2/13/16 Hand fingertip amputations, dupuytren's, vascular Flashcards
Lumbrical plus finger
- paradoxical extension of the finger with flexion of the IP joint.
- occurs in amputation at the middle phalanx
- the FDP retracts and causes increased tension on the lumbricals
- treat with division of the lumbricals except if ulnar nerve palsy; reattach FDP if lacerated
lumbrical anatomy
Lumbricals originate from the FDP tendon
- 1/2 = unipennate, MEDIAN nerve; FDP 2/3
- 3/4 = bipennate, ULNAR nerve; 3rd lumbrical = FDP 3/4, 4th lumbrical = FDP 4/5
- inserts on radial side of extensor expansion
Hypothenar hammer syndrome
trauma-induced thrombosis of the ulnar artery
- carpenter or baseball catcher
- unilateral and localized to the ulnar side of the hand
- sx: hypothenar pain, cold sensitivity, paresthesias, positive Allen test
- tx: activity modification, may need resection of the aneurysmal areas with vein graft
Buerger disease
acquired vasculitis in smokers
- bilateral and not localized.
- progresses from claudication to ulcer and necrosis of fingers
Reynaud’s
- young female with red, white, and blue finger
Forearm compartment syndrome
deep flexors are likely to be affected first (FDP), extensors are last to be affected.
- can lead to Volkmann’s ischemic contracture due to necrosis of muscles and resultant intrinsic minus position
Intrinsic minus
AKA Claw hand
- PIP, DIP flexed, MCP hyperextended
- due to loss of intrinsics (minus)
- Ulnar nerve: cubital or ulnar tunnel syndromes
- Median nerve: volkmann’s ischemic contracture, leprosy,
- tx: contracture release and passive tenodesis vs. active tendon transfer
review forearm anatomy & compartments
see book
Hook nail deformity
due to lack of bony support to sterile matrix
- tx: grafting, flaps, vascularize nail flaps
Compartment syndrome
- pressure greater than 30mmHg
- pain, paresthesias, poikilotherma, pulselessness
Toe to thumb transfer
- needs the MCP joint available.
- First dorsal metacarpal artery
Groin flap artery
superficial circumlex iliac artery (SCIA)
Types of joints
- Ball and socket: Shoulder and hip
- Condyloid: allows for flexion and extension, abduction and addution, circumduction; MCP of the IF, LF, RF, SF.
- hinge: MCP of thumb, IP joints of the other fingers
- pivot: rotation; atlas and axis gone
- saddle: CMC joint of thumb.
Osteoconduction
replace of graft through creeping substition
Osteoinduction
stimulation of bone-forming cells from surrounding tissue
Osteogenesis
provided from the surviving cells in the graft materail
Complex regional pain syndrome
tx: vitamin C
Lateral epicondylitis
The extensor carpi radialis brevis (ECRB) origin is the primary muscle involved in lateral epicondylitis. The undersurface is avascular, making it a potential site for degeneration and partial tears. The ECRB shares a common origin with the extensor carpi ulnaris, extensor carpi radialis longus, and brachioradialis. The extensor digiti minimi also originates from the lateral epicondyle and has been involved in some cases of lateral epicondylitis, but not as commonly as the ECRB.
