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figures, table new Flashcards

1
Q

What muscle attach to the proximal, middle and distal phalanx

A
  1. base - flexors interossi extensor hood and lumbrical extensor hood into central band
  2. middle - ED central slip, FDS splits come together
  3. Distal- ED lateral bands, FDP
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2
Q

what is the stable base of the hand

A
  • the relative immobile joints of the index and middle finder metacarpals and distal carpals
  • 4th and 5th are the mobile rays `
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3
Q

what role do the metacarpal bones play in the maintenance of the longitudinal arch

A

they have a slight dorsal arch in the sagittal plane

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4
Q

What structures support the transverse arch of the hand?

A
  1. superficial and deep transverse metacarpal ligaments
  2. tension of the finger flexors
  3. thenar and hyponthenar muscles
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5
Q

What Kienbock disease

A

AVN of the lunate

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6
Q

What is radial inclination of the wrist

A

slope of the distal radial articular joint

- normal is 15-20 degrees

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7
Q

What is ulnar variance

A

the position of the distal end of the ulna relative to the medial end of the radius

  • ulnar minus - short
  • ulnar postive - long
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8
Q

What is DISI and VISI

A
  • radiographic finding of a displaced lunate
  • dorsal intercalated segmental instability shows a dorsal tilt of the lunate relative to the radius and scaphoid
  • volar ISI - is a volar tilt
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9
Q

when the MP joint need to be immobilized what position should you put them in and why

A

flexion due the the mechanics of the collateral ligaments that are tight in flexion and loose in extension

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10
Q

what are the normal ROM for the wrist

A
  • flexion - 90
  • extension - 70
  • RD - 15-20
  • UD - 20-30
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11
Q

What ligament is injured with gamekeeper thumb

A

thumb UCL - is strained

complete rupture is knows as Stener lesion

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12
Q

What is the relative load transfer through wrist’s radial and ulnar joint with gripping and weight bearing

A

80% radial

20% unlar

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13
Q

What is the difference between the TFC and TFCC

A
  • TFC is part of the TFCC
  • TFCC is made up of TFC, articular disc, meniscus homologue, UCL, sheath of the ECU, dorsal and volar radioulnar ligaments
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14
Q

what is the ratio of palmar carpal ligaments to dorsal carpal ligaments

A

about 4:1

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15
Q

what is the space of poirier

A
  • mechanically weak area of the palmar carpal ligaments where the lunate tends to sublet
  • space between the 2 triangular ligament arrangement of the lunate and scaphoid apex
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16
Q

Name the content of the wrist extensor compartments

A 
221211
1- APL and EPB
2- ECRL and ECRB
3- EPL
4- ED and EI
5- EDQ
6- ECU
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17
Q

what are the layers of the carpal tunnel

A 
1- deepest- 4 FDP tendons
2- FDS
3- tends of the index and small finder
4- tendons of the long and ring finger
5- FPL is the most radial tendon
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18
Q

what are the pulleys of the fingers

A
  1. cruciate - X shaped - C1-3

2. annular - circular shaped - A1-5

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19
Q

what pulleys are “most important”

A

A2 and A5 located at the proximal and middle phalanges

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20
Q

What pulley is most closely associated with trigger finger

A

A1 at the metacarpal head

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21
Q

What is the origin and insertion of the lumbricals

A

tendon of the FDP and the radial side of the extensor hood

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22
Q

how do the lumbrical differ from each other

A

1 and 2 are unipennate

3 and 4 are bipennate

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23
Q

what is the location of the the annular pulleys

A

1- metacarpal head

  1. mid proximal phalanx
  2. PIP
  3. mid middle phalanx
  4. DIP
24
Q

what are the hypothenar muscles

A
  1. AbDM, FDM, ODM

2. arrise from the hook of the hamate, pisiform, flexor retinaculum and tunnel of guyon ligament

25
Q

what are the muscles of the thenar eminence

A
  1. APB
  2. OP
  3. FPB
  4. AP
26
Q

what is the only wrist extensor that the radial nerve innervates?

A

1- ECRL

2- PIN innervates all the other wrist extensor

27
Q

what is the difference between swan neck and boutonniere deformity

A
  1. swan neck - during MCP flexion you get flexion of DIP with hyperextension of PIP
  2. boutonniere - bow stringing from failure of the flexor pulley causing flexion of the PIP with extension of the DIP
28
Q

what might nail clubbing or spoon shaped nails indicates?

