Hand Flashcards
(201 cards)
1
Q
Contents of first dorsal wrist compartment.
A
APL/EPB
2
Q
Contents of second dorsal wrist compartment.
A
ECRL/ECRB
3
Q
Contents of third dorsal wrist compartment.
A
EPL
4
Q
Content of fourth dorsal wrist compartment.
A
EDC/EIP
5
Q
Contents of fifth dorsal wrist compartment.
A
EDM
6
Q
Contents of sixth dorsal wrist compartment.
A
ECU
7
Q
Location of sagittal bands.
A
MCP
8
Q
Central slip inserts here.
A
Middle phalanx.
9
Q
Eponym for oblique retinacular ligament.
A
Ligament of Landsmeer.
10
Q
Prevents volar subluxation of the lateral bands.
A
Triangular ligament.
11
Q
Prevents dorsal subluxation of the lateral bands.
A
Transverse retinacular ligament.
12
Q
This helps link PIP and DIP joint extension.
A
Oblique retinacular ligament.
13
Q
Action of FDS.
A
Flexes PIP.
14
Q
Action of FDP.
A
Flexion DIP.
15
Q
Each digit has ____ annular pulleys.
A
5
16
Q
Each digit has ___ cruciate pulleys.
A
3
17
Q
These pulleys prevent flexor tendon bowstringing.
A
A2 and A4
18
Q
Most radial structure in the carpal tunnel.
A
FPL
19
Q
Carpal tunnel contains these structures.
A
Median nerve, FDS x4, FDP x4, FPL.
20
Q
Roof of Guyon canal.
A
Volar carpal ligament.
21
Q
Prevalence of palmaris longus tendon.
A
80-85%
22
Q
FCU inserts here.
A
Pisiform.
23
Q
Number of dorsal interossei.
A
4
24
Q
Number of palmar interossei
A
3
25
Interossei innvervation.
Ulnar.
26
Lumbrical muscles originate here.
Radial aspect of FDP tendons.
27
Radial two lumbricals innervated by this nerve.
Median.
28
Ulnar two lumbricals innervated by this nerve.
Ulnar.
29
Palmar cutaneous branch of median nerve between these two tendons.
Palmaris longus and FCR.
30
Crossover variations between median and ulnar nerves.
Martin-Gruber anastomoses.
31
Distal radius fracture morphology associated with scapholunate ligament disruption.
Isolated radial styloid fracture.
32
AAOS guidelines for non-op distal radius fx treatment.
1. radial shortening less than 3mm
2. dorsal articular tilt less than 10 deg.
3. intra-articular step-off less than 2mm
33
Vitamin C dose of at least ____ mg/day may decrease CPRS after distal radius fx.
500 mg/day
34
Proximal row of carpus.
Scaphoid, lunate, triquetrum.
35
Distal row of carpus.
Trapezium, trapezoid, capitate, hamate.
36
Most common carpal fracture.
Scaphoid.
37
Blood supply to scaphoid.
Dorsal branch of radial artery.
38
Blood supply to scaphoid enters here.
Dorsal ridge just distal to waist.
39
Most commonly harvest vascularized bone grafting for scaphoid nonunion.
1,2 intercompartmental supraretinacular artery (a,2 ICSRA)
40
SNAC wrist stage I.
Radioscaphoid arthritis.
41
SNAC wrist stage II.
Scaphocapitate joint.
42
SNAC wrist stage III.
Lunocapitate joint.
43
Instability between individual carpal bones of single row.
Carpal instability dissociative (CID).
44
DISI and VISI are examples of this type of carpal instability.
CID
45
Instability between carpal rows.
Carpal instability non-dissociative (CIND).
46
Type of carpal instability secondary to perilunate dislocations.
Carpal instability complex.
47
Most common form of carpal instability.
DISI (CID).
48
Scaphoid and lunate deformities in DISI.
Scaphoid flexed, lunate extended.
49
Second most common form of carpal instability.
VISI.
50
Mayfield stages of perilunar disruption.
1. Scapholunate disruption
2. Scaphocapitate disruption
3. Lunotriquetral disruption
4. Circumferential disruption
51
Major deforming force of small finger CMC fracture-dislocation.
ECU
52
Deforming force of Bennett fractures.
APL and adductor pollicis.
53
This fragment is characteristically kept reduced to trapezium in Bennett fractures.
Volar-ulnar base.
