Hand

Question 1

Significance of proximal palmar crease?

Answer 1

Appx site of the superficial palmar arch

Question 2

Significant of distal palmar crease?

Answer 2

site of MCP joints (dorsally)

Question 3

Bennett’s fracture. Deforming force?

Answer 3

Base of thumb metacarpal fx (type 1): intraarticular fracture with proximal and radial dx of 1st metacarpal. Triangular bone fragments. APL deforms

Question 4

Rolando fracture. Complications?

Answer 4

Base of thumb metacarpal fx (type 2): Intraarticular fracture with Y-shape. DJD after

Question 5

Flexed fingers point to:

Answer 5

Tuberosity of scaphoid

Question 6

Most common metacarpal fracture?

Most common anatomic location?

Answer 6

5th MC

Neck of MC

Question 7

Boxer’s fracture?

Answer 7

Base of 5th MC

Question 8

Gamekeeper’s thumb

Answer 8

Thumb MCP joint proper ulnar collateral ligament injury from forced radial deviation. Ski pole injury often. Stener lesion seen. Test at 30° flexion

Question 9

Stenor lesion?

Answer 9

When adductor aponeurosis falls under torn ulnar collateral ligament, producing a palpable mass.

Question 10

Mallet finger?

Answer 10

Rupture of the extensor tendon from distal phalanx. Bony avulsion from EDU seen.

Question 11

Jersey finger?

Answer 11

FDP avulsion from P3 (avulsion fracture from volar base of P3)

Question 12

Flexor tendon zones I-V and Thumb I-III

Answer 12

I: distal to FDS inertion
II: Flexor retinaculum. No man’s land. avoid A2 and A4.
III: Palm.
IV: Carpal tunnel. Release and repair TCL during repair
V: Wrist and forearm.
Thumb I: Distal to FPL insertion
Thumb II: Thumb flexor retinaculum. Preserve either A1 or oblique pulley
Thumb III: Thenar eminence. Do not operate in this zone due to recurrent motor branch of median n

Question 13

Extensor tendon zones I-IX

Answer 13

I: DIP joint. Mallet finger
II: Middle phalanx
III: PIP joint. Central slip injury. If triangular ligament is disrupted, lateral bands migrate volarly resulting in boutinniere finger. 
IV: Proximal phalanx
V: MCP joint. Injury from fight bite. Repair tendon and sagittal bands as needed
VI: Metacarpal. 
VII: Wrist
VIII: Distal forearm. At MSC jxn
IX: proximal forearm.

Question 14

Draw flexor tendon sheath

Answer 14

A1 MCPJ, A2 proximal phalanx, A3 PIPJ, A4 middle phalanx, A5 DIPJ.

Question 15

What can cause trigger finger?

Answer 15

Tight A1 ligament

Question 16

Significance of Anterior oblique CMC ligament?

Answer 16

Ulnar side of 1st MC base to tubercle of trapezium. Beak ligament. Holds fragment in Bennett’s fx. Primary restraint to subluxation.

Question 17

Significance of dorsal radial CMC ligament?

Answer 17

Dorsal trapezium to dorsal MC base. Strongest ligament. Torn in dorsal dx.

Question 18

Cam effect in MC head and collateral ligament

Answer 18

Tight in flexion, loose in extension

Question 19

Significance of Grayson’s ligament

Answer 19

Volar to neurovascular bundle, stabilizes skill in NV bundle.

Question 20

Sig. of Cleland’s ligament

Answer 20

Dorsal to NV bundle. Stabilizes skin during flexion/extension.

Question 21

Flexion and extension of MCP joint

Answer 21

Flexion - IO muscles + lumbricals

Extension - EDC via sagittal bands

Question 22

Flexion and extension of PIPJ and DIPJ

Answer 22

PIPJ - flexion via FDS and FDP, extension via EDC and lumbricals via lateral bands
DIPJ - flexion via FDP, extension via EDC and oblique retinacular ligament.

Question 23

Parona’s space

Answer 23

Between flexor tendons and PQ. Possible horseshoe abscess.

Question 24

Heberden’s and Bouchard’s nodes

Answer 24

Seen in OA. Heberden’s at DIPJ (more common), Bouchard’s at PIPJ.

