Hand and Wrist (2008-2019)

Question 1

1. Extensor tendon subluxation at MCP, what is injured?
2. Central slip
3. Sagittal Band
4. Lateral Band
5. Oblique retinacular ligament

Answer 1

ANSWER: B

• 2012
• JAAOS 2015 - Sagittal Band Rupture
  
  • EDC tendon crosses MP joint and is stabilized by the dorsal extensor hood
  • Sagittal bands runs perpendicular to EDC and prevent subluxation of tendons
  • Proximal radial portion is most important

Question 2

2. What is true regarding a boutonniere deformity?
3. Can be associated with MCP, PIP and DIP pathology
4. Can be corrected with a fusion of the PIP joint
5. Can be corrected with a tenotomy of the lateral bands
6. Caused by dorsal subluxation of the lateral cords

Answer 2

ANSWER: B

• 2016 (Similar to 2015 question in RA)
• Definitely PIP and DIP pathology, can’t find a reference for MCP
• No description of DIP fusion for Boutoniere deformity
• Tenotomy of lateral bands described BUT accompanied with tenodesis to dorsal aspect OR release from transverse retinacular ligament
• JAAOS 2015 – Boutonniere Deformity
  
  • Disruption of the central slip and triangular ligament
  • Causes conjoint lateral bands to sublux volarly
  • Lateral bands then migrate proximally and tension the terminal tendon –> hyperextension at DIP

(I changed DIP to PIP to make b correct - priya)

Question 3

3. Treatment of swan neck. All true except?
4. crossed intrinsic tendon transfer
5. oblique retinacular repair
6. DIP fusion
7. FDS partial tenodesis

Answer 3

ANSWER:A

• 2011
• JAAOS - Operative Correction of Swan Neck and Boutonniere
  
  • FDS tenodesis
  • Oblique retinacular ligament reconstruction
  • DIP Fusion

Question 4

4. What does not cause swan neck?
5. Mallet finger
6. Volar subluxation of the proximal phalanx
7. FDP rupture
8. Tight intrinsics

Answer 4

ANSWER: C (< — which does NOT cause it)

• 2010

Question 5

5. Jersey finger with retraction to the palm. What is not true
6. Ring finger most frequent
7. This is the most common type of FDP injury
8. Good results can be achieved if fixed within 4-6 weeks
9. Often delayed diagnosis

 

Answer 5

ANSWER: B and C

• 2012
• JAAOS 2011 - Avulsion Injuries of the Flexor Digitorum Profundus Tendon
  
  • Ring finger most commonly affected
    
    • Most tethered motion, bipennate lumbricals, weakest insertion point
  • Patients with retraction to the palm should be treated within 10 days
• In type I injuries, the tendon retracts into the palm, the long and short vincula are both ruptured, leading to compromised tendon nutrition. These injuries have a worse prognosis if not diagnosed and treated within 7–10 days as the tendon contracts and becomes less viable. Type II injury is the most common type. The tendon retracts to the level of the PIPJ
• These injuries may be dismissed as minor sprains, however, and depending on the sport, some athletes may be capable of “playing through” the injury at a competitive level. It is not uncommon for competitive athletes to present in delayed fashion or once the season has ended.