54
This ligament keeps the volar-ulnar thumb MC base reduced to trapezium in Bennett fractures.
Anterior oblique or beak ligament.
55
Gamekeeper's thumb.
Chronic thumb MCP joint ulnar collateral ligament injury.
56
Competent thumb ulnar collateral ligament needed for this.
Pinch.
57
In a Stener lesion, this is interposed between avulsed MCP joint UCL and its insertion site on base of proximal phalanx.
Adductor pollicis aponeurosis.
58
Dorsal PIP joint dislocation may injure this.
Volar plate.
59
Volar PIP joint dislocation may injure this.
Central slip.
60
Inadequately treated central slip injury will lead to this.
Boutonniere deformity.
61
Splint in this position after PIP joint volar dislocation.
Full extension.
62
Irreducible DIP dislocation are due to interposition of this.
Volar plate.
63
Chronic mallet finger may lead to this deformity
Swan neck.
64
This epynonymous test for acute central slip rupture.
Elson's test.
65
In boutonneire's deformity, these sublux volarly.
Lateral bands.
66
Extensor zone V injury here.
Over MCP joint.
67
Extensor Zone IV injury here.
Over proximal phalanx.
68
Extensor zone III injury here.
Over PIP joint.
69
Extensor Zone VI injury here.
Over metacarpal.
70
Extensor Zone VII injury here.
Over wrist joint.
71
Risk of repaired tendon rupture greatest at this time.
3 weeks post repair.
72
Failure of tendon repair generally occurs here.
At suture knots.
73
Zone I flexor tendon injury.
FDP avulsion distal to FDS insertion.
74
Classification of FDP avulsion injuries.
Leddy and Packer.
Type I -- retraction into palm
Type II -- remains in digital sheath, implication that supporting vincula intact
Type III -- bony fragment attached to tendon stump stopped at A4 pulley
75
Location of Zone II flexor tendon injury.
Between FDS insertion and distal palmar crease.
76
location of Zone III flexor tendon injuries.
Between distal palmar crease and distal end of carpal tunnel.
77
Location of Zone IV flexor tendon injuries.
Carpal tunnel.
78
Trigger finger at this pulley.
A1.
79
First line of trigger finger treatment.
Corticosteroid injection into A1 pulley.
80
This first dorsal compartment tendon may have multiple slips.
APL
81
This first dorsal compartment tendon may have its own separate compartment.
EPB
82
Intersection syndrome symptoms occur here.
4-5 cm proximal to radiocarpal joint.
83
Intersection syndrome occurs at the junction of tendons in these compartments.
First (APL/EPB) and second (ECRL/ECRB).
84
Nail plate originates from this.
Germinal matrix.
85
Lies directly beneath nail plate and contributes keratin to increase plate thickness.
Sterile matrix.
86
Crescent-shaped white structure at junction of sterile and germinal matrices.
Lunula.
87
Lies between distal nail bed and skin of fingertip.
Hyponichium.
88
Distal margin of the proximal nail fold.
Eponychium (cuticle).
89
Lateral margins of the nail fold.
Paronychium.
90
2-octylcyanoacrylate.
Dermabond.
91
Fingertip injuries without exposed bone.
Heal by secondary intention.
92
Dorsal thumb injury best covered with.
First dorsal metacarpal artery kite flap.
93
Degree of lengthening from Z-plasty (a) 30 deg, (b) 45 deg, (c) 60 deg.
25%, 50%, 75%
94
Viable warm ischemia time for amputated digit.
12 hours.
95
Viable cold ischemia time for amputated digit.
24 hours.
96
Viable warm ischemia time for amputation proximal to carpus.
6 hours.
97
Viable cold ischemia time for amputation proximal to carpus.
12 hours.
98
Contraindications to digit replantation (5).
1. Single digit (esp index)
2. Crush injury
3. Prolonged ischemia
4. Segmental amputation
5. Level of amp within flexor zone II
99
Most common cause of early (12 hrs) replantation failure.
Arterial thrombosis from persistent vasospasm.
100
Most common cause of failure after 12 hrs of replant.
Venous congestion or thrombosis.
101
Medicinal leeches technical name.
Hirudo medicinalis.
102
Medicinal leeches produce this.
Hirudin.
103
Leech therapy infection with this.
Aeromonas hydorphila.
104
Prophylactic abx with leech therapy.
Ceftriaxone or ciprofloxacin.
