Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MBBS Orthopedics > Hand > Flashcards

Hand Flashcards

1
Q

What is the classification of trigger finger (stenosing tenovaginitis)

A

Green classification
Stages
I: pre-triggering: pain along flexor tendon but no demonstrable triggering
II: triggering: catch but can actively extend
III: triggering and locking
a: req active extension
b: req active flexion
IV: contracture: fixed flexion contracture of PIPJ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the mgx of trigger finger

A

Conservative
- lifestyle: avoid trauma
- occupational therapy: splint PIPJ in 15deg/ physioT
H&L injections (triamcinolone and lignocaine)
Op:
- division of A1 pulley in the midline (tendon sheath)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the kanavel signs

A

infectious tenosynovitis of flexor tendon sheath in hand
o Slight flexed position of affected finger
o Fusiform swelling over affected tendon
o Tenderness on percussion along tendon sheath
o Tenderness on extension of affected finger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the zones of the hand

A 
o Zone 1: FDP
o Zone 2: FDP and FDS (‘No man’s land as healing is poor) 
o Zone 3: Palm
o Zone 4: Carpal tunnel
o Zone 5: Forearm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

principles of tx of infected hand

A
  • antibiotics: flucloxacillin/ cephalosporin
  • rest and elevation: sling, roller towel
  • analgesia
  • drainage
  • send pus for microb investigation
  • splintage (where ligaments are in greatest length - reduce likelihood of stiffness)
  • physiotherapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the 5 tissues of the hand

A
  • skin and subcutaneous tissue
  • muscle and tendon
  • blood vessels
  • nerves
  • bones and joints
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Ulnar nerve examination

  • look
  • test
A

Look:
- claw hand
- wasting of the first dorsal interosseous, guttering
Test:
- abduction of index finger (1st dorsal interosseous)
- adduction (cross first 2 fingers)
- FDP of little finger
- froment sign (adductor policis)
- sensation to little finger and hypothenar eminence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does the ulnar nerve supply

A

Motor: thenar muscles except LOAF

  • hypothenal (ODM, AbDM, FDM)
  • 3rd/4th lumbricals
  • dorsal and palmar interossei
  • adductor pollicis

forearm: FCU, radial half of FDP

Sensory: innervate anterior and posterior surfaces of the medial 1 Half fingers and its associated palm area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Localising site of injury in ulnar n lesions

A

Elbow: FDP and sensation to hypothenar lost
wrist: above is preserved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Differentials of ulnar n palsy

A
  • carrying angle of elbow
  • lacerations over medial aspect of elbow
  • thickened ulnar nerve
  • ulnar n subluxation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Median n examination

A 
Look: wasting of thenar eminence
Test:
- FPB (abducting thumb)
- ok sign (FDP and FPL)
- flexion of PIPJ (FDS)
Special:
- tinel and phalen at carpal tunnel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Localisation in medial n palsy

A

carpal tunnel:

  • spare thenar sensation, FDP, FPL, FDS
  • affects FPB

AIN lesion:
- hits FDP, FPL

High lesion:
affects all

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does the median nerve supply

A

Motor:

  • flextors in forearm less FCU and ulnar 2 FDP: pronator teres, FCR, palmaris longus, FDS, lat 2 FDP, FPL, PQ
  • LOAF: lumbricals 1,2 and thenar muscles

Sensory

  • palmar: thenar eminence + 3half fingers
  • volar: tips of 3half fingers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Radial nerve examination

A 
Look: finger drop/ wrist drop
Test:
- EPL (retropulsion of thumb)
- extension of fingers (ED)
- extension of wrist (ECR, ECU)
- extension of elbow (triceps brachii)
- sensation over first webspace
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Localisation of radial nerve lesion

A

PIN:

  • finger drop (no wrist drop)
  • no sensory loss

Spiral groove:

  • wrist drop
  • sensory loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does the radial nerve supply

A

Sensory: posterior forearm, dorsal hand
Motor:
- triceps brachii
- extensor muscles in forearm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how many dorsal components does the hand hand and their contents

A

1st: APL, EPB
2nd: ECRL, ECRB
3rd: EPL
4th EDC + Ex indicis
5th EDM
6th ECU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is a ganglion and

Common sites for ganglions

A

Ganglion: fluid filled outpouching of the synovial mb of a joint or tendon sheath

Usually found over dorsal or palmar radial side of wrist, over flexor sheaths and over DIPK

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

PVNS

  • what is it
  • how to diagnose
  • types and where to find
  • features
  • tx
A

benign proliferative disorder of synovial lining of joint, bursa, tendon sheaths > inflammation and nodular thickening of synovial mb

histo diagnosis (giant cell seen)

