2/13/16 Hand fingertip amputations, dupuytren's, vascular

Question 1

Lumbrical plus finger

Answer 1

• 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

Question 2

lumbrical anatomy

Answer 2

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

Question 3

Hypothenar hammer syndrome

Answer 3

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

Question 4

Buerger disease

Answer 4

acquired vasculitis in smokers

• bilateral and not localized.
• progresses from claudication to ulcer and necrosis of fingers

Question 5

Reynaud’s

Answer 5

• young female with red, white, and blue finger

Question 6

Forearm compartment syndrome

Answer 6

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

Question 7

Intrinsic minus

Answer 7

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

Question 8

review forearm anatomy & compartments

Answer 8

see book

Question 9

Hook nail deformity

Answer 9

due to lack of bony support to sterile matrix

- tx: grafting, flaps, vascularize nail flaps

Question 10

Compartment syndrome

Answer 10

• pressure greater than 30mmHg

- pain, paresthesias, poikilotherma, pulselessness

Question 11

Toe to thumb transfer

Answer 11

• needs the MCP joint available.

- First dorsal metacarpal artery

Question 12

Groin flap artery

Answer 12

superficial circumlex iliac artery (SCIA)

Question 13

Types of joints

Answer 13

• 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.

Question 14

Osteoconduction

Answer 14

replace of graft through creeping substition

Question 15

Osteoinduction

Answer 15

stimulation of bone-forming cells from surrounding tissue

Question 16

Osteogenesis

Answer 16

provided from the surviving cells in the graft materail

Question 17

Complex regional pain syndrome

Answer 17

tx: vitamin C

Question 18

Lateral epicondylitis

Answer 18

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.