Question 25

MCP nodes

Answer 25

Seen in OA

Question 26

Dupuytren's contracture

Answer 26

Flexion contracture of 4th and 5th fingers. Palpable nodules. Caused by myofibroblast proliferation creating cords of type 3 collagen.

Question 27

Four cardinal signs of Kanavel

Answer 27

Sings of purulent tenosynovitis: 1) Pain on extension 2) Fusiform swelling 3) Slight flexion 4) Tenderness along tendon sheath

Question 28

1/2LOAF1/2

Answer 28

``` Median n innervates (motor recurrent branch) 1/2 lumbricals Opponens pollicis Abductor pollicis brevis 1/2 flexor pollicis brevis ```

Question 29

Hoffman's

Answer 29

Flick middle finger DIPJ into flexion. If thumb IPJ flexes, myleopathy

Question 30

Profundus test

Answer 30

Stabilize PIPJ in extension, flex DIPJ only. FDP pathology

Question 31

Sublimbus test

Answer 31

Extend all fingers, flex one PIPJ at a time. FDS pathology

Question 32

Froment's sign

Answer 32

Hold paper with thumb and index finger. Pull paper. If thumb IP flexion is positive, suggest adductor pollicis weakness/ulnar nerve palsy.

Question 33

CMC grind test

Answer 33

Axial compress and rotate CMC joint. Pain = arthritis

Question 34

Finger instability test

Answer 34

Stabilize proximal joint, apply varus/valgus stress. Laxity=collateral ligament instability

Question 35

Thumb instability test

Answer 35

Stabilize MCP, apply valgus stress in extension and 30° of flexion. Laxity at 30° indicates ulnar collateral ligament injury. Laxity in extension indicates accessory collateral/volar plate injury

Question 36

Brunnell-Littler test

Answer 36

Extend MCPJ, passively flex PIPJ. If easier to flex PIPJ in MCPJ flexion, tight intrinsic muscles

Question 37

Elson test

Answer 37

Flex PIPJ 90° over table edge, resist P2 extension. If the DIPJ extends (via lateral bands) indicates central slip injury (boutonniere)

Question 38

Which lumbricals are unipennate vs bipennate

Answer 38

1/2 are unipennate (median nerve) | 3/4 are bipennate (ulnar nerve)

Question 39

What are the actions of dorsal and palmar interossei

Answer 39

DAB | PAD

Question 40

Innervation of FPB

Answer 40

Deep head by ulnar n, superficial head by median n.

Question 41

Radial and Ulnar artery continuation in the hand.

Answer 41

Radial artery's deep branch runs through the 1st dorsal interosseous and becomes the deep palmar arch. Ulnar artery's superficial branch branch terminates as the superficial palmar arch

Question 42

Relationship of deep and superficial palmar arches?

Answer 42

Superficial arch is distal to deep arch. Limit of superficial arch is called Kaplan's line.

Question 43

Kaplan's line?

Answer 43

Distal limit of superficial palmar arch

Question 44

Swan neck deformity cause

Answer 44

FDS insertion/volar plate injury, associated with RA.

Question 45

Boutonniere deformity cause

Answer 45

Central slip of EDC and triangular ligament injury. Lateral bands subluxate volarly which hyperflexes PIPJ.

Question 46

Common bacteria in human/animal bites

Answer 46

Staph, strep Human: Eikenella Animal: Pasturella

Question 47

Retinacular cyst

Answer 47

Ganglion type cyst of flexor tendon sheath.

Question 48

Syndactyly

Answer 48

Failure of finger tissue differentiation (fused fingers)

Question 49

Camptodactyly

Answer 49

Congenital finger flexion abnormality. Usually PIPJ of small finger.

Question 50

Clinodactyly

Answer 50

Deviation of finger in coronal plane. Usually radial deviation of small finger. Due to delta shaped middle phalanx.

Question 51

Preaxial polydactyly

Answer 51

Duplicate thumb. 7 types, #4 most common.

Question 52

Constriction band syndrome

Answer 52

Bands lead to digit necrosis or diminished growth.

Question 53

Volar approach to finger | dangers

Answer 53

Digital artery/nerve, flexor tendons. NV bundle is lateral to tendon sheath.

Question 54

Mid-lateral approach to finger | dangers

Answer 54

Digital artery/nerve