more hands
35
Median nerve supplies the more ____ muscles in forearm
More superficial ones
36
Why is Extensor Carpi Radialis spared in finger drop of PIN palsy?
Cuz ECR supplied by more proximal part of radial nerve
37
What effect can RA have on extensor tendon in finger?
Tendon subluxation!!! RA pushes extensor tendon to the side = cant extend finger
38
McGowan's classification of Cubital tunnel syndrome?
1 = sensory symptoms wo loss of two-point sensibility or muscular atrophy 2 = Sensory symptoms + weakness on pinch and grip without atrophy 3 = Sensory symptoms + atrophy and low intrinsic muscle strength 4 = profound muscle atrophy and sensory disturbance
39
Colles' frac vs Smith's frac?
Colles' = Low-energy FOOSH in wrist extension Smith's = FOOSH in wrist flexion
40
Early complications of Colles and Smiths?
TFCC injury from RUJ subluxation Associated scaphoid/ulnar head/ulnar styloid # Carpal tunnel syndrome
41
Late complications of Colles and Smiths?
EPL tendon rupture Malunion Secondary OA Stiffness Complex regional pain syndrome
42
What is Barton's #?
Smith's # that enters radiocarpal joint resulting in ant subluxation of distal fragment carrying carpus with it.
43
What is Bennett's #?
Partial intra-articular 1st MCP base # w/wo proximal, dorsal, radial displacement ## Footnote Mx - closed reduction and fixation/ORIF
44
What is Rolando's fracture?
Intra-articular, comminuted 1st MCP base # ## Footnote NO subluxation or dislocation
45
What is Gamekeeper's thumb?
Avulsion # of attachment of ulnar collateral lig at MCP joint or thumb Usually due to instability of ulnar collateral lig ## Footnote Can cause valgus instability
46
47
48
What is PIN compression syndrome?
PIN from Radial nerve affects nerve supply of forearm extensor compt
49
Classify radial nerve palsy?
Elbow and below: PIN syndrome [only motor] Wartenberg syndrome [only sensory] Above elbow: Humeral shaft frac Sat Night Palsy
50
Cause of PIN syndrome?
Trauma, space filling lesions, inflammation, iatrogenic | Basically just compression ## Footnote Space filling lesions e.g. ganglion, lipoma etc
51
Common site of PIN entrapment in PIN syndrome?
Arcade of Frohse, where PIN pierces supinator nerve | most superior part of the superficial layer of supinator muscle ## Footnote Tennis elbow a/w PIN syndrome
52
Motor presentation of PIN syndrome?
IPJ extension of thumb [EPL] MCPJ 2-5 extension [ED] Wrist extension preserved but radially deviated ## Footnote Resisted supination will cause pain
53
Common site of nerve entrapment in Wartenberg syndrome?
Superficial Radial Nerve compressed by scissoring action of brachioradialis and ECRL tendons during forearm pronation
54
What condition is Wartenberg syndrome a/w?
DeQuervain's disease in 20% - 50%
55
Boundaries of carpal tunnel?
Lat = Scaphoid + Trapezium Medial = Pisiform + hook of Hamate Roof = transverse
56
Contents of carpal tunnel?
FDP tendon FDS tendon FPL Median nerve
57
Causes of Carpal Tunnel syndrome? ## Footnote Some associated conditions?
Inflamed synovium Space occupying lesions e.g. gout A/w: DM, obesity, RA, HypoT, Pregnancy ## Footnote Inflamed synovium is commonest idiopathic cause
58
Branches of Median Nerve after Carpal Tunnel? ## Footnote Where do they lie?
Palmar digital branch Recurrent motor branch Palmar for palmar surface and fingertips | Recurrent for thenar muscles ## Footnote PC branch lies at level of wrist flexion crease
59
What wasting seen on PE of Carpal tunnel syndrome?
Thenar eminence wasting
60
Branches of Median Nerve in forearm?
AIN Palmar cutaneous nerve | AIN supplies deep muscles in anterior forearm
61
Presentation for AIN syndrome ## Footnote Only motor!! No sensory
Thumb adducted [Ape hand] Benediction sign
62
Brief description of Ganglion cyst?
Content: Glairy fluid (uncooked egg white colour and consistency) 2 types: simple and Compound
63
Common site of ganglion cysts?
Grow out of tissues surrounding synovial joints and tendon sheaths
64
What is Rolando fracture?
Completely intra-articular fracture of base of thumb
65
66
When do Dupuytren's contractures commonly occur? | what age
50s-70s. Males 2x more common. AD inheritance
67
68
Compare muscular loss in CTS and High median nerve lesion?
High MN lesion = All flexors of 3.5 digits + OAF lost CTS = Only Opponens Pollicis and APB gone | 'O' = opponens, 'A' = abductor, 'F' = flexor
69
Thenar eminence lost in what lesion? Why?
Opponens, Abductor, Flexor muscle lesions. They have big thenar eminence.
70
What is trigger finger? | Commonly presents with nodule at where?
Inhibition of smooth tendon gliding due to mechanical impingement at level of A1 pulley. Nodule on palm in line with finger [at flexor tendon]
71
Mx of trigger finger?
Splinting NSAIDs Steroids injections Surgical release
72
Mx of DeQuervain's Tenosynovitis?
Conservative = thumb spica braces, injections In Refractory cases = 1st dorsal compartment surgical release
73
What conditions predispose to DeQuervain's Tenosynovitis?
RA HyperT Pregnancy etc etc
74
When to take XR post-fracture in Smith's or Colle's?
7-10 days. Ensure frac is not slipped, even when plate is used.
75

Ortho (11 decks)

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