Introduction to common injuries and surgery of the hand

Question 1

Where do the extrinsic and intrinsic muscles of the hand enter the hand and originate from?

Answer 1

• intrinsic = originate in hand and do not cross the wrist

- extrinsic = originate outside of the hand and cross the wrist

Question 2

What is the palmar fascia, also called the palmar aponeurosis?

Answer 2

• a triangular structure in the palm of the hand based distally
• a continuation of the deep fascia of the forearm, especially the palmaris longus

Question 3

What is the palmar fascia, also called the palmar aponeurosis, is also called by another name, what is this?

1 - valgus surface
2 - varus surface
3 - skin
4 - volar surface

Answer 3

4 - volar surface

Question 4

There are 3 layers of the palmar fascia, what are they called?

1 - deep, middle and superficial
2 - lateral, medial and deep
3 - deep, anterior and posterior
4 - deep, middle and lateral

Answer 4

1 - deep, middle and superficial

Question 5

There are 3 layers of the palmar fascia, where does the superficial layer attach?

1 - muscles of the hand
2 - epidermis of the skin
3 - dermis of the skin
4 - bones of the hand

Answer 5

• the dermis of the skin

Question 6

There are 3 layers of the palmar fascia, where does the middle layer attach?

1 - metacarpophalangeal joint with longitudinal fibres
2 - carpal joint with longitudinal fibres
3 - proximal phalangeal joint with longitudinal fibres
4 - distal phalangeal joint with longitudinal fibres

Answer 6

1 - metacarpophalangeal joint with longitudinal fibres

- forms spiral bands

Question 7

There are 3 layers of the palmar fascia, where does the deep layer attach?

1 - metacarpophalangeal joint with longitudinal fibres
2 - flexor and extensor mechanisms
3 - carpal joint with longitudinal fibres
4 - proximal phalangeal joint with longitudinal fibres

Answer 7

2 - flexor and extensor mechanisms

Question 8

The palmar fascia enters the hand proximally from the palmaris longus tendon and merges with a ligament at the wrist. What is this ligament in the image called?

1 - extensor retinaculum
2 - flexor retinaculum
3 - palmar reticulum
4 - palmar aponeurosis

Answer 8

2 - flexor retinaculum

Question 9

The palmar fascia enters the hand proximally from the palmaris longus tendon and merges with a ligament at the wrist. What happens to the palmer fascia when the palmaris longus muscle contracts?

Answer 9

• palmer fascia tightens

Question 10

What is Dupuytren’s contracture?

1 - thickening of skin in palm of the hand and base of fingers
2 - thickening of palmar fascia in palm of the hand and base of fingers
3 - thickening of skin and palmer fascia in palm of the hand and base of fingers
4 - thickening of muscle tendons in pam of the hand and base of fingers

Answer 10

3- thickening of the skin and palmar fascia in the palm of your hand at the base of your fingers

Question 11

Dupuytren’s contracture is a thickening of the skin and palmar fascia in the palm of your hand at the base of your fingers. Normal palmar fascia bonds thicken forming contracted tissue known as nodules, normally on the ulnar border. As these thicken and become larger they form what?

1 - bows
2 - strings
3 - cords
4 - bands

Answer 11

3 - cords

Question 12

Dupuytren’s contracture is a thickening of the skin and palmar fascia in the palm of your hand at the base of your fingers. Normal palmar fascia bonds thicken forming contracted tissue known as nodules, normally on the ulnar border. As these thicken and become larger they form cords. This causes a progressive flexion contracture of the fingers. What joint in the hand is generally affected first?

1 - metacarpophalangeal joints
2 - proximal interphalangeal joint
3 - distal interphalangeal joint
4 - saddle joint

Answer 12

1 - metacarpophalangeal joints

- then spreads to the proximal interphalangeal joint

Question 13

What fingers are normally affected in dupuytren’s contracture?

Answer 13

• little and ring finger

- sometimes the middle finger

Question 14

Is dupuytren’s contracture more common in men or women?