A
  1. clubbing - pulmonary or inflammatory bowel

2. spoon - iron deficient, Raynaud’s or lupus

29
Q

What are the four stages of tendon gliding

A
  1. open hand
  2. hook fist
  3. straight fist
  4. full fist
30
Q

what is a hook fist

A

flexion of the PIP and DIP by the FDS and FDP

- requires good lumbrical mobility

31
Q

what is a straight fist

A

first without DIP flexion

- requires maximum FDS gliding

32
Q

what is a composite fist

A

full fist and brings in maximum FDP gliding

33
Q

what are the different pinch types and how can they be used in DD?

A
  1. key or lateral - ulnar nerve emphasis via 1st dorsal interossi
  2. tip - fromete sign -PIN
  3. 3 point - median
34
Q

what muscles can you test in the hand to differentiate median nerve from ulnar nerve?

A
  1. median APB - back of the hand on the table, lift the thumb towards the ceiling and resist
  2. ulnar 1st DI - hand on table neutral pronation, thumb add, and abd index and push down on index
35
Q

what is the DeQuervain CPR parts

A
  1. Finkelstein
  2. tenderness over the APL and EPB
  3. pain over radial styloid process
  4. swelling
  5. thickening
  6. paon on resisted thumb extension
  7. pain in the 1st dorsal compartment with wrist movment
36
Q

what are the stages of the Finkelstein test?

A

I. forearm on the table let the wrist drop off the table into UD
II. apply passive over pressure to the wrist
III. apply passive over pressure to the thumb

37
Q

What is the scaphoid shift test?

A
  1. palpate scaphoid tubercle and passively move wrist into UD
  2. maintain pressure of scaphoid and move wrist into RD
  3. positive if there is a clunk or crepitus
38
Q

what is the scapholunate ballotement test

A
  1. pronate the wrist and mobilize the scaphoid on the lunate
39
Q

what is the ulnar fovea sign

A

tenderness in the space between the ulnar styloid process and tendon of the FCU
- possible disruption of the DRUJ ligaments

40
Q

what is the piano key sign

A
  1. hold the hand and press down on the distal ulna like pressing a piano key
  2. positive is symptom production or relative hypermobility
41
Q

What are the monofilament norms

A
  1. 2.83 normal
  2. 4.31 diminished light touch
  3. 4.56 loss of protective sensation
  4. 6.65 untestable
42
Q

how do you perform monofilmant testing

A
  • start with the smallest

- apply 3 times 1” on 1” off

43
Q

2 point discrimination norms

A

less than 6mm normal

44
Q

How does the information from 2 point discrimination differ from monofilament testing

A
  • 2 point how many nerves are present

- monofilament how many nerves are awake

45
Q

how do you perform 2 point discrimination

A

begin at 5 mm applying to the point of blanching,

  • alternate between one and two points
  • must correctly identify 7 of 10 trails
46
Q

what is forment sign

A

try and pull card out from key pinch

- the thumb will collapse into DIP extension due to weakness of the Ulnar nerve innervated FDB deep head and AP

47
Q

what is the scratch collapse test?

A

scratch over a superficial nerve region and test shoulder ER (B), positive will be a brief loss of strength

48
Q

what is the most important factor related Flexor tendon repair strength

A

The number of core strands across the repair

49
Q

What surgical factors will influence flexor tendon repair plan

A
  1. number of core suture strands
  2. core suture configuration
  3. core suture size
  4. addition of peripheral epitendinous sutures
50
Q

Immobilization of a flexor tendon repair occurs how long and in what position?

A
  1. 4 weeks

2. wrist in flexion 20-25 degree, MP joints in 50-60 degree flexion

51
Q

When does AAROM and tendon gliding begin with flexor tendon repairs

A

1-2 weeks, goal is to put slack on the repaired tendons

52
Q

when does strengthen begin after flexor tendon repair

A

About 8 weeks for light resistance, 10-12 weeks heavy (greater than 10 pounds)

53
Q

What criteria might suggest a patient is able to perform an early mobilization program following flexor tendon repair

A
  1. people who follow rules well

2. repair should have at least 4 strands of repair

54
Q

How would you isoloate motion of FDP versus FDS

A
  1. FDP - block all but the DIP during flexion

2. FDS - block flexion all fingers except target and flex target at the PIP

55
Q

What are the flexor tendon zones

A
  1. injuries in zone I would produce cut to flexor digitorum profundus only.
  2. No mans land
  3. distal palmar crease to the distal edge of flexor carpal ligament. It is also called lumbrical zone because of the presence of lumbricals in this zone.
  4. zone under carpal tunnel
  5. from wrist to muscle belly
56
Q

what are the extensor tendon zones?

A

I-VII, with Odd numbers at each joint (I-DIP, VII-wrist)

57
Q

what extensor tendon zones do mallet finger and boutonniere deformities occur in

A
  1. mallet - zone 1

2. boutonniere - zone 3

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