Forearm Flashcards

1
Q

What runs around Lister’s tubercle?

A

EPL tendon

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2
Q

1 carpal fracture? Risks?

A

Scaphoid, risks of nonunion/AVN

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3
Q

Which bone articulates with the triangular fibrocartilage complex (TFCC)

A

triquetrum

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4
Q

Which tendon does the trapezium have a groove for?

A

FCR

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5
Q

Scaphoid lunate angle average?

A

47° (range 30°-60°)

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6
Q

Monteggia fracture. Complications?

A

Proxima ulna fracture characterized by anterior angulation of ulna and anterior dislocation of radial head Complications: Radial nerve/PIN injury. Compartment syndrome

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7
Q

Galeazzi fracture

A

Distal 1/3 radial shaft fracture with distal RU dx. May be anterior or posterior.

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8
Q

Colles fracture

A

Distal radial head fracture with dorsal angulation

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9
Q

Frykman classification

A

I: extraarticular radius II: I+ulnar styloid III: Radiocarpal intraarticular IV: III+ Ulnar stuloid V: Intraarticular distal radioulnar VI: V+ulnar styloid VII: Intraarticular radiocarpal and distal radioulnar VIII: VII+ ulnar styloid

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10
Q

Most common scaphoid fx location? Complications?

A

Middle/waist followed by proximal pole and distal pole Complications: Osteonecrosis, nonunion, SLAC (scaphoid lunate advance collapse)

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11
Q

Mayfield classification

A

Perilunate instability I: Scapholunate disruption II: lunocapitate disruption III: Lunotriquetral disruption IV: lunate (peri) dislocation

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12
Q

Dislocation of lunate occurs through?

A

Space of Poirier

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13
Q

Torus fracture?

A

Buckle fracture of radius

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14
Q

Greenstick fracture?

A

concave, cortex intact or buckled.

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15
Q

Are palmar (volar) or dorsal hand ligaments stronger?

A

palmar

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16
Q

Radiocarpal joint: Superficial ligaments

A

RSC (RS and RC) long RL UC

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17
Q

Radiocarpal joint: Deep ligaments

A

short RL UL (help stabilize the DRUL) ulnotriquetral (“”) RSL (ligament of Testut)

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18
Q

Radiocarpal Extrinsic - dorsal

A

Dorsal RC (superficial and deep bundles)

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19
Q

Contents of the carpal tunnel?

A

9 tendons: 4 FDS 4 FDP 1 FPL 1 nerve: Median n

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20
Q

Primary fxn of triangular fibrocartilage complex?

A

Stabilizes the DRUJ

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21
Q

Borders of carpal tunnel?

A

Roof: transverse carpal ligament (flexor retinaculum) Floor: central carpal bones Medial wall: pisiform and hamate Lateral wall: trapezium and scaphoid

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22
Q

Borders of ulnar tunnel/Guyon’s canal

A

Floor: TCL Roof: volar carpal ligament Medial wall: pisiform Lateral wall: hook of hamate

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23
Q

Contents of the ulnar tunnel

A

Ulnar nerve and artery

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24
Q

1 cause of ulnar tunnel nerve compression?

A

Ganglion cysts

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25
Q

Extensor compartments of the wrist 1-6?

A

1: APL, EPB 2: ECRL, ECRB 3: EPL 4: EDC/EI 5: EDM 6: ECU

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26
Q

deQuervain’s tenosyovitis

A

pain in the first extensor compartment

27
Q

Phalen’s test

A

flex wrists for one minute, median nerve tingling=positive

28
Q

Durkan carpal compression

A

manually compress the median nerve at carpal tunnel. Reproduction=positive. most sensitive test

29
Q

Tinel test

A

tap volar wrist. tingling=CTS

30
Q

Finkelstein test

A

Flex thumb and ulnar deviate wrist. Pain in 1st dorsal compartment= de Quervain’s

31
Q

Piano Key

A

stabilize the ulnar and try to translate radius. Positive = DRUJ instability

32
Q

Watson test

A

Scaphoid shift. Push dorsally on pole of scaphoid, bring wrist from ulnar to radial deviation. Click/clunk = carpal instability

33
Q

Allen test

A

Occlude both radial and ulnar arteries, release one artery only. Absence of pinking suggests arterial compromise.

34
Q

First layer forearm flexors (superficial)

A

1: Pronator teres 2: FCR 3:PL 4:FCU

35
Q

Second layer forearm flexors (middle)

A

FDS

36
Q

Action of FDS

A

PIPJ flexion

37
Q

Action of FDP

A

DIPJ flexion

38
Q

Third layer forearm flexors (deep)

A

1:FDP 2:PQ 3:FPL

39
Q

AIN innervates? AIN test

A

Deep flexors (1/2 FDP, PQ, FPL) Make the “OK” sign

40
Q

Where does ulnar nerve run in forearm

A

Between FDS and FDP, ulnar to the artery

41
Q

Where does superior branch of radial nerve run in forearm

A

Runs under brachioradialis tendon/muscle, radial to the artery

42
Q

Where does median nerve run in forearm?

