Hand Flashcards
(128 cards)
1
Q
flexor tendon blood supply in relation to the MCP
A
proximal to the MCP nutrition is via diffusion from the synovial sheath
2
Q
function of the triangular ligament
A
prevent volar subluxation of the lateral bands
3
Q
function of the oblique retinacular ligament
A
link PIP and DIP extension
4
Q
relationship of cleland and graysons ligaments to the neurovascular bundle
A
cleland is dorsal, graysons is palmar/volar. Graysons ground, Clelands ceiling
5
Q
orientation of the flexors in the carpal tunnel
A
FPL is most radial. FDP all more deep than FDS. Long and ring FDS are most volar
6
Q
orientation of the lumbrical insertions
A
volar to the transverse metacarpal ligaments, inserting on the radial side of the extensor hood/lateral bands
7
Q
orientation of the digital nerves in relation to the arteries
A
nerves are volar to the arteries
8
Q
AAOS postreduction guidelines for distal radius
A
stepoff
9
Q
treatment of EPL rupture in distal radial fx care
A
common after closed treatment, and primary repair often not possible. Either palmaris graft, or EIP-to-EPL transfer
10
Q
this is the most common tendon injury after volar plating of DR fx
A
FPL rupture.
11
Q
vit C dose for RSD in DR fx
A
500mg per day
12
Q
these scaphoid fxs are more at risk of AVN
A
waist and proximal pole
13
Q
most common mechanism of scaphoid fx
A
forced hyperextension and radial deviation
14
Q
indications for scaphoid fxs
A
displacement >1mm, humpback deformity (35* angulation), and trans-scaphoid perilunate dislocation
15
Q
benefits of percutaneous fixation of scaphoid fx
A
faster time to union, and faster return to activity
16
Q
benefits of volar approach to fixing displaced scaphoid fxs
A
avoids disruption to the blood supply, which is the dorsal branch off the radial artery that enters just distal to the waist
17
Q
SNAC wrist stages
A
1 - radioscaphoid, 2 - + scaphocapititate, 3 - + lunocapitate
18
Q
symptomatic hook of hamate fxs that fail nonop
A
excise; ORIF has high complication and little benefit
19
Q
relative strengths of the carpal ligament fibers
A
the dorsal ones are stronger than the volar
20
Q
etiology of DISI
A
SLL distruption
21
Q
3 radiographic indications of DISI
A
SL angle >70*, SL interval >3mm, cortical ring sign
22
Q
gold standard for dx of DISI
A
wrist arthroscopy
23
Q
this is spared in SLAC wrist
A
radiolunate articulation
24
Q
SLAC stages
A
radial styloid beaking, radioscaphoid, midcarpal
25
in chronic SL instability this is a treatment option
ECU tendon graft
26
2mm of metacarpal shortening equals this amount of extensor lag
7*
27
deforming force in baby bennett
ECU
28
deforming force in bennett
APL and the thumb extensors, cause proximal, dorsal, and radial displacement of the metacarpal shaft. Adductor pollicis causes supination and adduction.
29
anterior oblique ligament (beak) in bennett fxs
connection between the volar-ulnar portion of MC shaft and the trapezium
30
why thumb MCP stability is tested in 0* and 30*
instability at 30* is due to UCL proper. Instability at both 0* and 30* implies injury to the volar plate and/or accessory UCL
31
stener lesion
interposition of the adductor pollicis aponeurosis between the avulsed UCL and its insertion on the proximal phalanx
32
PIP dorsal disloc'n
Injury to volar plate AND at least one collateral.
33
PIP volar disloc'n
Injury to central slip AND at least one collateral.
