Miller's Flashcards
(111 cards)
1
Q
Pinch strength after CTR returns
A
6 wks
2
Q
Grip strenght returns after CTR when?
A
3 mos
3
Q
difference btw AIN syndrome/pronator syndrome
A
AIN is motor only usually presents as Parsonage-Turner Syndrome
Pronator syndrome is due to compression
4
Q
Mannerfelt lesion
A
FPL rupture in RA
5
Q
Diagnostic finding on electrodx study for cubital tunnel syndrome
A
<50m/sec conduction
6
Q
only time to transpose unlar n
A
subluxing/unstable nerve
7
Q
Guyon Canal zones and assoc most common pathology
A
1- motor/sensory, ganglio
2- motor, hook of hamate fx
3- sensory, ulnar a thrombosis
8
Q
Surgery for concomitant CTS and guyon canal syndrome
A
release transverse carpal ligament
9
Q
Difference btw PIN and Radial tunnel syndrome
A
PIN is motor deficit ONLY
Radial tunnel -> a pain syndrome without motor/sensory deficits
10
Q
Treatment for PIN and radial tunnel
A
at least 12 most nonop b4 decompression
11
Q
Adson test
A
diminished radial artery pulse with inhalation -> consistent with subclavian vessel compression
12
Q
Timing and management of pre-ganglioninc injury
A
not repairable
reconstruct at 3 mos
13
Q
upper brachial plexus injury in obstetrics management
A
surgery if no biceps contraction by 6 mos
14
Q
Radial nerve is out
What are the transfers to restore function
A
Wrist extension: Pronator teres -> ECRB (most consistent in testing)
Finger extension: FCR/FCU/FDS -> EDC
- FCR => EDC is most common
Tumb Ext: PL -> EPL
15
Q
Elderly with severe long standing CTS and poor opposition
A
Camitz - palmaris longus transfer
16
Q
Transfer for loss of adduction of thumb from ulnar n issue
A
ECRB to adductor pollicis
FDS-> adductor
17
Q
Congenital abscence of thenar muscles
reconstruction?
A
Huber: ADM to thumb proximal phalanx
18
Q
2-octylcyanoacrylate
A
dermabond
19
Q
Dorsal distal phalanx flap coverage
A
digital island
20
Q
Dorsal thumb skin coverage
A
FDMA kite flap
- comes from dorsal IF
21
Q
Volar distal phalanx skin coverage if not doing secondary intention
A
Cross finger in adult
thenar flap in kids (maybe)
22
Q
dorsal hand flap coverage
A
groin or abdomen flap
23
Q
Dominante arch/artery of hand
% of people with complete arch in hand
A
Ulnar/superficial
80%
24
Q
digital brachial index that is abnormal
A
< 0.7
25
hypothenar hammer syndreome
- when DBI > .7
- when DBI < .7
> --> sympathectomy
| < -- reconstruct
26
level wheren embolic disease occurs in the hand
PIP level
27
Diff btw Raynaud Disease and Phenomenon
Phenom is assoc with an undelrying disease thus treat the systemic disease
28
order of replant in hand
BEFNAV
| bone, extensor, flexor, nerve, a/v
29
abx to treat infection from leech
ceftriaxone or cipro
30
>50% extensor tendon injury
repair and protect mobilization
31
Zone 4 exten tendon injury > 50%
| - how to manage
repair
| place in Yoke splint (relative motion splint)
32
EPL rupture after nondisplaced DR fx
| - how to treat
EIP transfer to EPL
33
Intrinsic tightness that doesn't respond to therapy stretching
surgical release of the lateral bands
34
gap in tendon repair at risk for rerupture
> 3mm
35
minimal strands in core repair for flexor tendon repair
at least 4 core sutures
| more is stronger
36
benefits of epitendinouse suture in flexor tendon repair
smooths surface
increase strength by 10-50%
decreases gap formation
37
where to flexor tendon repairs usually fail if they do
at the knots
38
timing of repair of flexor tendon avulsions
Type 1 -> within 1 wk b'c blood supply disrupted
| Type 2,3 -> up to 6 wks
39
partial flexor tendon injury
< 25%-> trim
25-50% -> epi repair
>50% -> core and epitenon repair
All with protected mobilization
40
treatment for lumbrical plus finger
release lumbrical
41
pronator's space
potential space just superficial to pronator quadratus
42
bug causing hand celluliti s
Group A betahemolytic strep
43
most common bug of necrotizing fasciitis
Group A beta-hemolytic strep
44
most important variable in high pressure injection finger injury
material injected
- paint is worse (oil specifically)
others: > 10 hrs on presentation, > 7k psi
45
pathologic tissue in medial epicondylitis
at junction of FCR/PT
46
aspect of SC joint that provides most stability
posterior and costoclavicular
47
medial to lateral footprint of rotator cuff insertion
~12mm
48
Beighton's number considered to be hyperlax
>6
49
impingement test vs sign
sign is no pain with impingement test after lidocaine injection
50
XR view for bony bankart
West point
51
view for hillsachs
stryker notch
| internal rotation AP
52
ALPSA
Anterior labral periosteal sleeve avulsion
| - may require an open procedure to completely address it
53
GLAD
Glenoid labrum articular disruption
54
HAGL is addressed via
subscap approach, open when open
| when posterior -> scope it
55
indications for surgery in first time anterior shoulder dislocators
< 22 yo
contact athlete
bony bankart
56
open bankart with capsulorahy over scope benefits
lower recurrence
57
number of anchors needed in bankart repair
at least 3
58
number of anchors needed in bankart repair
at least 3
59
closing down rotator interval can be done for
MDI or inferior subluxation of HH
60
Best way to get into subacramial space with injection
lateral
61
Bear hug test
for subscap tear, good test
62
critical shoulder angle > 35-38 is assoc with
increase risk of rotator cuff tear
63
Mini open vs arthroscopic cuff repair
equivalent outcomes with less pain, better visualization and less risk
64
Deadmans angle
45 degrees for anchors in RCR
65
Barbotage procedure
guided aspiration of calcific tendinopathy
66
Age cut off for labral repair
< 35 should repair
> 35 tenodesis vs tenolysis
IF RED FLAG -> don't repair, tenodes (workers comp)
67
Surgical treatment for labral tear in over head throwing athlete
repair
68
Max amount of distal clavicle that can be resected
1 cm
69
SC joint injury in someone around 18 where is the injury really?