Answer 14

• men

- 10:1 ratio

Question 15

Which group of people are more likely to have dupuytren’s contracture?

1 - southern europeans
2 - asians
3 - northern europeans
4 - Americans

Answer 15

3 - northern europeans (Scandinavians)

- autosomal dominant (only need 1 abnormal allele)

Question 16

Normal palmar fascia is composed of type I collagen. The disease pathophysiology of dupuytren’s contracture can be divided into proliferation, involutional changes and residual. In the proliferation stage what happens to the composition of the palmar fascia in dupuytren’s contracture pathophysiology?

1 - fibroblasts lay down type II collagen
2 - myofibroblasts lay down new muscle
3 - fibroblasts and myofibroblasts lay down new type 1 collagen
4 - fibroblasts and myofibroblasts lay down type III collagen

Answer 16

4 - fibroblasts and myofibroblasts lay down type III collagen

Question 17

Normal palmar fascia is composed of type I collagen. The disease pathophysiology of Dupuytren’s contracture can be divided into proliferation, involutional changes and residual. In the involutional stage what happens to the palmer fascia once fibroblasts and myofibroblasts lay down type III collagen in the 1st stage (proliferation). What is the next step in the pathophysiology of dupuytren’s contracture?

1 - abnormal type III collagen aligns with skin
2 - abnormal type III collagen aligns with tendinous bands
3 - abnormal type III collagen aligns with muscles
4 - abnormal type III collagen aligns with ligaments

Answer 17

2 - abnormal type III collagen aligns with tendinous bands

Question 18

Normal palmar fascia is composed of type I collagen. The disease pathophysiology of Dupuytren’s contracture can be divided into proliferation, involutional changes and residual. In the residual stage what happens to the palmer fascia once fibroblasts and myofibroblasts lay down type III collagen in the 1st stage (proliferation), which has then aligned with the lines of tension in the palm (2nd stage: involutional changes) forming scar tissue. As this scar tissue remains, what ultimately occurs with it?

1 - scar tissue aligns with flexor tendons, shortens and contracts
2 - scar tissue aligns with lumbricals, shortens and contracts
3 - scar tissue aligns with interossei, shortens and contracts
4 - scar tissue aligns with extensor tendons, shortens and contracts

Answer 18

1 - scar tissue aligns with flexor tendons, shortens and contracts
- as it aligns with flexor tendons, it causes flexion of the fingers

Question 19

Is dupuytren’s contracture normally painful?

Answer 19

• no

- generally affects activities of daily living

Question 20

Does dupuytren’s contracture affect active and passive flexion?

Answer 20

• yes

- unable to move it all all, or very little

Question 21

For mild dupuytren’s contracture is there any non-operative treatments?

Answer 21

• no

- most patients will progress within 8 years and need surgery

Question 22

If a patient is older has a mild version of dupuytren’s contracture, they may receive a percutaneous needle fasciotomy. What is this procedure?

1 - hand is opened up and cords are removed
2 - hand is opened using a small needle and cords are removed
3 - hand is opened using a small needle and cords are divided and cut
4 - hand is opened and tendons are removed to remove cords

Answer 22

3 - hand is opened using a small needle and cords are divided and cut
- fascia is divided NOT removed

Question 23

If a patient is older has a mild version of dupuytren’s contracture, they may receive a percutaneous needle fasciotomy, which is where incisions are made and multiple cords are cut under local anaesthetic. Is this always 100% effective?

Answer 23

• no

- can commonly re-occur

Question 24

For more serious versions of dupuytren’s contracture, there are a number of surgical options. What is open fasciotomy?

Answer 24

• open surgery
• bands are cut to be separated BUT not removed
• they are put in a splint and physio
• BUT there is a high occurrence rate

Question 25

For more serious versions of dupuytren's contracture, there are a number of surgical options. Fasciectomy, which is the GOLD STANDARD is the most common surgery. What is Fasciectomy?

