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ABOS Part 1 > Hand > Flashcards

Hand Flashcards

1
Q

Neuropraxia is defined as…

A

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2
Q

DRUJ is most stable in this position?

A

Supination
(If dorsal ulnar displacement)

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3
Q

The SL ligament is strongest/thickest where?

A

Dorsally (260N)

Disruption leads to DISI deformity with SLAC wrist.

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4
Q

What causes VISI deformity?

A

Disruption of lunotriquetral ligament
(Volar is strongest portion of ligament)

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5
Q

Dorsal compartments of the wrist with associated tendons, etc

A

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6
Q

Radial nerve innervation…
First to be reinnervated after proximal nerve lacteration? Last?

A

innervation order from proximal to distal was brachioradialis, extensor carpi radialis longus, supinator, extensor carpi radialis brevis, extensor digitorum communis, extensor carpi ulnaris, extensor digiti quinti, abductor pollicis longus, extensor pollicis longus, extensor pollicis brevis, and extensor indicis proprius

Brachoradialis
Extensor indices proprius

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7
Q

Nerve repair indications for:
-Direct repair
-Conduit repair (bovine / porcine collagen)
-Graft

A

Direct repair must have no tension and is usually epineurial repair.
Conduit is used for sensory repair only (<2-3cm).
Graft
-allograft is for mixed motor and sensory <5 cm
-autograft (sural n.) for mixed motor and sensory >5cm

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8
Q

Most important factor for nerve repair prognosis

A

Age

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9
Q

EMG signs of muscle denervation

A

Positive sharp waves
Fibrillations
Fasciculations

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10
Q

Nerve myelin loss leads to this nerve conduction velocity finding?

A

Increased latency and decreased velocity

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11
Q

Nerve conduction velocity finding with nerve axonal loss?

A

Decreased amplitude

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12
Q

This nerve compression neuropathy is associated with Parsonage Turner syndrome.

A

AIN syndrome
Brachial plexus neuritis

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13
Q

muscles innervated by the radial nerve (not PIN)?

A

Triceps
1/2 of brachialis
brachoradialis
ECRL

(Note ECRB is innervated by PIN, so a PIN injury will have maintained wrist extension but it will radially deviate)

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14
Q

Complete radial nerve injury…
What are the principles for this tendon transfer?
What is the most common transfer?

A

For radial nerve injury you need to re-establish wrist extension, finger extension, thumb extension

Pair synergistic effects of muscles
- wrist extensors with finger flexors
- wrist flexors with finger extenders

Brand transfer
- pronator teres to ECRB
- FCR to extensor digitorum
- palmaris longus to EPL

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15
Q

Median nerve transfer for severe carpal tunnel with loss of thumb opposition?

A

Camitz transfer:
Palmaris longus to the thumb proximal phalanx

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16
Q

Median nerve transfer to gain thumb opposition in congenital hand deformity?

A

Huber:
Abductor digiti minimi to thumb proximal phalanx

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17
Q

45 deg z-plasty flap lengthens coverage by…
30 deg?
60 deg?

A

45 deg = 50%
30 deg = 25%
60 deg = 75%

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18
Q

Distally the ulnar artery creates the ____ palmar arch.

A

Superficial

19
Q

Distally the radial artery creates the ____ palmar arch.

A

Deep

20
Q

Leaches secrete this anticoagulant, have this bug and require tho prophylaxis?

A

Hirudin
Aeromonas hydrophilia
Ceftriaxone or Ciprofloxacin

Due to some Ciprofloxacin resistance sulfamethoxazole-trimethoprim (Bactrim) is a good oral alternative agent

21
Q

Chronic mallet finger results in this deformity?

A

Swan neck

22
Q

Chronic central slip injury results in this deformity?

A

Boutonnière deformity

23
Q

Quadriga most commonly results after…

A

FDP flexor tendon injury that has been repaired and over-advanced (typically >1cm)

24
Q

In order, the two most common flexor tendon ruptures with a distal radius volar plate that is placed past the watershed line are?

A

1. FPL
2. FDP Indices

25
Q

Ligament that if injured can result in VISI deformity?

A

Volar lunotriquetral ligament

26
Q

This ligament must be preserved when doing PRC?

A

Radioscaphocspitate

27
Q

Primary stabilizer of the DRUJ?

A

Deep fibers of the foveal attachment of the radioulnar ligaments

28
Q

Main blood supply to the scaphoid?

A

Oblique dorsal ridge (retrograde flow)

29
Q

Operative indications for scaphoid fracture?

A

30
Q

Scaphoid screw placement location?

A

Centrally
3.5mm screw

31
Q

Wrist ligaments associated with dorsal chip triquetral fracture?

A

Dorsal radiocarpal ligament
Dorsal intercarpal ligament

32
Q

After hook of hamate excision you lose ___% of grip strength, primarily due to…

A

15%
Loss of pulley action of the hook of hamate with the ring and small finger FDP tendons

33
Q

Fall on outstretched hand with the wrist radially deviated can result in this injury?

A

Scaphoid fracture

34
Q

The primary ligament maintaining lunate reduction?

A

Short radiolunate ligament

35
Q

Chronic scaphoid AVN, what are your the appropriate treatments?
With humpback deformity?
Without humpback deformity?

A

AVN + humpback = free-vascularized medial femoral condyle graft (volar approach)

AVN no humpback = 1,2 intercompartmental supraretinacular artery graft (ICSRA) (dorsal approach)

36
Q

Bennet fractures…
1. Deforming force
2. Constant fragment
3. Reduction maneuver

A

1. Abductor policus longus
2. Volar ulnar fragment which is attached to the volar oblique ligament
3. TAPE (traction, abduction,pronation, external rotation)

37
Q

Treatment of finger PIP dislocations without fracture…
1. Dorsal dislocation
2. Volar dislocation

A

1. Reduction and buddy taping - main risk is stiffness so need early active motion

2. Reduction and extension splinting of PIP joint with DIP free - likely a central slip injury and so PIP needs to be immobilized in extension for healing otherwise could result in boutonnière deformity

38
Q

Position of immobilization for DRUJ injuries when DRUJ is dislocated…
1. Volar
2. Dorsal

A

1. Pronation
2. Supination

39
Q

Arthroscopic wrist portals that place subcutaneous nerves at most risk?

A

1-2 portal = dorsal sensory radial nerve
6-U portal = dorsal sensory ulnar nerve

40
Q

Cell responsible for dupuytrens disease and it excretes what?

A

Myofibroblast
alpha-SMA
Results in increased type 3 collagen (normal collagen type for palmar fascia is type 1)

41
Q

How to assess intrinsic vs. extrinsic hand stiffness?

A

Evaluate MCP and PIP motion.

Intrinsic stiffness: PIP motion improves with MCP flexion (stiff with MCP extension)

Extrinsic stiffness: PIP motion better with MCP extension as compared to MCP flexion

42
Q

What long term complication can result from distal scaphoid resection?

A

DISI

43
Q

Culture technique for mycobacterium marinum?

A

Lowstein-Jensen medium at 30 Celsius

ABOS Part 1 (11 decks)

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