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Ortho > Hand > Flashcards

Hand Flashcards

1
Q

Immediate treatment in AnE for perilunate dislocation

A

MAnipulation and reduction
Carpal tunnel release if median nerve compression
Needs definitive fixation

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2
Q

Origin of ulnar nerve?

A

Medial cords C8 - T1

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3
Q

Types of ulnar nerve palsy?

A

Wrist - Guyon Canal syndrome
Above wrist - Cubital tunnel syndrome, Tardy ulnar nerve palsy

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4
Q

Borders of Guyon’s Canal?

A

Medial = Pisiform
Lateral = Hook of hamate
Roof = Palmar carpal lig
Floor = Flexor retinaculum

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5
Q

Causes of Guyon’s canal syndrome?

Only the more common ones

A

Ganglion cyst compression [80% of nontraumatic causes]
Hypothenar hammer syndrome
Hook of hamate fracture

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6
Q

Symptoms of Guyon Canal syndrome?

A

Motor = Opponens Digiti Minimi
Dorsal Interosseous, Palmar interosseoust
Sensory = Palmar 1.5 medial digits

Froment sign, Wartenberg sign, ulnar claw

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7
Q

Borders of cubital tunnel?

A

Medial = olecranon
Lateral = Medial epicondyle
Roof = FCU
Floor = MCL

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8
Q

Location of cubital tunnel syndrome lesion?

A

Lesion at medial epicondyle of humerus

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9
Q

Symptoms of cubital tunnel syndrome?

A

Referred pain in forearm
Sensory loss in hand [UN dermatomes]
Muscle atrophy and weakness [UN myotomes]
Intrinsic muscle wasting - guttering
Slight clawing

Wartenberg’s sign

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10
Q

Etiology of Saturday night palsy?

A

Humeral shaft fracture
Prolonged RN compression along humerus

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11
Q

Symptoms of saturday night palsy?

A

Sensory: 1sst dorsal webspace
Motor:
Low - IPJ extension of thumb + MCPJ 2-5 extension
High - Wrist extension drop+ elbow drop

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12
Q

Source of Median Nerve?

A

Medial and lateral cords.
C5-T1

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13
Q

Tests in Median nerve lesion?

A

Clench fist & test power - Benedict hand
Ant Intero Nerve
Test FDS
Test FPL
Test FDP
Test APB (Carpal tunnel syndrome)

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14
Q

Special tests in Median Nerve lesion?

A

Tinel’s sign
Phalen’s sign
Durkan’s compression test

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15
Q

What relieves pain in carpal tunnel syndrome?

A

Shaking hand of hanging arm over side of the bed

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16
Q

What to take note of for diabetics in nerve injuries?

A

DM can cause peripheral nerves to be more sensitive to compression. Not all numbness in diabetics are peripheral neuropathy

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17
Q

Does Carpal tunnel syndrome have Benediction sign?

A

No. Only higher lesions like AIN

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18
Q

Common site of AIN entrapment?

Median nerve

A

Deep head of pronator teres

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19
Q

Conservative Mx of ganglion cysts?

A

Leave alone - favoured, resolve after months
Aspiration (50% recurs)
Rupture
OR CONSERVATIVE EXCISION

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20
Q

What are the hand tendinopathies?

A

Stenosing Tenosynovitis
De Quervain’s Tenosynovitis
Suppurative Tenosynovitis

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21
Q

What is Stenosing Tenosynovitis?

A

Tenosynovitis of flexor tendons at level of A1 pulley.
Diagnosed clinically

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22
Q

RF for Stenosing Tenosynovitis?

A

Women >50
Tendon overuse
PMH = DM, HypoT, Gout, RA, pregnancy, Acromegaly

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23
Q

Green classification for Trigger finger?

A

Grade 1 = Palm pain + tenderness at A1 pulley
2 = Catching of digit
3 = Locking of digit, passively correctable
4 = Fixed, locked digit

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24
Q

Presentation of Stenosing Tenosynovitis?

A

Clicking, catching and locking of digit - 엄지, 중지, 약지
Progressive pain over distal palm
FFD

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25
Q

What happens in Stenosing Tenosynovitis if A2, A4 pulley is involved instead of A1?

A

Bowstringing of the finger

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26
Q

What is DeQuervain’s Tenosynovitis?

A

Entrapment tendinitis of dorsal first extensor compartment affecting EPB & APL

The tendons run along the thumb side of the wrist and attach to the base of the thumb

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27
Q

Signs of DeQuervain’s Tenosynovitis in PE?

