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Flashcards in Hand & Wrist Deck (407)
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1

What is Vaughn-Jackson syndrome? Treatment?

Attritional rupture of extensor tendons due to RA (caput ulnae)

Occurs ulnar --> radial (ie pinky first)

Treatment:

EIP --> EDC transfer + distal ulnar resection

or

Side to side EDC tenodesis (3rd to 4th/5th) + distal ulnar resection

2

What is the primary lesion in a swan neck deformity?

Lax volar plate

3

What is the ligament associated with madelung's?

Where does it run?

Vicker's ligament

Goes from radius to lunate (short RL ligament)

Tethers volar ulnar radius

4

2 most common complications of perilunate injury?  Are they going to get back to full function?

decreased grip strength

stiffness

No - unlikely to regain full function

5

 

4 causes of Swan Neck?

 

  1. MCP joint volar subluxation (rheumatoid arthritis)
  2. mallet finger
  3. FDS laceration
  4. intrinsic contracture

6

What is the aim of a nerve repair?

A tension free repair in a clean wound bed with matched fascicles

7

1st line treatment in trigger thumb in kids < 2 with no fixed flexion deformity

Stretching

8

Where are the dominant digital arteries found in the fingers?

Found on the median (closer to midline) side of the digit

9

What vessel is dominant in the deep arch?

Radial artery

10

Most common reason for persistent carpal tunnel symptoms after open release?

Incomplete release of the transverse carpal ligament

11

Describe anatomy of Guyon's canal

Zone 1: motor and sensory (prior to bifurcation)

Zone 2: Motor

Zone 3: sensory

12

In a low radial nerve palsy, why do you get radial deviation with wrist extension?

Maintained action of ECRL (attaches base of 2nd MC)

13

What happens to the relationship between the scaphoid and lunate with SL injury?

Scaphoid flexes, lunate extends

14

In neutral ulnar variance, what percentage of the load of the wrist is taken up by the radius and ulna

radius: 80%

Ulna: 20%

15

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

16

 

Name two hand intrinsics and 3 extrinsics.

 

  1.  intrinsics (interosseoi and lumbricals)
  2.  extrinsics (FDS, FDP, EDC)

17

Diagnosis & treatment?

Mucous cyst due to OA of DIP

Surgical resection (not aspiration) and debridment of osteophytes

Can watch as some resolve spontaneously

18

What is the most reliable sign of proximal pole vascularity?

intraoperative punctate bleeding

19

Clinical Diagnostic test for SL injury

Watson test

20

Diagnosis?

CIND

Radiocarpal instability

>50% ulnar translation of lunate on lunate facet

21

What period of a woman's life is DeQuervain's most likely to occur?

Pregnancy, lactation, post-partum

22

Dupuytren's: Spiral cord is _____ & _____ to the neurovascular bundle

Deep & lateral

23

 

What ligaments retain and position common extensor mechanism during PIP and DIP flexion?

 

  • Retinacular Ligaments
    • Oblique and Transverse bands

24

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

25

 

4 important complications of Dupuytrens surgery?

 

  1. Hematoma - can cause flap necrosis
  2. NV injury
  3. Flare reaction (like CRPS)
  4. Recurrence - up to 50%

26

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)

27

What are the 3 parts of the scapholunate interosseous ligament?  what is the strongest?

Dorsal (strongest)

Volar

Proximal

28

Name & briefly describe classic DRUJ reconstruction technique

Adam's technique

Radioulnar ligament reconstruction with allograft through bone tunnels in radius & ulna

29

Diagnosis & Treatment?

CMC arthritis with MCP subluxation & adduction/webspace contracture

Treat with:

LRTI & MCP Fusion

MCP fusion indicated when MCP hyperextension > 40 degrees

30

What are the prerequisites for a nerve repair?

Clean wound bed

well vascularized

Not a war wound (ie crush or blast)