Answer 25

- fibrous bands excising the bands - limited fasciectomy is the gold standard for most cases - skin closure can be a challenge.

Question 26

For more serious versions of dupuytren's contracture, there are a number of surgical options. What is dermo-fasciectomy?

Answer 26

- used for severe disease - overlying skin and fascia are removed - requires a skin graft

Question 27

What is Dupuytren’s Diathesis?

Answer 27

- a very rare aggressive order in younger patients - symmetrical affecting flexors on both hands, mainly radial side - can affect all but the thumb - strong family links

Question 28

The extensors located in the posterior compartment of the forearm all contain their own tendinous sheaths, which is commonly views as 6 separate compartments of the posterior forearm. What are the 6 extensor compartments of the forearm?

Answer 28

1 - Extensor pollicis brevis and abductor pollicis longus 2 - Extensor carpi radialis longus and brevis 3 - Extensor pollicis longus 4 - Extensor indicis & extensor digitorum 5 - Extensor digiti minimi 6 - Extensor carpi ulnaris

Question 29

The extensor pollicis longus hooks around a bony landmarks in the wrist, acting as a pulley and allows the muscle to extend the thumb. What is this bony landmark called? 1 - hook of hamate 2 - smiths tubercle 3 - lister’s tubercle 4 - guyons canal

Answer 29

3 - lister’s tubercle

Question 30

There are 6 extensor compartments of the hand and forearm that are named based on their location. Compartment 1 is located on the radial border located close to the anatomical snuffbox. What is contained within compartment 1? 1 - abductor pollicis longus + extensor pollicis brevis 2 - extensor pollicis longus + extensor pollicis brevis 3 - abductor pollicis longus + extensor pollicis longus 4 - extensor pollicis longus + extensor digitorum

Answer 30

1 - abductor pollicis longus + extensor pollicis brevis

Question 31

There are 6 extensor compartments of the hand and forearm that are named based on their location. Compartment 2 is located on the radial border deep to the anatomical snuffbox. What is contained within compartment 2? 1 - extensor carpi radialis longus + extensor pollicis brevis 2 - extensor carpi radialis longus + brevis 3 - abductor pollicis longus + extensor pollicis longus 4 - extensor pollicis longus + extensor digitorum

Answer 31

2 - extensor carpi radialis longus + brevis

Question 32

There are 6 extensor compartments of the hand and forearm that are named based on their location. Compartment 3 contains the third muscle of the thumb that is not contained with compartment 1 (abductor pollicis longus + extensor pollicis brevis). What is contained within compartment 3? 1 - extensor carpi radialis longus 2 - extensor carpi radialis longus 3 - abductor pollicis longus 4 - extensor pollicis longus

Answer 32

4 - extensor pollicis longus

Question 33

There are 6 extensor compartments of the hand and forearm that are named based on their location. Compartment 4 is located on the middle of the forearm and contains the extensors of the fingers. What are the 2 muscles contained within compartment 4? 1 - extensor digitorum + extensor pollicis brevis 2 - extensor carpi radialis longus + extensor indices 3 - extensor digitorum + extensor indices 4 - extensor pollicis longus + extensor digitorum

Answer 33

3 - extensor digitorum + extensor indices

Question 34

There are 6 extensor compartments of the hand and forearm that are named based on their location. Compartment 5 is located laterally to compartment 4 and includes 1 muscle. What muscle is contained within compartment 5? 1 - extensor digitorum 2 - extensor carpi radialis longus 3 - extensor digitorum 4 - extensor digiti minimi

Answer 34

4 - extensor digiti minimi

Question 35

There are 6 extensor compartments of the hand and forearm that are named based on their location. Compartment 6 is located laterally to compartment 5 and includes 1 muscle. What muscle is contained within compartment 6? 1 - extensor digitorum 2 - extensor carpi ulnaris 3 - extensor digitorum 4 - extensor digiti minimi