105
Factor most predictive of digit survival after replantation.
Mechanism of injury.
106
Main contributor to superficial palmar arch.
Ulnar artery.
107
Main contributor to deep palmar arch.
Radial artery.
108
Initial treatment of frostbite.
Rapid rewarming in water bath at 40-42 deg C.
109
Surgical debridement or amputation after frostbite done at this time.
Delayed.
110
Inability to discern two-point greater than ___ mm is considered abnormal.
6 mm
111
Most sensitive carpal tunnel syndrome provacative test.
Carpal tunnel compression test.
112
Abnormal distal sensory latencies.
More than 3.5 msec
113
Abnormal motor latencies.
More than 4.5 msec
114
Courses between the supracondylar process and the medial epicondyle.
Ligament of struthers.
115
Supracondylar process best seen on this x-ray.
Lateral or elbow or humerus.
116
Differentiates pronator teres syndrome from AIN syndrome.
AIN syndrome has no sensory component.
117
Floor of cubital tunnel.
MCL and elbow joint capsule.
118
Walls of cubital tunnel.
Medial epicondyle and olecranon.
119
Roof of cubital tunnel made up of these (2).
1. FCU fascia
| 2. Arcuate ligament of osborne
120
Most common cause of ulnar tunnel syndrome.
Ganglion cyst.
121
Roof of Guyon canal.
Volar carpal ligament.
122
Floor of Guyon canal.
Transverse carpal ligament.
123
Radial border of Guyon canal.
Hook of hamate.
124
Ulnar border of Guyon canal.
Pisiform and abductor digit minimi.
125
Zones of the Ulnar tunnel (3).
Zone 1 -- proximal to bifurcation of ulnar nerve. Mixed motor/sensory
Zone 2 -- deep motor branch. Pure motor symptoms
Zone 3 -- distal sensory branches. Pure sensory
126
Sites of compression in PIN compression syndrome (5).
1. fascial band at radial head
2. recurrent leash of henry
3. edge of ECRB
4. arcade of Frohse (proximal edge of supinator)
5. distal edge of supinator
127
Broad types of thoracic outlet syndrome (2).
1. Vascular
| 2. Neurogenic
128
Adson test for thoracic outlet syndrome.
Patient arm at side, hyperextension of neck, rotate head to affected side. Results in diminished radial artery pulse.
129
Vascular thoracic outet syndrome caused by this.
Subclavian vessel compression or aneurysm.
130
Neurogenic thoracic outlet syndrome described as this.
Entrapment neuropathy of lower trunk of brachial plexus.
131
Essential for work up of neurogenic thoraic outlet syndrome.
Cervical and chest radiographs.
132
Most important prognostic factor for nerve recovery.
Age.
133
Wallerian degeneration in these two types of nerve injuries.
Axonotmesis and neurotmesis.
134
Brachial plexus injuries at this location have worst prognosis.
Preganglionic (nerve root).
135
Most reliable clinical sign of nerve regeneration and recovery after brachial plexus injury.
Advancing Tinel sign.
136
Oberlin nerve transfer.
Ulnar nerve branch to FCU transfer to musculocutaneous nerve to help restore elbow flexion.
137
Most important predictor of success in upper extremity surgery for CP spasticity.
Voluntary muscle control.
138
Thumb in palm deformity in CP is corrected with this (3).
1. Release/lengthening of adductor pollicis, first dorsal interosseous, flexor pollicis brevis, FPL
2. First webbed space Z-plasty
3. Tendon transfer to augment thumb extension/abduction
139
Amplitude or muscle excursion is proportional to this when doing tendon transfers.
Length of the muscle.
140
These types of muscle transfers are easiest to rehabilitate.
Synergistic.
141
This amount of motor strength lost after transfer.
One grade of motor strength.
142
Vaughan-Jackson syndrome.
Extensor tendon rupture in RA, starting with EDM.
143
Carpus subluxes in these directions in RA (2).
Volarly and ulnarly
144
Difference in MCP deformity in juvenile versus adult RA.
Adult MCP ulnar deviation. Juvenile RA MCP radial deviation.
145
Eponym for systemic juvenile RA.
Still disease.
146
Nail pitting and sausage digits.
Psoriatic arthritis.
147
Pencil-in-cup deformity.
Psoriatic arthritis.
148
Kienbock disease.
Idiopathic osteonecrosis of the lunate.
149
First line of surgical treatment for Kienbock disease.
