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finger clubbing

family trait and harmless

but can be associated w lung disease, liver disease, heart disease, inflammatory bowel disease, and AIDS


red lunula associated w

Cardiovascular disease
Cardiac failure
Collagen vascular disease

Carbon dioxide poisoning

Prednisone use


An Absent lunula may indicate

anemia or malnutrition


Pale nails may be a sign of:

Congestive heart failure
Liver disease


Bluish nails (cyanosis) may indicate

Raynaud’s disease
respiratory disorders
cardiovascular disorders


Splinter hemorrhage is associated with the following conditions:

Bacterial endocarditis
Mitral stenosis
Chronic glomerulonephritis


Painful, red and swollen nail fold, or skin and soft tissue that surrounds the nail, nail infection



Paronycha may be...

is most often caused by...

may be acute, where it develops over a few hours
or chronic, where it lasts more than six weeks

most often caused by infection, injury or irritation

or eczema or psoriasis
or diabetes or HIV


Crused fingertips:
subungual hematoma

nail bed can bleed, usually after an injury, under the nail creating a hematoma (abnormal collection of blood outside a blood vessel)


Crushed fingertips:
Fractures of the fingertip, usually of the type called a

tuft fracture (distal phalanx), usually heal well if given a chance to rest (a splint may be needed)


Zone 2

not a a lot of blood (tendon injuries here don’t heal as well because of lack of blood supply to tendon) no man’s land


Tendons don't have what?

Tendons don’t have a good blood supply


Finger tip amputations two types?

minor injury or primary closure (revision amputation)


Finger tip amputations: minor injury

Minor injury (< 2cm skin loss)
Indications: adults and children with no bone or tendon exposed

May close on its own with protective dressing and regular cleansing


Finger tip amputations: primary closure (revision amputation)

Indications: finger amputation with exposed bone and the ability to remove bone proximally without compromising bony support to nail bed,
or loss of >50% of distal phalange

Or irreparable damage to the nail matrix


Digit amputation surgical options

Full thickness skin grafting

Indication: exposed bone or tendon where rongeuring (snipping) bone proximally is not an option

Reconstructive flap may be necessary to cover the wound with new skin, as well as the fat and blood vessels underneath


Ring Avulsion injury (degloving)

Sudden pull on a finger ring (jewelry) results in severe soft tissue injury ranging from circumferential soft tissue laceration to complete amputation skin, nerves, vessels are often damaged

Fingers one of the most sensitive parts of body


Ring Avulsion injury: prognosis

extent of injury is greater than what it appears to be

poor prognosis because of associated vascular injury

advances in interposition graft techniques have improved results


Common Shoulder Surgical Procedures include the

Arthroscopic Rotator cuff repair


Rotator Cuff Repair

Surgical repair of the torn rotator cuff which often involves re-attaching the tendon to the head of humerus

A partial tear, however, may need only a trimming or smoothing procedure


Rotator Cuff Repair: Arthroscopy can assess....

Arthroscopy can assess and treat damage to other structures within the joint
Bone spurs are often removed arthroscopically
No need to detach the deltoid muscle with Mini-Open Repair


Physician’s order for rehabilitation

Immobilization - Repair needs to be protected (not stressed) while the tendon heals

Cast or splint (non-surgical immobilization)
Instructions to the patient include use a sling and avoid using arm for the first 4 to 6 weeks

Length of time of immobilization depends upon the severity of injury


Shoulder Post-op Exercises

Passive Exercise
referral to a PT for passive ROM (PROM) ex.

CPM may be ordered
In most cases, passive ROM is begun within the first 4 to 6 weeks after surgery

After 4 to 6 weeks, progress to doing active exercises

At 8 to 12 weeks, start strengthening exercise program

Complete recovery will take several months

Most patients have a functional range of motion and adequate strength by 4 to 6 months after surgery


Cut tendon that means

likely nerve is injured as well!


Peripheral nerves can

regenerate, but full cut needs a graft to get to motor endplate!


to stabilize a long bone fracture, a plate and screws outside the bone or a rod inside the bone may be used

internal fixation


screws are placed into the bone above and below the fracture, and a device is attached to the screw from outside the skin where it may be adjusted to realign the bone

external fixation