Answer 35

2 - extensor carpi ulnaris

Question 36

DeQuervain’s tenosynovitis is an inflammatory problem affecting the tendon sheath of compartment 1 of the extensor compartments of the hand. What muscles are therefor affected that are located most radially? 1 - abductor pollicis longus + extensor pollicis brevis 2 - extensor pollicis longus + extensor pollicis brevis 3 - abductor pollicis longus + extensor pollicis longus 4 - extensor pollicis longus + extensor digitorum

Answer 36

1 - abductor pollicis longus + extensor pollicis brevis | - 2 most lateral tendons of the anatomical snuffbox

Question 37

DeQuervain’s tenosynovitis is an inflammatory problem affecting the tendon sheath of compartment 1 of the extensor compartments of the hand, which is abductor pollicis longus + extensor pollicis brevis muscles. Which 4 groups of people are most at risk? 1 - men, pregnant women, repetitive jobs/hobbies, 30-50 y/o 2 - women, pregnant women, repetitive jobs/hobbies, 30-50 y/o 3 - men, pregnant women, labour jobs, >50 y/o 4 - women, pregnant women, repetitive jobs/hobbies, <50 y/o

Answer 37

1 - women, pregnant women, repetitive jobs/hobbies, 30-50 y/o

Question 38

DeQuervain’s tenosynovitis is an inflammatory problem affecting the tendon sheath of compartment 1 of the extensor compartments of the hand, which is abductor pollicis longus + extensor pollicis brevis muscles. How do patients most commonly present with this? 1 - pain on ulnar border and impaired opposable movements 2 - pain in anatomical snuff box and extensors of hand impairment 3 - pain in anatomical snuff box and tenderness on pincer movements 4 - pain on ulnar border and tenderness on pincer movements

Answer 38

3 - pain in anatomical snuff box and tenderness on pincer movements

Question 39

DeQuervain’s tenosynovitis is an inflammatory problem affecting the tendon sheath of compartment 1 of the extensor compartments of the hand, which is abductor pollicis longus + extensor pollicis brevis muscles. How is this commonly treated?

Answer 39

- rest - steroid injections - lifestyle adaptation (reduce repetitive injuries) - rarely surgical decompression

Question 40

There are 3 muscles that make up the thenar muscles of the hand located on the palmar surface of the hand. Label them using the labels below: abductor pollicis brevis flexor pollicis brevis opponens pollicis

Answer 40

1 - flexor pollicis brevis 2 - abductor pollicis brevis 3 - opponens pollicis

Question 41

There are 3 muscles that make up the hypothenar muscles of the hand located on the palmar surface of the hand. Label them using the labels below: abductor digiti minimi oponens digiti minimi flexor digiti minimi

Answer 41

``` 1 = oponens digiti minimi 2 = flexor digiti minimi 3 = abductor digiti minimi ```

Question 42

What is the name given to the intrinsic muscles of the hand that do not attach to a bone, instead attaching to tendons. 1 - lumbricals 2 - interossei 3 - adductor pollicis brevis 4 - opponens digiti minimi

Answer 42

1 - lumbricals

Question 43

The lumbricals are an intrinsic muscles of the hand that do not attach to a bone. Instead where do they attach which gives them a unique action?

Answer 43

- origin = flexor digitorum profundus tendons | - insertion = extensor hood

Question 44

The lumbricals are an intrinsic muscles of the hand that do not attach to a bone. Instead where they begin in the flexor tendons and insert onto the extensor hood. What movements does this assist with?

Answer 44

- flexion at the metacarpophalangeal joint | - extension of the PIP and DIP joints

Question 45

The interossei are intrinsic muscles of the hand and can be divided into the palmar and dorsal muscles. They attach in between adjacent metacarpals facilitating what 2 movements?

Answer 45

- adduction and abduction

Question 46

The interossei are intrinsic muscles of the hand and can be divided into the palmar and dorsal muscles. They attach in between adjacent metacarpals facilitating adduction and abduction. What is the mnemonic for remembering which muscle performs which action?

Answer 46

- DAB = Dorsal interossei = ABduction | - PAD = Palmer interossei = ADduction

Question 47

All intrinsics are innervated by the deep branch of the ulnar nerve except which muscles that are innervated by the median nerve? Use LOAF mnemonic to help

Answer 47

- L = Lumbricals I and II on lateral palm (closest to thumb) - O = opponens pollicis - A = abductor pollicis brevis - F = flexor pollicis brevis

Question 48

If the lumbricals were ruptured where they attach to the extensor hood this can cause the muscle attach to sublux (drop down) and then begins acting as a what? 1 - flexor 2 - extensor 3 - adductor 4 - abductor

Answer 48

1 - flexor | - can cause a boutonniere finger as PIP and DIP cannot extend

Question 49

The extensor pollicis longus is a muscle that extends the thumb. It is able to do this as it hooks around listers tubercle at the writs. If this ruptures or is damaged what movements are lost? 1 - adduction of the thumb 2 - abduction of the thumb 3 - flexion of the thumb 4 - extension of the thumb

Answer 49

4 - extension and retropulsion of the thumb | - place hand flat on table and try to raise the thumb

Question 50

There are 3 layers of the anterior flexor tendons. Label the 4 muscles of the superficial layer in the image below? flexor carpi radialis flexor carpi ulnaris pronator teres palmaris longus

Answer 50

