Hand

Question 1

Neuropraxia is defined as…

Question 2

DRUJ is most stable in this position?

Answer 2

Supination
(If dorsal ulnar displacement)

Question 3

The SL ligament is strongest/thickest where?

Answer 3

Dorsally (260N)

Disruption leads to DISI deformity with SLAC wrist.

Question 4

What causes VISI deformity?

Answer 4

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

Question 5

Dorsal compartments of the wrist with associated tendons, etc

Question 6

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

Answer 6

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

Question 7

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

Answer 7

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

Question 8

Most important factor for nerve repair prognosis

Answer 8

Age

Question 9

EMG signs of muscle denervation

Answer 9

Positive sharp waves
Fibrillations
Fasciculations

Question 10

Nerve myelin loss leads to this nerve conduction velocity finding?

Answer 10

Increased latency and decreased velocity

Question 11

Nerve conduction velocity finding with nerve axonal loss?

Answer 11

Decreased amplitude

Question 12

This nerve compression neuropathy is associated with Parsonage Turner syndrome.

Answer 12

AIN syndrome
Brachial plexus neuritis

Question 13

muscles innervated by the radial nerve (not PIN)?

Answer 13

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)

Question 14

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

Answer 14

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

Question 15

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

Answer 15

Camitz transfer:
Palmaris longus to the thumb proximal phalanx

Question 16

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

Answer 16

Huber:
Abductor digiti minimi to thumb proximal phalanx

Question 17

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

Answer 17

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

Question 18

Distally the ulnar artery creates the ____ palmar arch.

Answer 18

Superficial

Question 19

Distally the radial artery creates the ____ palmar arch.

Answer 19

Deep

Question 20

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

Answer 20

Hirudin
Aeromonas hydrophilia
Ceftriaxone or Ciprofloxacin

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

Question 21

Chronic mallet finger results in this deformity?

Answer 21

Swan neck

Question 22

Chronic central slip injury results in this deformity?

Answer 22

Boutonnière deformity

Question 23

Quadriga most commonly results after…

Answer 23

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

Question 24

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

Answer 24

1. FPL
2. FDP Indices

Question 25

Ligament that if injured can result in VISI deformity?

Answer 25

Volar lunotriquetral ligament

Question 26

This ligament must be preserved when doing PRC?

Answer 26

Radioscaphocspitate

Question 27

Primary stabilizer of the DRUJ?

Answer 27

Deep fibers of the foveal attachment of the radioulnar ligaments

Question 28

Main blood supply to the scaphoid?

Answer 28

Oblique dorsal ridge (retrograde flow)

Question 29

Operative indications for scaphoid fracture?

Answer 29

Question 30

Scaphoid screw placement location?

Answer 30

Centrally 3.5mm screw

Question 31

Wrist ligaments associated with dorsal chip triquetral fracture?

Answer 31

Dorsal radiocarpal ligament Dorsal intercarpal ligament

Question 32

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

Answer 32

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

Question 33

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

Answer 33

Scaphoid fracture

Question 34

The primary ligament maintaining lunate reduction?

Answer 34

Short radiolunate ligament

Question 35

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

Answer 35

AVN + humpback = free-vascularized medial femoral condyle graft (volar approach) AVN no humpback = 1,2 intercompartmental supraretinacular artery graft (ICSRA) (dorsal approach)

Question 36

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

Answer 36

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

Question 37

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

Answer 37

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

Question 38

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

Answer 38

1. Pronation 2. Supination

Question 39

Arthroscopic wrist portals that place subcutaneous nerves at most risk?

Answer 39

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

Question 40

Cell responsible for dupuytrens disease and it excretes what?

Answer 40

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

Question 41

How to assess intrinsic vs. extrinsic hand stiffness?

Answer 41

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

Question 42

What long term complication can result from distal scaphoid resection?

Answer 42

DISI

Question 43

Culture technique for mycobacterium marinum?

Answer 43

Lowstein-Jensen medium at 30 Celsius