physis b'c it closes so late
70
Treatment for latissimus avulsion
nonop: rest, PT, return to sport
71
Essential lesion of frozen shoulder
coracohumeral ligament and rotator interval contracture -> loss of ext rotation
72
Roos (East) test
Elevation of arm above head causes thoracic outlet syndrome sx's
73
Failed nonop of medial scapular winging
Split pec major transfer
74
Fix for lateral winging
Eden Lange Transfer
| - transfer levator scapulae and rhomboids
75
Joint where it is reasonable to scope and debride with OA
Shoulder
| Elbow
76
Peg vs keel glenoid component difference
Peg has lower loosening
77
most common complication in TSA
glenoid loosening
78
most likely cause of humeral loosening in TSA
infection
79
preventing of scapular notching in rTSA
lateralize
| place glenoid inferior with tilt facing down
80
What is Cultibacterium Acnes
Sames as proprionobacterium
81
Consider these tricks for trigger release in RA pt
More extensive tenosynovectomy
release pulley on radial side
consider FDS slip excision
82
number of people that respond to trigger finger injection
| - what pt is it less effective in
60%
| - diabetics
83
EMG findings with nerve injury
| insertional activity/spontaneous activity minimal activity
neuropraxia - normal/silent/none
| axonotmesis/neurotmesis - increased/fibrillations and positive sharp waves
84
Z plasty cuts and respective lengths gained
60 degree -> 75% increase
45 -> 50% increase
30 -> 25 % increase
85
Most common intra-articularsoft tissue injury of the wrist
TFCC
86
Most predictive of loss of reduction of DR fx treated nonop
age > 60 yo
87
Outcomes for Distal Radius fx op vs nonop in pts > 65 yo
Overall no difference except for . . .
| Op pts with > grip strength and better xrays
88
Assoc injury with the below MOA:
- wrist ext + radial deviation
- wrist ext + ulnar deviation
radial -> scaphoid injury
| ulnar -> TFCC
89
complication of hammate hook excise
ulnar n injury
| 15% grip strength b'c pulley for 4/5 FDP disrupted
90
fite bite management
gotta take to OR to washout the joint
91
2 most important thumb ligaments
Volar oblique -> fx frag that remains stable in bennet fx
| dorsoradial -> primary restraint to dorsal dislocation od CMC of thumb
92
Treatment for chronic Gamekeep with arthritis
fusion
93
DRUJ dislocation
- dorsal
- palmar
splint
- dorsal -> supination
- palmar -> pronation
94
how to assess for ulnar impaction on xray
True PA xray (0 degree PA)
| - any rotation causes movement of ulna
95
Max in Wafer procedure
4mm more will inur radioscaphocapitate (i thin kthat's what he said)
if more needed ->< ulnar shortening
96
primary complication of
- DIP fusion
- DIP arhtroplasty
fusion
- K wire -> infection
- screw -> gotta listen to the lecrure wasn't on slide
Arthroplasty -> extensor lag
97
best prosthetic for PIP joint replacement
constrained silicone
| - good stability
98
inability to extent SF in FA
tendon rupture b'c ulna tends to sublux dorsal (caput ulnar syndrome)
99
most sensitive test for detecting early RA disease
MRI with contrast of the joint
100
#1 compication with wrist replacement in RA
distal component loosening
101
When to perform complete radiocarpal arthrodesis for SLAC
when the lunate facet is arthritic
102
Preiser Disease
Scaphoid AVN
103
causes MCP joint flexion in dupuytren's
| spiral lig causes
pretendinous cord
| displaces N/v structure
104
When to operate on duputrey
any PIPj contracture
| MCP contractur e> 30
105
Which fascial structure is never involved in Dupuytren's
Cleland's
106
gold standard for motor nerve reconstruction
autograft
107
Hemangioma of skin in kid
| - nautral history
70% regress by 7 yo
| 90% regress by age 9
108
Lat Epicondylitis
- main tendon involved
- other tendon involved 50% of the time
ECRB
| anterior edge of EDC 50% of the time
109
most common cause of elbow arthritis
RA
110
When is ligament repair weakest?
When does repair ligament near full strength?
% of strength return compared to original tendon ?
weakest 7-10d
Nears full strength 21-28d
usually 2/3 of original strength
111
Sequence of functiona loss from nerve injury
| - recovery sequence?
motor -> proprioception -> touch -> temp -> pain -> sympathetics
*MP Touched Toots PartS
recovery occurs reverse