34
result of poorly treated PIP volar disloc'n
since these are central slip injuries, they can go on to boutonniere deformity
35
rotatory PIP dislocations hard to reduce bc
phalangeal condyle buttonholes through lateral bands and the central slip
36
initial mgmt of chronic injury resulting from central slip rupture
boutonniere deformity, needs to have maximal passive motion prior to any operative treatment. Dynamic splinting or serial casting
37
strength of flexor tendon repair proportional to
number of strands that cross repair
38
benefit of high-caliber suture in flexor tendon lacs
decreases gap formation, increases strength and stiffness
39
benefit of locking loop technique in flexor tendon lacs
decreases gap formation
40
why repair the epitenon in flexor lacs
increases repair strength by 30-50%
41
repair of the flexor tendon sheath in lac repair
no benefit
42
timeframe for weakness in tendon repair
3 weeks is weakest, and fails at the knots
43
minimum repair of flexor tendon lac to allow active motion protocol
4 strand repair needed for active motion
44
types and the mgmt of zone I flexor tendon injuries
type I retracts all the way to the palm and needs to fixed within 7-10 days. type 2 can wait 6 weeks, as the vinculae prevent retraction past PIP. Type 3 also can wait 6 weeks.
45
how quadrigia occurs
if an injured 3-4-5 FDP is advanced more than 1cm, the remaining 3-4-5 digits will not flex anymore once the repaired digit bottoms out.
46
commonality b/t kleinert and duran OT protocols
both restrict active flexion for 6 weeks
47
how flexion is performed with the kleinert and duran protocols
in the kleinert passive flexion performed with bands (?) and duran it is performed with the other hand (COMPLIANCE)
48
difference bt pediatric and adult trigger thumbs
in peds the pathology is in the tendon itself, rather than the tendon sheath
49
treatment for pediatric trigger finger
a simple A1 pulley release may not be enough. May need to release A3, or resect FDS slip
50
this % gets better with injection of DQ synovitis
80%
51
this tendon often has more than one slip when surgically treating 1st dorsal compt synovitis
APL
52
this tendon often has its own compartment when surgically treating 1st dorsal compt synovitis
EPB
53
intersection syndrome
inflammation/bursitis bt the 1st and 2nd dorsal extensor compartments
54
this motion can lead to traumatic subluxation of the ECU tendon
hypersupination and ulnar deviation
55
rate of incidental TFCC tears in wrist scopes
50%
56
ulnar variance with pronation
positive
57
ulnar variance with supination
negative
58
these two ligaments have their origins on the TFCC
ulnolunate and ulnotriquetral ligaments
59
percent of load borne by the TFCC at neutral ulnar variance
20%
60
surgical considerations in ulnocarpal impaction syndrome
if the DRUJ is free of arthritis, you can shorten the ulna
61
threshold for removal of nail plate in subungal hematoma
>50%
62
why are FTSG better for fingertip injuries
sensibility, durability
63
flap for volar oblique fingertip injury
cross-finger
64
flap for volar oblique fingertip injury to the index or middle digit
either cross-finger, or can do thenar flap
65
who would get a thenar flap, and what are the concerns
flap for volar oblique fingertip injury to the index or long, and can get PIP stiffness especially if older
66
flap for transverse or dorsal oblique fingertip injury
V-Y advancement
67
flap for transverse or volar oblique fingertip injury of the thumb
moberg
68
probably created a few of these in the mgmt of fingertip injuries treated by acute shortening
lumbrical plus finger can result from violation of the FDP insertion and retraction. This pulls on the lateral bands (and the extensor mech) through the lumbricals, as they originate on the now shortened FDP
69
this flap is done for dorsal thumb skin loss
kite flap (1st dorsal metacarpal artery)
70
these are preferred for coverage of dorsal hand wounds
STSG
71
these are preferred for coverage of volar hand wounds and fingertips
FTSG
72
this provides 75% lengthening along the central limb of a flap
60* Z-plasty
73
blood supply for gracilis flap
medial femoral circumflex
74
blood supply for latissimus flap
thoracodorsal
75
blood supply for serratus flap
serratus branch of the subscapular artery
76
blood supply for anterolateral thigh flap
descending branch of the lateral femoral circumflex
77
blood supply for lateral arm flap
posterior branch of the radial collateral artery
78
amputations in zone II: replant?
nope
79
amputations in zone I: replant?
relative indication to replant distal to the FDS insertion
80
amputations at the wrist level: replant?
wrist level and proximal is indication to replant
81
amputations in polytrauma: replant?