``` 1 = flexor carpi radialis 2 = palmaris longus 3 = pronator teres 4 = flexor carpi ulnaris ```

Question 51

There are 3 layers of the anterior flexor tendons. What is the 1 muscle of the intermediate layer in the image below? 1 - flexor carpi radialis 2 - flexor carpi ulnaris 3 - flexor digitorum profundus 4 - flexor digitorum superficialis

Answer 51

3 - flexor digitorum superficialis

Question 52

There are 3 layers of the anterior flexor tendons. Label the 3 muscles of the deep layer in the image below? flexor digitorum profundus pronator quadratus flexor pollicis longus

Answer 52

``` 1 = pronator quadratus 2 = flexor pollicis longus 3 = flexor digitorum profundus ```

Question 53

The flexor digitorum superficialis (FDS) and profundus (FDP) tendons both attach to the digits, with the FDP lying deeper in the palm. Where do the FDP and FDS insert onto the fingers?

Answer 53

- FDS = sides of middle phalanges | - FDP = palmar surface of distant phalanges

Question 54

The flexor digitorum superficialis (FDS) and profundus (FDP) tendons both attach to the digits, with the FDP lying deeper in the palm. These muscles attach as follows: - FDS = sides of middle phalanges - FDP = palmar surface of distant phalanges As both of these muscles are trying to attach to fingers, which is a very tight space, what does one of the muscles do, and which muscle does this?

Answer 54

- FDS - divides allowing FDP to pass through | - passing of the FDS and FDP is called chiasma of camper

Question 55

The blood supply to the fingers is contained within what? 1 - vinculae 2 - flexor digitorum superficialis sheath 3 - pulleys 4 - flexor digitorum profundus sheath

Answer 55

1 - vinculae

Question 56

As there is a lot contained within the fingers there needs to be something that contains all the tendons within. If not then the tendons could bow string. What is this called in the fingers? 1 - vinculae 2 - flexor digitorum superficialis sheath 3 - annular pulleys 4 - flexor retinaculum

Answer 56

3 - annular pulleys

Question 57

As there is a lot contained within the fingers there needs to be something that contains all the tendons within. If not then the tendons could bow string. They are held in place by annular pulleys. What are annular pulleys?

Answer 57

- thickened connective tissue | - role is to keep the flexors from bowing

Question 58

As there is a lot contained within the fingers there needs to be something that contains all the tendons within. If not then the tendons could bow string. They are held in place by pulleys which are thickened connective tissue that keep the flexors from bowing. How many annular pulleys are located digits II-V? 1 - 2 2 - 3 3 - 4 4 - 5

Answer 58

4 - 5

Question 59

Trigger finger, also called tenosynovitis is a common condition. What causes trigger finger? 1 - idiopathic 2 - tight muscles 3 - tendon nodule inflammation 4 - infection

Answer 59

3 - tendon nodule inflammation

Question 60

Trigger finger, also called tenosynovitis is a common condition and most commonly caused by tendon nodule inflammation. How does present most commonly? 1 - locking/catching of the PIP affects A1 pulley 2 - locking/catching of the DIP affects A3 pulley 3 - locking/catching of the MCP affects A1 pulley 4 - locking/catching of the wrist affects A1 pulley

Answer 60

3 - locking/catching of the MCP affects A1 pulley | - patients feel it is in the PIP joint

Question 61

Trigger finger most commonly occurs at which joint and which joint do patients think it occurs in? 1 - PIP 2 - DIP 3 - MCP 4 - wrist

Answer 61

3 - MCP | - patients think it is at the proximal interphalangeal joint

Question 62

