Extremity

Question 1

Anterior tarsal syndrome

Answer 1

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

Question 2

Froment’s sign

Answer 2

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)

Question 3

Mirror hand/mirror foot (anteroposteraior axis abnormality)

Answer 3

Duplication of ZPA (regulation involves SHH and Hox B-8 proteins)

Question 4

Arrested limb development (proximal/distal)

Answer 4

Abnormality in AER (regulated by fibroblast growth factor)

Question 5

Abnormalities in ventral/dorsal limbs

Answer 5

BMP, engrailed-1 (ventral)
Wnt7 (dorsal)
May also affect proximal/distal patterning

Question 6

Stener lesion

Answer 6

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

Question 7

Ulnar nerve compression at the elbow

Answer 7

Causes: 2 heads FCU, arcade of Struthers, medial intramuscular septum, Osborne ligament, anconeus epitrochlearis

Question 8

PIN (radial) compression in the forearm

Answer 8

Cause: Arcade of Frohse (proximal supinator)

Question 9

How to reduce a Bennett fracture

Answer 9

Longitudinal traction
Palmar abduction
Pronation
Pressure over MC base

Question 10

Possible anomalous connection to FPL

Answer 10

FDP to the index (unilateral in 25%)

Question 11

FDP retraction by Leddy/Packer classification

Answer 11

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

Question 12

blood supply to medial soleus flap

Answer 12

posterior tibial artery

Question 13

blood supply to lateral soleus

Answer 13

peroneal artery

Question 14

blood supply to the gastrocnemius flap

Answer 14

medial and lateral sural arteries

Question 15

most common metastatic tumor to the hand

Answer 15

lung > GI > kidney > breast

Question 16

ligament that prevents radial subluxation at the thumb CMC joint

Answer 16

anterior oblique ligament

dorsal radial ligament also important for basal joint stabilization

Question 17

length of ulna needed for below elbow prosthesis

Answer 17

5 cm

Question 18

Blauth II thumb hypoplasia

Answer 18

small
hypo plastic thenars, UCL instability
tx: opponensplasty (Huber transfer), webspace deepening

Question 19

Blauth IIIA

Answer 19

Intact CMC, extrinsic muscle abn

tx: tendon transfers

Question 20

Standard Boyes transfers (radial nerve palsy)

Answer 20

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)

Question 21

Median n compression at the forearm

Answer 21

Ligament of Struthers
Lacertus fibrosis/bicipital aponeurosis
PT
FDS facial arch

Sx: Pronator syndrome (motor and sensory, aching in prox forearm, worsened with pronation)

Question 22

Ulnar n compression at the elbow

Answer 22

Arcade of Struthers
ancones epitroclearis
osbourne ligament
FCU

includes dorsal sensory n sx