HAND Flashcards
Tx AVN of capitate
vascularized bone raft
best coverage for dorsal thumb wounds
1st DMA flap
best coverage for volar thumb pulp
moberg advancement
best coverage for volar soft tissue finger defect
cross finger
best coverage for dorsal soft tissue finger defect
reverse cross finger
what is most that can be repaired w/o gap formation w epitendinous repair
partial lac up to 75% flexor tendon
tx proximal pole scaphoid fx
ORIF dorsal
tx distal pole scaphoid fx
ORIF volar
side effect of collagenase injection
pruritic rash
axillary LAD
what can arise from DIPJ in OA
mucous cyst
main restraint against ulnar translation of carpus
Radioscaphocapitate ligament
tx for CMC arthritis w thumb MCP hyperextension more than 30 deg
excision trapezium +/- LRTI
AND MCPJ arthrodesis to avoid adduction contracture
thenar flap best for
volar oblique defect of long or index finger in less than 30 y/o
mallet finger
disruption of extensor tendon distal to DIPJ so volar subluxation of distal phalanx
over tension of FDP tendon so can’t form grip
quadrigia effect
extension lag at MCPJ after metacarpal fx due to
shortening more than 2-5 mm
Best option for PIPJ arthroplasty
silicone implant
volar approach
volar subluxation of carpus after DRF due to damage to
short volar radiolunate ligament
Wartenberg sign due to
SF held in abducted position from ulnar nerve palsy
martin gruber anastamosis
connection btwn ulnar/median nerve in forearm
volar PIP disloation
what is usu ruptured
tx?
central slip of extensor tendon –> leads to boutonniere
immobilize in extension splint x6 wks
strength of tendon repairs depends on
number of strands crossing repair site (at least 4-6 strains)
best way to repair tendon
core suture 10 mm from cut edge
circumferential simple running epitendinous suture
digit amps where have poor function for replant
proximal to insertion of FDS (btwn FDS and distal palmar crease- zone 2)
best way to see hook of hamate fx
carpal tunnel view xr
central slip injury appears like
PIP flexion
DIP extension
tx central slip injury
full time extension split of PIPJ x5 wks with ACTIVE DIP flexion encouraed
MC mech for TFCC injury
wrist extension
forearm pronation
order of release for PIPJ flexion contracture
1) pulley takedown
2) release check rein lig
3) release accessory collateral lig and volar plate
4) proper collateral lig
in dupuytren’s
bands are __
cords are ___
bands = nl cords = abnl
spiral cord travels ___ to NVBundle and displaces it ___
spiral cord = dorsal to NV and displaces it volarly
radial tunnel vs PIN compression
radial tunnel = NO motor or sensory changes
tx radial túnel
initial = nonop
then release Arcade of Froshe, distal supinator
PIN syndrome
dorsal wrist pain w thumb, wrist, finger extension and pain w resists supination d/t leash of Henry/arcade of Froshe
what must be done during surgery for radioulnar synostosis
interposition btwn radius and ulna
position immobile ECU subluxation
pronation extension radial deviation
gene assoc w congenital radioulnar synostosis
47 XXY
ulnar nerve relation to ulnar artery
nerve = ulnar and dorsal to ulnar artery
tx arterial insuff after replant
heparin
stellate ganglion block
tx Kienbock (AVN lunate) w/o sig OA
radial shortening osteotomy
boutonniere deformity due to (volar dx of PIPJ)
central slip of extensor tendon
tx sagittal band rupture (when tendon slides to the side w flexion)
yoke splint
contracture of triangular ligament leads to
swan neck deformity
EPB is more ___ than APL
which may be in accessory compartment
EPB DORSAL to APL
EPB may be in accessory comps
EPB is more ___ than APL
which may be in accessory compartment
EPB DORSAL to APL
EPB may be in accessory comps
BUNNELL test for intrinsic tightness positive when
loss of PIP flexion when MCPJ extended
w MCP flexed, PIP motion nl
bony inj assoc w dorsal PIPJ fx dx
middle phalanx palamar lip fx
best flap for 1st web space
PIA flap
pain distal to lateral epicondyle + pain w active extension of long finger
radial tunnel syndrome
risk factors for Kienbock
decr radial inclination
vascular congestition 2/2 high intraosseous pressure
medical dz
ulnar neg variance
when to operate on bony mallet
if volar subluxation of distal phalanx
positive intrinsic tightness test
means
decr PIPJ flexion w extension of MCPJ
contracture of the intrinsics
first joint affected in SLAC wrist
radioscaphoid
roof and floor of cubital tunnel
osborne’s lig
MCL
borders of guyon canal
superficial palmar carpal lig deep flexor retinaculum hypothenar pisiform hook hamate
if scar more than 1 cm in flexor tendon injury tx?
tendon grafting with palmaris longus tendon
when to do 2 stage flexor recon
if tendon sheath not intact
for PIP fx dx, when to do surgery
if more than 25% joint involved and doesn’t reduce w flexion
OTHERWISE
extension block splinting
tx prox pole scaphoid vs distal pole
prox pole = dorsal
distal pole = volar
wartenberg sign
SF in abducted/extended position d/t accessory slip of EDM (radial n) unopposed pull (weak SF lumbrical)
recurrent br of median n innerv what
opponens pollicis
beyond what finger lvl is there poor function with replant
if amputation is proximal to insertion of FDS
good prognostic factor with pediatric cubital tunnel syndrome
- ulnar nerve instability / subluxation
flexor tendon zone 2 gets nutrition from
diffusion from synovial sheath
mc fracture with dorsal PIP fx-dx
middle phalanx palmar lip fx
tx acute unstable and chronic dorsal PIP fx dx
volar plate arthroplasty
tx if flexor tendon inj less than 60%
trim frayed edges
begin early ROM
MFC vascularized bone graft blood supply
longitudinal br of descending genicular artery
basis for Froment sign
thumb IP flexion by FPL (AIN) compensates for loss of metacarpal adduction by adductor pollicis
diff btwn ulnar tunnel and cubital tunnel
ulnar tunnel
- less clawing
- sensory deficit to dorsal hand
diff btwn C8 radiculopathy and cubital tunnel
C8 = sx improve w shoulder abduction
poor prognosis in cubital tunnel correlates most with
intrinsic muscle atrophy
acrosyndactyly with proximal sinus tracts assoc w what
amniotic band syndrome
another name for hypothenar hammer syndrome
ulnar artery thrombosis = cold sensation, poor flow in ulnar artery
what is stener lesion
when UCL superficial to adductor aponeurosis