along with psych conditions, polytrauma pts may be poor replant candidates
82
sequence for replant of a single digit amputation
bone, extensors, flexors, artery, vein, nerve
83
sequence for replant of multiple digit amputation
thumb, long, ring, small, index
84
what else can be measured besides pulse ox in replanted digit
skin surface temperature; 2* in an hour indicates decreased perfusion
85
most predictive of digit survival after replant
mechanism of injury, then probably ischemia time
86
failure of replant within 12 hours
arterial vasospasm
87
failure of replant after 12 hours
venous congestion
88
this goes with leech therapy for late replant failure
cipro or rocephin; leech saliva has aeromonas in it
89
most commonly performed procedure after successful replant
tenolysis
90
ring avulsion injuries
treatment depends on vascularity first, then bony or tendon injury. 1 - circulation intact, salvage with coverage. 2 - circulation disrupted, but no gross bony or tendon injury, revascularization. 3 - complete degloving, needs amp'd.
91
this class of meds may help with raynaud's dz
calcium channel blockers
92
these muscles are the most vulnerable to ischemic forearm contracture
FDP and FDL
93
imaging in frostbite
bone scan
94
these are last to go in compression neuropathy
pain and temperature sensation
95
viral illness preceding neuritis
parsonage-turner
96
semmes weinstein test this
cutaneous pressure threshold; large nerve fibers (which are first to be affected in compressive neuropathy)
97
greater than this 2 point is abnormal sensation
6mm
98
most common cause of CTS in peds
mucopolysaccharidoses
99
injection rate of success in CTS
80% after 6 weeks, but only 20% of those are symptom-free at 1 year. Surgery is less successful for those in which injections don't work
100
how to distinguish pronator syndrome from carpal tunnel syndrome on sensation alone
palmar cutaneous branch of the median nerve won't be affected in CTS (comes off prior)
101
sites of pronator compression
ligament of struthers, lacertus fibrosis (biceps aponeurosis), two heads of pronator teres, FDS aponeurosis
102
testing for pronator syndrome
pain with resisted elbow flexion in forearm supination, and forearm pronation with elbow extended
103
pronator syndrome associated with this and improves if you treat it
medial epicondylitis
104
compressive neuropathy with pure motor loss
AIN syndrome. FPL, FDP to 1st, pronator quadratus
105
testing for pronator quadratus involvement in AIN syndrome
pain on resisted pronation with elbow flexed
106
AIN syndrome could be confused for this
Mannerfelt lesion in RA. This is FPL rupture.
107
floor of the cubital tunnel
MCL and elbow capsule
108
wartenberg sign
pinky abduction and extension when trying to adduct; ulnar nerve compression
109
threshold for diagnosis of ulnar compression based on conduction velocity
conduction velocity less than 50m/sec
110
ulnar decompression vs transposition
no difference
111
most common cause of ulnar tunnel syndrome
ganglion cyst
112
PIN syndrome exam
radial deviation with wrist extension (ECRL innervated higher)
113
sites of PIN compression
CHEFS - capsule, leash of Henry, ECRB, arcade of Frohse, supinator (distal edge)
114
most important prognostic factor for nerve recovery after injury
age
115
indication for nerve conduit in digital nerve
gap larger than 8mm
116
this type of plexus injury has the worst prognosis
preganglionic
117
most important predictor of success in operative mgmt of CP
voluntary muscle control
118
this has not demonstrated a benefit over placebo or corticosteroids in CMC arthritis
off-label hyaluronic acid
119
there is evidence that this has similar outcome to more complicated basal joint arthritis treatments
trapeziectomy
120
first to be affected in vaughn-jackson syndrome
EDM
121
direction of progression in vaughn-jackson
from the EDM radially
122
mannerfelt lesion
attritional FPL rupture, due to volar STT joint osteophyte
123
treatment of mannerfelt lesion
direct repair fails, so tendon transfer more desirable
124
this might be the initial presentation of RA MCP joint involvement
extensor lag
125
why RA MCP's deviate ulnarly
pannus stretches the weaker radial sagittal bands
126
this is a temporary solution in RA MCP treatment
synovectomy and centralization of the extensor tendons
127
perilunate dislocation begins with
scaphoid extension, then scaphoid failure
128
mayfield progression
scaphoid extension, scaphoid failure, distal row dissociation, triquetral hyperextension, lunotriquetral ligament failure, dorsal dislocation of the carpus