Types

  • diffuse: knee>hip>ankle>shoulder
  • localised: hands/ feet (volar aspect of DIPJ)
  • firm, not transilluminable, non tender

TX: synovectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

RA features of the hand

A

Elbow: swelling, subluxation of radius

Wrist: carput ulnae syndrome, swelling

MPJ: ulnar deviation, swelling, volar subluxation

Fingers: boutonneire/ swan neck

Thumb: CMC swelling/ subluxation, z deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

OA features of hand

A

PIP: radial/ulnar dev, Bouchard nodes
DIP: heberden nodes, mucous cyst, mallet deformities, deviation
Thumb:
- swelling/ subluxation of CMC jt, grind test positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

active vs passive ROM limitation

A

active < passive:

  • muscle weakness/ nerve palsy
  • tendon rupture
  • tendon adhesion

Passive limited
- joint contracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Allen test

  • what does it test
  • how to test
  • significance
A

Test patency of palmar arch (communication between radial and ulnar artery)
- test arterial blood flow

  1. elevate hand, clench fist for 30 sec
  2. occlude ulnar and radial arteries
  3. open hand
  4. release ulnar pressure. maintain radial pressure. time length req for colour to return (n=5-15sec)

if time increased: ulnar artery supply insufficient. may not be safe to cannulate/ needle radial artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

DeQuervain tenosynovitis

  • what tendons involved
  • RF
  • how to test
  • mgx
A

first dorsal comp: EPB, AbPL
RF: clothes wringing, pruning, cutting with scissors
Finkelstein test

