Extremity Flashcards
Anterior tarsal syndrome
Deep peroneal nerve entrapment Loc: superior border of inferior extensor retinaculum/beneath EHL tendon Sx: Pain along dorsum of foot Numbness 1st dorsal web space Weakness EDB Tx: start with EMG
Froment’s sign
Tests adductor pollicis (ulnar n.)
Used to diagnose ulnar n. injuries
Pt uses FPL (median n) to flex thumb IP to grab paper against index finger (compensates for lost adductor)
Mirror hand/mirror foot (anteroposteraior axis abnormality)
Duplication of ZPA (regulation involves SHH and Hox B-8 proteins)
Arrested limb development (proximal/distal)
Abnormality in AER (regulated by fibroblast growth factor)
Abnormalities in ventral/dorsal limbs
BMP, engrailed-1 (ventral)
Wnt7 (dorsal)
May also affect proximal/distal patterning
Stener lesion
Thumb UCL injury with dorsal adductor aponeurosis interposition
Cannot be treated closed
Dx: US
If no Stener lesion and firm endpoint on valgus testing, can treat with cast immobilization
Ulnar nerve compression at the elbow
Causes: 2 heads FCU, arcade of Struthers, medial intramuscular septum, Osborne ligament, anconeus epitrochlearis
PIN (radial) compression in the forearm
Cause: Arcade of Frohse (proximal supinator)
How to reduce a Bennett fracture
Longitudinal traction
Palmar abduction
Pronation
Pressure over MC base
Possible anomalous connection to FPL
FDP to the index (unilateral in 25%)
FDP retraction by Leddy/Packer classification
I: to palm (tethered at lumbrical origin, both vincula ruptured)
II: to PIP (Vincula longus preserved, brevis ruptured)
III: to A4 pulley (vincula intact, large fracture fragment attached)
IV: (rare) large fragment but tendon also avulsed to palm
V: above + distal phalanx fx
blood supply to medial soleus flap
posterior tibial artery
blood supply to lateral soleus
peroneal artery
blood supply to the gastrocnemius flap
medial and lateral sural arteries
most common metastatic tumor to the hand
lung > GI > kidney > breast
ligament that prevents radial subluxation at the thumb CMC joint
anterior oblique ligament
dorsal radial ligament also important for basal joint stabilization
length of ulna needed for below elbow prosthesis
5 cm
Blauth II thumb hypoplasia
small
hypo plastic thenars, UCL instability
tx: opponensplasty (Huber transfer), webspace deepening
Blauth IIIA
Intact CMC, extrinsic muscle abn
tx: tendon transfers
Standard Boyes transfers (radial nerve palsy)
PT to ECRL/ECRB (wrist ext)
FCR to EPL/APB (thumb ext)
FDS III to EDC (finger ext)
FDS IV to EPL/EIP (index ext)
Median n compression at the forearm
Ligament of Struthers
Lacertus fibrosis/bicipital aponeurosis
PT
FDS facial arch
Sx: Pronator syndrome (motor and sensory, aching in prox forearm, worsened with pronation)
Ulnar n compression at the elbow
Arcade of Struthers
ancones epitroclearis
osbourne ligament
FCU
includes dorsal sensory n sx
