What is Vaughn-Jackson syndrome? Treatment?
Attritional rupture of extensor tendons due to RA (caput ulnae)
Occurs ulnar --> radial (ie pinky first)
EIP --> EDC transfer + distal ulnar resection
Side to side EDC tenodesis (3rd to 4th/5th) + distal ulnar resection
What is the primary lesion in a swan neck deformity?
Lax volar plate
What is the ligament associated with madelung's?
Where does it run?
Goes from radius to lunate (short RL ligament)
Tethers volar ulnar radius
2 most common complications of perilunate injury? Are they going to get back to full function?
decreased grip strength
No - unlikely to regain full function
4 causes of Swan Neck?
- MCP joint volar subluxation (rheumatoid arthritis)
- mallet finger
- FDS laceration
- intrinsic contracture
What is the aim of a nerve repair?
A tension free repair in a clean wound bed with matched fascicles
1st line treatment in trigger thumb in kids < 2 with no fixed flexion deformity
Where are the dominant digital arteries found in the fingers?
Found on the median (closer to midline) side of the digit
What vessel is dominant in the deep arch?
Most common reason for persistent carpal tunnel symptoms after open release?
Incomplete release of the transverse carpal ligament
Describe anatomy of Guyon's canal
Zone 1: motor and sensory (prior to bifurcation)
Zone 2: Motor
Zone 3: sensory
In a low radial nerve palsy, why do you get radial deviation with wrist extension?
Maintained action of ECRL (attaches base of 2nd MC)
What happens to the relationship between the scaphoid and lunate with SL injury?
Scaphoid flexes, lunate extends
In neutral ulnar variance, what percentage of the load of the wrist is taken up by the radius and ulna
What is clinodactyly?
Curvature in the radio-ulnar plane of the fingers
Most commonly at middle phalanx of small fingers
Associated with Downs (25%)
Can be normal
Name two hand intrinsics and 3 extrinsics.
- intrinsics (interosseoi and lumbricals)
- extrinsics (FDS, FDP, EDC)
Diagnosis & treatment?
Mucous cyst due to OA of DIP
Surgical resection (not aspiration) and debridment of osteophytes
Can watch as some resolve spontaneously
What is the most reliable sign of proximal pole vascularity?
intraoperative punctate bleeding
Clinical Diagnostic test for SL injury
>50% ulnar translation of lunate on lunate facet
What period of a woman's life is DeQuervain's most likely to occur?
Pregnancy, lactation, post-partum
Dupuytren's: Spiral cord is _____ & _____ to the neurovascular bundle
Deep & lateral
What ligaments retain and position common extensor mechanism during PIP and DIP flexion?
- Retinacular Ligaments
- Oblique and Transverse bands
Treatment of venous congestion in finger replantation
Leech application - used for venous, not arterial!
- Releases Hirudin
- Aeromonos hydrophilia infection can occur
- Prophylax with bactrim or ciprofloxacin
Heparin soaked pledgets if leeches not available
4 important complications of Dupuytrens surgery?
- Hematoma - can cause flap necrosis
- NV injury
- Flare reaction (like CRPS)
- Recurrence - up to 50%
How do you test proper and accessroy ulnar collateral ligament of the thumb?
Proper: Thumb in flexion (resists valgus in MCP flexion)
Accessory: thumb in neutral (resists valgus in extension, along with volar plate)
What are the 3 parts of the scapholunate interosseous ligament? what is the strongest?
Name & briefly describe classic DRUJ reconstruction technique
Radioulnar ligament reconstruction with allograft through bone tunnels in radius & ulna
Diagnosis & Treatment?
CMC arthritis with MCP subluxation & adduction/webspace contracture
LRTI & MCP Fusion
MCP fusion indicated when MCP hyperextension > 40 degrees
What are the prerequisites for a nerve repair?
Clean wound bed
Not a war wound (ie crush or blast)