What are 3 key risk factors for trigger finger? 1 - smoking, hyperthyroidism and middle aged women (30-50 y/o) 2 - alcohol, diabetes and middle aged women (30-50 y/o) 3 - smoking, diabetes and middle aged women (30-50 y/o) 4 - smoking, hypothyroidism and middle aged women (30-50 y/o)

Answer 62

3 - smoking, diabetes and middle aged women (30-50 y/o)

Question 63

How is trigger finger most commonly treated? 1 - surgical incision to release the flexor annular pulley system 2 - surgical incision to cut the flexor annular pulley system 3 - surgical incision to remove the flexor annular pulley system 4 - surgical incision to remove flexor muscle

Answer 63

1 - surgical incision to release the flexor annular pulley system

Question 64

Although there are exceptions, match the muscle groups below with the nerves that innervate them: radial, median and ulnar nerve with: long extensors intrinsic muscles of the hand long flexors

Answer 64

- radial nerve = long extensors - median nerve = long flexors - ulnar nerve = intrinsic muscles of the hand

Question 65

Splinting is one of the first things that can be tried in a patient with carpal tunnel syndrome. What is the purpose of this and what is the problem with most wrist splints bought commercially?

Answer 65

- splints place wrist in neutral position removing pressure on median nerve - most splints place wrist in extension, further stressing the median nerve

Question 66

What medication can be tried in patients with carpal tunnel?

Answer 66

- NSAIDs | - steroid injections

Question 67

In patients with carpal tunnel syndrome who require surgery, what does the surgeon do? 1 - reduces size of flexor tendons 2 - increases size of carpal tunnel 3 - cuts flexor retinaculum 4 - cuts the flexor tendons

Answer 67

3 - cuts flexor retinaculum - the flexor retinaculum, also known as transverse carpal ligament is cut, which releases compression of the median nerve

Question 68

What is common amongst older patients in the thumb? 1 - osteoarthritis of the carpometacarpal joint 2 - RA of the carpometacarpal joint 3 - osteoporosis of the carpometacarpal joint 4 - immune disorder affecting just the carpometacarpal joint

Answer 68

1 - osteoarthritis of the carpometacarpal joint

Question 69

Osteoarthritis of the carpometacarpal joint of the thumb is common in older populations. What are the bones that form this joint in the thumb called?

Answer 69

- trapezium which is concave - metacarpal bone which is convex - together the above form a synovial saddle joint

Question 70

Osteoarthritis of the carpometacarpal joint of the thumb is common in older populations. How can patients present?

Answer 70

- Pain/burning/aching near base of thumb. - axial loading painful (grind test) - subluxation test. - hyperextension deformity

Question 71

Osteoarthritis of the carpometacarpal joint of the thumb is common in older populations. What syndrome is the commonly associated with? 1 - raynauds syndrome 2 - carpal tunnel syndrome 3 - white finger syndrome 4 - guyons tunnel syndrome

Answer 71

2 - carpal tunnel syndrome

Question 72

In younger middle aged individuals who are still working, what surgery is most often performed in patients with osteoarthritis of the carpometacarpal joint of the thumb?

Answer 72

- trapeziectomy

Question 73

What is the most commonly fracture bone in the wrist?

Answer 73

- scaphoid bone

Question 74

What bone in the hand is commonly damaged in a brawlers fracture? 1 - distal phalanx 2 - metacarpals 3 - proximal phalanx 4 - carpal bones

Answer 74

2 - metacarpals | - mainly on the ulnar border of the hand

Question 75

Is morning hand stiffness more common in the RA of osteoarthritis?