Joint leveling procedure (radial shortening to neutral or ulnar positive).
150
Association exits between Dupuytren's diseaes and occupation. True or false?
False.
151
Predominant cell type in Dupuytren's fascia.
Myofibroblasts.
152
These ligaments are not involved in Dupuytren's.
Cleland.
153
This structure leads to PIP contracture in Dupuytren's disease.
Spiral cord.
154
In Dupuytren's, the spiral cord puts the neurovascular bundle at risk by displacing it in this direction.
Centrally and superficially.
155
Dupuytren's of the plantar fascia of foot.
Ledderhose disease.
156
Dupuytren's of the penis.
Peyronie's disease.
157
Procedure of choice for Dupuytren's.
Open limited fasciectomy.
158
Hueston test for Dupuytren's.
Inability to place hand flat on tabletop.
159
This procedure for Dupuytren's no longer favored due to high complication rate.
Total palmar fasciectomy.
160
Most common complication after fasciectomy for Dupuytren's is this.
Recurrence.
161
Most common soft tissue mass of the hand and wrist.
Ganglion.
162
Most wrist ganglion's originate from this articulation.
Scapholunate.
163
These occur at dorsum of DIP joint in patients with osteoarthritis.
Mucous cysts.
164
Second most common soft tissue mass of the hand.
Giant cell tumor of tendon sheath.
165
Treatment of giant cell tumor of tendon sheath.
Marginal excision.
166
Slow-growing, nontender, multilobulated mass on volar aspect of a digit.
Giant cell tumor of tendon sheath.
167
Smooth muscle tumor in finger characterized by pain and cold intolerance.
Glomus tumor.
168
Treatment of glomus tumor.
Marginal excision.
169
Most common malignancy of the hand.
Squamous cell carcinoma.
170
Most common subungual malignancy.
Squamous cell carcinoma.
171
Most common metastatic cancer to hand.
Lung.
172
Location of paronychia.
Eponychium.
173
Location of felon.
Pulp space.
174
Herpetic whitlow caused by this.
HSV 1
175
Horseshoe abscess is based on communication between flexor tendon sheaths of these fingers.
Thumb and small finger.
176
Most common organism in necrotizing fasciitis.
Group A beta-hemolytic strep.
177
Limb bud appears during this week of gestation.
4th
178
Most congential anomalies occur by this time.
The end of embyrogenesis at 8 weeks.
179
This structure mediates proximal to distal growth of limb.
Apical ectodermal ridge.
180
This structure mediates anterior to posterior growth of limb.
Zone of polarizing activity.
181
Pathway important for anterior to posterior growth.
Sonic hedgehog gene.
182
Pathway important for dorsoventral axis growth.
Wnt signalling.
183
Most common congenital hand anomaly.
Polydactyly.
184
Syndactyly results from failure of this.
Apoptosis to separate digits.
185
Pure syndactyly has this inheritance pattern.
Autosomal dominant.
186
Most common preaxial polydactyl thumb type.
Type IV -- duplicated proximal phalanx
187
If duplicate thumbs of equal size, preserve this side.
Ulnar thumb to retain ulnar collateral ligament for pinch.
188
Critical structure when evaluating thumb hypoplasia.
CMC joint.
189
Determines whether hypoplastic thumb can be reconstructed or requires poliicization.
CMC joint.
190
Disruption of the volar ulnar physis of distal radius.
Madelung deformity.
191
Implicated tether structure in Madelung deformity.
Vickers ligament.
192
Primary restraint to valgus stress within functional elbow ROM.
Anterior bundle of medial collateral ligament.
193
Histologic finding in lateral epicondylitis.
Angiofibroblastic hyperplasia.
194
Location of partial distal biceps tears.
Radial side of tuberosity footprint.
195
Technique for superior strength for distal biceps repair.
Endobutton.
196
Risk of single incision technique for distal biceps repair.
Neurologic injury (PIN and LABCN).
197
Risk of two incision technique for distal biceps repair.
Radioulnar synostosis.
198
Anterior bundle of MCL of elbow inserts here.
Sublime tubercle on ulna.
199
Posterolateral elbow rotatory instability caused by this.
Incompetence of lateral UCL.
200
Highest stress of elbow MCL on this phase of throwing.
Late cocking.
201
Osteophytes here block fulle xtension with valgus extension overload of elbow.
Posteromedial olecranon process.