A

Between FDP and FPL into carpal tunnel

43
Q

Where does PIN start? Run?

A

Starts after radial nerve pierces the supinator. Runs between APL and EPL along IO membrane.

44
Q

What innervates the capsule of extensor compartment 4?

A

PIN

45
Q

Where does the MC nerve run in arm?

A

Between biceps and brachialis, runs in subcutaneous tissues above the brachioradialis.

46
Q

Where does ulnar nerve run in forearm?

A

Exits cubital tunnel then through the FCU heads.

47
Q

Classes of TFCC tears?

A

1: traumatic (repair) 2: degenerative (conservative)

48
Q

Pronator syndrome caused by?

A

Caused by median nerve compression

49
Q

Places median nerve can be compressed proximally?

A

1: ligament of Struthers 2: Pronator teres 3: Lacertus fibrosis 4: FDS aponeurosis/arch

50
Q

PIN syndrome, compression sites (5)

A

1) Fibrous bands 2) Leash of Henry 3) ECRB 4) Arcade of Frohse (proximal supinator edge) 5) Distal edge of supinator

51
Q

Radial tunnel syndrome

A

Lat elbow pain, pain only, no weakness

52
Q

Wartenberg’s syndrome

A

Compression of superficial radial nerve at wrist (b/w ERCL and BR tendons). Pain only, no weakness

53
Q

Ulnar tunnel compression

A

Numbness/weakness in hand with atrophy. Can be zone 1 (mixed) 2 (motor) or 3(sensory)

54
Q

Dissociative Carpal Instability. 2 main types

A

Instability within a carpal row. Two main types: Dorsal intercalated segment instability (DISI) due to SL ligament disruption or scaphoid fracture/nonunion. Volar intercalated segment instability due to lunotruquetral ligament disruption. Need RC lig injury

55
Q

Nondissociative carpal instability

A

Instability between carpal rows. Midcarpal or radiocarpal variations

56
Q

Combined carpal instability

A

Instability both within and between rows. Perilunate dislocation most common. Grater arc injury - transosseus injury Lesser arc injury = ligamentous injury

57
Q

Scapholunate advanced collapse (SLAC), stages? spared joint?

A

wrist arthritis due to posttraumatic scaphoid flexion deformity. Stage 1: radial styloid + scaphoid DJD Stage 2: Radioscaphoid joint DJD Stage 3: Capitolunate joint DJD Stage 4: Capitate migration Radiolunate joint spared

58
Q

Kienböck’s disease, stages

A

Osteonecrosis of the lunate from trauma or repetitive microtrauma. associated with ulnar negative variance of the wrist. Stage I: normal XR Stage 2: Lunate sclerosis Stage 3A: Lunate fragmented Stage 3B: 3A+scaphoid flexed Stage 4: DJD of adjacent joints

59
Q

Madelung’s deformity?

A

Deformity of distal radius with prominence of ulnar head.

60
Q

Radial club hand

A

Failure of formation of the radius causing bowing of the forearm and radial deviation of the hand.. Associated with VATER and TAR syndromes.

61
Q

Henry approach to forearm IN plane, dangers

A

Anterior approach IN plane proximal: brachioradials (radial n) and pronator teres (median n) IN plane distal: brachioradials (radial n) and FCR (median n) Dangers: radial artery, superficial radial nerve, PIN.

62
Q

Dorsal approach to wrist IN plane? Dangers?

A

No IN plane (all are PIN). 4h dorsal compartment in opened (innervated by sensory branch of PIN) Dangers: Superficial radial nerve Radial artery

63
Q

Volar approach to wrist IN plane? Dangers?

A

IN plane proximally brachioradials (radial) and FCR (median n) Distal no IN plane Dangers: Median nerve (palmar cut. branch, motor recurrent branch), superficial palmar arch

64
Q

Wrist arthroscopy portals (7)

A

1-2: between APL and ECRL tendons. Deep branch of radial artery, superficial radian n branches, lateral antebrachial cutaneous branches. 3-4: Between EPL and EDC. No dangers. Workhorse portal 4-5: Between EDC and EDQ. No dangers 6R: Radial side of ECU tendon. Dorsal cutaneous branch of ulnar a 6U: ulnar side of EUC. Dorsal cutaneous branch of ulnar a Midcarpal radial: 1cm distal to 3-4 along border of 3rd MC. None Midcarpal ulnar: 1cm distal to 4-5 protal in line with 4th MC. None