Answer 75

- RA

Question 76

In RA which joints are predominantly affected? 1 - MCP, PIP, DIP 2 - DIP only 3 - MCP, PIP 4 - PIP only

Answer 76

3 - MCP, PIP - metacarpophalangeal and proximal interphalangeal joints - distal interphalangeal joint are spared

Question 77

In RA, what happens to the metacarpophalangeal joints? 1 - sublux and we get radial deviation 2 - sublux and we get flexion 3 - sublux and we get extension 4 - sublux and we get ulnar deviation

Answer 77

4 - sublux and we get ulnar deviation

Question 78

In RA, patients can present with swan neck deformity. What is this?

Answer 78

- DIP is permanently flexed | - PIP is hyperextended

Question 79

What does the term paronychia mean?

Answer 79

- greek meaning around the nail

Question 80

Paronychia refers to the nails of the hands. What happens in patients who have infections in the nails?

Answer 80

- pus forms under the nails at the eponychial fold (where skin meets the nail) - most common cause is staphylococcus aureus

Question 81

Paronychia refers to the nails of the hands. When infected pus forms under the nails. How is this commonly treated? 1 - patients are given antibiotics 2 - incision is made, infection is drained and then given antibiotics 3 - incision is made and infection is drained 4 - infection is drained using a needle and then given antibiotics

Answer 81

2 - incision is made, infection is drained and then given antibiotics

Question 82

Felon is an infection of the fingers. What occurs here?

Answer 82

- infection of deep pulp space of the finger - infection collects in septa of the finger - treatment includes an incision of all compartments containing pus - then give antibiotics

Question 83

What is a fight bite?

Answer 83

- cut to the skin of the hand after punching someone

Question 84

Fight bites are when there is a cut to the skin of the hand after punching someone. What can this cause if not treated? 1 - scar 2 - infection 3 - septic arthritis at affected joint 4 - inflammation of metacarpal bone

Answer 84

3 - septic arthritis at affected joint

Question 85

Fight bites are when there is a cut to the skin of the hand after punching someone. This can cause septic arthritis if not treated properly. How is this commonly treated?

Answer 85

- washed and debridement

Question 86

What is flexor sheath infection?

Answer 86

- the palmar aponeurosis of the hand becomes infected | - can spread on palm or on individual flexor tendon sheaths

Question 87

Flexor sheath infection is when the the palmar aponeurosis of the hand becomes infected. This can spread on palm or on individual flexor tendon sheaths. What are the 4 cardinal signs of this if a patient comes into A&E?

Answer 87

1 - finger is in flexed position 2 - finger that is flexed is swollen 3 - extreme pain in extension 4 - extreme tenderness on tendon sheath

Question 88

Flexor sheath infection is when the the palmar aponeurosis of the hand becomes infected. This can spread on palm or on individual flexor tendon sheaths. Is this dangerous?

Answer 88

- medical emergency | - needs surgery

Question 89

Flexor sheath infection is when the the palmar aponeurosis of the hand becomes infected. This can spread on palm or on individual flexor tendon sheaths. This is a medical emergency and requires surgery. How is this treated?

Answer 89

- skin opened, cleaned and debridement

Question 90

What does volar refer to clinically?

Answer 90

- palm or sole of the hand and foot, respectively

Question 91

Prior to giving a patient with an infection of the hand and/or fingers antibiotics, what must be done 1st?

Answer 91

- pus must be drained | - leave wound open