Mgx:
Conservative
- lifestyle: rest
- occupational: thumb spica
- physioT: ultrasound
- meds: NSAIDS
H&amp;L
Sx: decompression of 1st compartment (tendon sheath release)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Differentials for lump in hand
Cystic/ soft: ganglion, lipoma, vascular Firm: PVNS, Neuroma, Fibroma Hard: osteochondroma, bone tumor
26
differentials for painful wrist
Referred: cervical spondylosis Joint: OA, RA, infection Periarticular: dequervain, tenosynovitis, instability
27
differentials for painful hand
Referred: neck, shoulder, mediastinum Joint: OA, RA Periarticular: carpal tunnel, tenosynovitis, infection
28
What to look for in a lateral hand/wrist x ray
alignment of bones - cup in cup | 3rd metacarpal - capitate - lunate -radius in one straight line
29
What are the carpal bones
Scaphoid Lunate Triquetrium Pisiform | Trapezium Trapezoid Capitate Hamate
30
what is Kienbock disease
AVN of lunate
31
Contraindications for H&L
plantar fasciitis and archilles tendonitis
32
SE of H&L
- hypo pigmentation of skin - depression in skin (lipoatrophy) - infx - tendon rupture - nerve injury
33
What is wallerian degeneration
degeneration of axons distal to site of transection (resorbed by phagocytes)
34
What is sedon classification
Peripheral n injury classification Seddon - neuropraxia (mildest, segmental demyelination, axonal continuity preserved, affects motor > sensory > autonomic) - axonotmesis (loss in continuity of axon and covering myelin but preserve connective tissue framework of nerve) - neurotmesis (destruction of endoneural tubes) > better to use Sunderland
35
What is Sunderland system
``` 1st deg: neuropraxia (segmental demyelination) 2nd deg: axonotmesis (axon disruption) 3rd deg: 2+endoneurium 4th deg: 3+perineurium 5th deg: 4+epineurium ```
36
Why is there thenar eminence sparing in carpal tunnel syndrome
palmar cutaneous branch to thenar eminence given off before carpal tunnel
37
What does the Anterior interosseous nerve supply
FPL PQuadratus radial 1/2 FDP no sensory loss!
38
What does the median nerve proper supply
``` FDS pronator teres FCR palmaris longus L1, L2 ```
39
Features of high median n lesion (e.g. pronator teres syndrome)
benediction sign posture: loss of thumb abductoin wasting: flexor pronator mass, thenar eminence motor: - paralysis of long flexors to thumb, index, middle (FDS and FDP) - intrinsics: loss of opposition and abduction of thumb Sensory - loss of lateral 3.5
40
what are the thenar muscles
opponens pollicis abductor pollicis brevis flexor pollicis brevis
41
Anatomical boundaries of carpal tunnel and its contents
radial side: scaphoid and trapezium ulnar side: pisiform + hook of hamate volar: flexor retinaculum content: - FDP (4) - FDS (4) - FPL - median nerve
42
Causes of carpal tunnel syndrome
- idiopathic - anat abnormalities > bone: wrist #, acromegaly > ST: lipoma, ganglia - physio > fluid imbalances: pregnancy, menopause, cardiac/ renal failure, obesity > inflam: RA > prev trauma > met: Gout > neuro: DM, alcoholism > endo: hypothyroidism, acromegaly
43
Mgx of carpal tunnel syndrome
Conservative - lifestyle modification: reduce repetitive activity - occupational therapy (splint wrist) - vit B complex - NSAIDs - H&L injection SX: carpal tunnel release
44
Explain the ulnar paradox
lower the lesion, the worse the clawing high lesion: medial half FDP not working - less claw low lesions: FDP contributes to flexion
45
Explain the claw hand
hyperextension of MCP of little and ring fingers, flexion of IPJ - unopposed FDS and FDP - loss of 3rd and 4th lumbrical + interossei fx: normally flex MCP and extend IPJs - median and index finger normal: lateral lumbricals supplied by median nerve
46
Explain wartenberg sign
ulnar deviation of little finger in extension due to unopposed action of extensor digiti minimi (insertion is slightly medial) adduction ability of intrinsics lost
47
what is ulnar tunnel syndrome | - differentiator from cubital tunnel syndrome
compression of ulnar n as it passes through Guyon canal | - preserved strength of wrist and 4/5th digit flexors
48
Causes of cubital tunnel syndrome and mgx
- constriction by fascial bands - subluxation of ulnar nerve over medial epicondyle - cubitus valgus - bony spurs - tumors, ganglion - repetitive elbow flexion and extension mgx: - simple decompression - medial epicondylectomy - anterior transposition of ulnar n - steroid injection
49
What does the PIN supply
extensor digitorum, digiti minimi, carpi ulnaris, pollicis brevis, pollicis longus, indicis, abductor pollicis longus
50
Which muscles control wrist extension
ECRL, ECRB, ECU
51
What is a waiter tip deformity
from Erb's palsy (C5,6,7) - shoulder int rotated - elbow extended - wrist flexed and pronated
52
Duputren contracture - what - associations - mgx
nodular hypertrophy and contracture of palmar aponeurosis DEAFEST PAIL: DM, epilepsy, age, family history, epileptic med (phenobarbitone), Smoking, Trauma, Peyronie disease, AIDs, idiopathic, liver disease (alcohol) mild: modifying tools mod: intralesional glucorticoid injectin with triamcinolone and lidocaine severe: surgery - fasciotomy - partial fasciectomy w z-plasty - dermo fasciectomy - arthrodesis, amputation
53
Differentials for radial sided wrist pain
- intersection syndrome - de quervain - wartenberg syndrome (sup br of radial n compression) - scaphoid # - scapholunate instability - 1st CMC jt OA
54
RF of trigger finger
overuse/ local trauma DM RA gout
55
complications of wrist #
common: poor grip strength, stiffness, radial shortening ``` Early: - difficult reduction/ loss of reduction - compartment syndrome - EPL rupture - acute carpal tunnel syndrome Late: - malunion - painful wrist from ulnar prominence - frozen shoulder - post traumatic arthritis - carpal tunnel syndrome - reflex sympathetic dystrophy ```
56
Scaphoid # - intra or extra articular? - x rays to order
ALWAYS intra-articular | X rays: AP, lat, scaphoid view, 2 oblique (semi pronate, semi supinated)
57
Mgx of scaphoid # - initial (# not seen) - displaced (acute vs non union) - cx
initial: scaphoid plaster and sling in glass holding position (hand pronate, wrist dorsi, radial dev, thumb forward) displaced #: ORIF with scaphoid compression screw acute: percutaneous fixation, arthroscopy non union: open fixation with bone grafting cx: AVN, non union, OA
58
Non traumatic causes of ulnar claw hand
1. compression of ulnar nerve at cubital tunnel - osteophytes in OA elbow - ganglion cyst in cubital tunnel - inflammation and edema from RA of elbow - ext compression prolonged - lean elbow on bike handle 2. stretching/ irritation of ulnar nerve at cubital tunnel - cubital valgus (malunion of lateral condylar #) - repeated subluxation
59
What is the mgx of mallet finger deformity and for how long
Conservative - immobilisation in mallet splint - analgesia - rest, ice, elevate Sx if - bony mallet >2/3 of joint - unstable # - non union NUH: 6w whole day + 6 w at night
60
what to think of for ganglion at DIPJ
called a mucocyst | a/w with OA of underlying joint
61
ultrasound findings of ganglion
well defined margins, thick walls, appears anechoic

MBBS Orthopedics (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions