Hand Surgery, C69 P578-585 Flashcards by Tiggee R

Who operates on hands?

P578

Plastic surgeons and orthopaedic surgeons

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What are the bones of the
hand?
P578

Phalanges (fingers)
Metacarpal bones
Carpal bones

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What is the distal finger joint?

P578

Distal InterPhalangeal (DIP) joint

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What is the middle finger joint?

P578

Proximal InterPhalangeal (PIP) joint

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What is the proximal finger
joint?
P578

Metacarpal Phalangeal (MP) joint

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What are the “intrinsic”
hand muscles?
P578

Lumbricals, interosseous muscle

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What is ADDuction and
ABDuction of the fingers?
P578 (picture)

ADDuction is to midline and ABDuction

is separation from midline

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What are the trauma zones
of the hand?
P579

(see picture)

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Where is “no man’s land”?

P579 (picture)

Zone extending from the distal palmar

crease to just beyond the PIP joint (zone 2)

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What is the significance of
the “no man’s land”?
P579 (picture)

Flexor tendon injuries here have a poor
prognosis; a hand expert needs to repair
these injuries

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SENSORY SUPPLY TO THE HAND
What is the ulnar nerve
distribution?
P579 (picture)

(see picture)

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SENSORY SUPPLY TO THE HAND
What is the radial nerve
distribution?
P580 (picture)

(see picture)

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SENSORY SUPPLY TO THE HAND
What is the median nerve
distribution?
P580 (picture)

(see picture)

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SENSORY SUPPLY TO THE HAND
How can the radial
nerve motor function be
tested?
P580

Wrist and MCP extension

2. Abduction and extension of thumb

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SENSORY SUPPLY TO THE HAND
How can the ulnar nerve
motor function be tested?
P580

Spread fingers apart against
resistance
Check ability to cross index and
middle fingers

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SENSORY SUPPLY TO THE HAND
How can the median nerve
function be tested?
P580

Touch the thumb to the pinky (distal
median nerve)
Squeeze examiner’s finger (proximal
median nerve)

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SENSORY SUPPLY TO THE HAND
How can the flexor
digitorum profundus
(FDP) apparatus be tested?
P581 (picture)

Check isolated flexion of the finger

DIP joint

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SENSORY SUPPLY TO THE HAND
How can the flexor
digitorum superficialis
(FDS) apparatus be tested?
P581 (picture)

Check isolated flexion of the finger at the

MP joint

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SENSORY SUPPLY TO THE HAND
Where do the digital
arteries run?
P581

On medial and lateral sides of the digit

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SENSORY SUPPLY TO THE HAND
What hand laceration should
be left unsutured?
P581

Lacerations from human bites or animal

bites

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SENSORY SUPPLY TO THE HAND
Should a clamp ever be used
to stop a laceration bleeder?
P581

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No; use pressure and then tourniquet for
definitive repair if bleeding does not cease
because nerves run with blood vessels!

SENSORY SUPPLY TO THE HAND
What is a felon?
P582

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Infection in the tip of the finger pad
(Think: felon = fingerprints = infection
in pad); treat by incision and drainage

SENSORY SUPPLY TO THE HAND
What is a paronychia?
P582

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Infection on the side of the fingernail

(nail fold); treat by incision and drainage

SENSORY SUPPLY TO THE HAND
What is tenosynovitis?
P582

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Tendon sheath infection

SENSORY SUPPLY TO THE HAND What are Kanavel’s signs? P582

Four signs of tenosynovitis: 1. Affected finger held in flexion 2. Pain over volar aspect of affected finger tendon sheath upon palpation 3. Swelling of affected finger (fusiform) 4. Pain on passive extension of affected finger

SENSORY SUPPLY TO THE HAND Most common bacteria in tenosynovitis and paronychia? P582

Staphylococcus aureus

SENSORY SUPPLY TO THE HAND How are human and animal hand bites treated? P582

Débridement/irrigation/administration of | antibiotics; leave wound open

SENSORY SUPPLY TO THE HAND What unique bacteria are found in human bites? P582

Eikenella corrodens

SENSORY SUPPLY TO THE HAND What unique bacteria are found in dog and cat bites? P582

Pasteurella multocida

SENSORY SUPPLY TO THE HAND What is the most common hand/wrist tumor? P582

Ganglion cyst

SENSORY SUPPLY TO THE HAND What is an extremely painful type of subungual tumor? P582

Glomus tumor (subungual: under the nail)

SENSORY SUPPLY TO THE HAND What is a “boxer’s fracture”? P582

Fracture of the fourth or fifth metacarpal

SENSORY SUPPLY TO THE HAND What is a “drop finger” injury? P582 (picture)

Laceration of extensor tendon over the | MP joint

``` SENSORY SUPPLY TO THE HAND What is the classic deformity resulting from laceration of the extensor tendon over the DIP joint? P583 (picture) ```

Mallet finger

``` SENSORY SUPPLY TO THE HAND What is the classic deformity resulting from laceration of the extensor tendon over the PIP joint? P583 (picture) ```

Boutonniere deformity

SENSORY SUPPLY TO THE HAND Which fracture causes pain in the “anatomic snuffbox”? P583

``` Scaphoid fracture; often not seen on x-ray at presentation, usually seen at a later date (2 weeks) on x-ray Can result in avascular necrosis Place in a cast if clinically suspected, regardless of x-ray findings ```

SENSORY SUPPLY TO THE HAND What is the “safe position” of hand splinting? P583 (picture)

(see picture)

SENSORY SUPPLY TO THE HAND What is Dupuytren’s contracture? P584

Fibrosis of palmar fascia, causing | contracture of and inability to extend digits

SENSORY SUPPLY TO THE HAND What is Gamekeeper’s thumb? P584 (picture)

Injury to the ulnar collateral ligament of | the thumb

SENSORY SUPPLY TO THE HAND How should a subungual hematoma be treated? P584

Release pressure by burning a hole in the nail (use hand-held disposable battery-operated coagulation probe)

CARPAL TUNNEL SYNDROME What is it? P584 (picture)

Compression of the median nerve in the | carpal tunnel

CARPAL TUNNEL SYNDROME What is the most common cause? P585

Synovitis

CARPAL TUNNEL SYNDROME What are other causes? P585

``` “MEDIAN TRAPS”: Median artery (persistent) Edema of pregnancy Diabetes Idiopathic Acromegaly Neoplasm (e.g., ganglioneuroma) ``` ``` Thyroid (myxedema) Rheumatoid arthritis Amyloid Pneumatic drill usage SLE ```

CARPAL TUNNEL SYNDROME What are the symptoms? P585

Pain and numbness in the median nerve | distribution

CARPAL TUNNEL SYNDROME What are the signs? P585

Tinel’s sign (symptoms with percussion over median nerve), Phalen’s test (symptoms with flexion of wrists), thenar atrophy, Wartenberg’s sign

CARPAL TUNNEL SYNDROME What is Wartenberg’s sign? P585

With hand resting on a surface, the fifth digit (“pinky”) rests in ABduction compared to the other 4 fingers

CARPAL TUNNEL SYNDROME What is the workup? P585

EMG, nerve conduction study

CARPAL TUNNEL SYNDROME What is initial treatment? P585

Nonoperative, rest, wrist splint, NSAIDs

CARPAL TUNNEL SYNDROME What are indications for surgery? P585

Refractory symptoms, thenar atrophy, | thenar weakness

CARPAL TUNNEL SYNDROME What surgery is performed? P585

Release transverse carpal ligament

Hand Surgery, C69 P578-585 Flashcards

(50 cards)