A

Swelling and palpable sheath thickening over course of tendons
Radial sided wrist pain, worse with Finkelstein maneuver (thumb extension)

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28
Q

What are Kanavel’s signs in suppurative tenosynovitis?

A

Pain on passive extension (earliest)
Fusiform swelling of finger
Digit held in flexion
Pain along distribution of flexor sheath

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29
Q

Signs of paronychia?

A

Nail fold tenderness
Fluctuance -> abscess
Nail bed motility -> tracking under nail
Chronic paronychia - nail plate hypertrophy, nail fold blunting/retraction, prominent transverse ridges

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30
Q

Conditions a/w Dupuytren’s contracture? DEAFEST PAIL

A

DM
Epilepsy
Age
Family Hx/fibromatoses
Epileptic meds
Smoking
Trauma/Manual labour

Peyronie’s disease
AIDS
Idiopathic
Liver disease

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31
Q

What is Dupuytren’s Contracture?

A

Nodular hypertrophy and contracture of palmar aponeurosis, causing tendons attached to finger to be unable to move properly

32
Q

Hand manifestations of RA?

A

Bilaterally deforming arthropathy with MCPJ, PIPJ and DIPJ or all fingers
Swan neck - flexion of DIPJ, hyperextension of PIPJ
Boutonniere’s - Hyperextension of DIPJ, flexion of PIPJ

33
Q

Mallet finger which tendon/muscle affected?

A

Disruption of terminal extensor tendon distal to DIP joint.
Diagnosed with distal phalanx about 45° of flexion with lack of active DIP extension

34
Q

Median nerve supplies more in ____, almost all ____ except the medial few ones

A

Median nerve supplies more in arm, almost all flexors except medial few ones.
Ulnar nerve supplies more hands

35
Q

Median nerve supplies the more ____ muscles in forearm

A

More superficial ones

36
Q

Why is Extensor Carpi Radialis spared in finger drop of PIN palsy?

A

Cuz ECR supplied by more proximal part of radial nerve

37
Q

What effect can RA have on extensor tendon in finger?

A

Tendon subluxation!!! RA pushes extensor tendon to the side = cant extend finger

38
Q

McGowan’s classification of Cubital tunnel syndrome?

A

1 = sensory symptoms wo loss of two-point sensibility or muscular atrophy
2 = Sensory symptoms + weakness on pinch and grip without atrophy
3 = Sensory symptoms + atrophy and low intrinsic muscle strength
4 = profound muscle atrophy and sensory disturbance

39
Q

Colles’ frac vs Smith’s frac?

A

Colles’ = Low-energy FOOSH in wrist extension
Smith’s = FOOSH in wrist flexion

40
Q

Early complications of Colles and Smiths?

A

TFCC injury from RUJ subluxation
Associated scaphoid/ulnar head/ulnar styloid #
Carpal tunnel syndrome

41
Q

Late complications of Colles and Smiths?

A

EPL tendon rupture
Malunion
Secondary OA
Stiffness
Complex regional pain syndrome

42
Q

What is Barton’s #?

A

Smith’s # that enters radiocarpal joint resulting in ant subluxation of distal fragment carrying carpus with it.

43
Q

What is Bennett’s #?

A

Partial intra-articular 1st MCP base #
w/wo proximal, dorsal, radial displacement

Mx - closed reduction and fixation/ORIF

44
Q

What is Rolando’s fracture?

A

Intra-articular, comminuted 1st MCP base #

NO subluxation or dislocation

45
Q

What is Gamekeeper’s thumb?

A

Avulsion # of attachment of ulnar collateral lig at MCP joint or thumb
Usually due to instability of ulnar collateral lig

Can cause valgus instability

46
Q
A
47
Q
A
48
Q

What is PIN compression syndrome?

A

PIN from Radial nerve affects nerve supply of forearm extensor compt

49
Q

Classify radial nerve palsy?

A

Elbow and below: PIN syndrome [only motor]
Wartenberg syndrome [only sensory]

Above elbow: Humeral shaft frac
Sat Night Palsy

50
Q

Cause of PIN syndrome?

A

Trauma, space filling lesions, inflammation, iatrogenic

Basically just compression

Space filling lesions e.g. ganglion, lipoma etc

51
Q

Common site of PIN entrapment in PIN syndrome?

A

Arcade of Frohse, where PIN pierces supinator nerve

most superior part of the superficial layer of supinator muscle

Tennis elbow a/w PIN syndrome

52
Q

Motor presentation of PIN syndrome?

A

IPJ extension of thumb [EPL]
MCPJ 2-5 extension [ED]
Wrist extension preserved but radially deviated

Resisted supination will cause pain

53
Q

Common site of nerve entrapment in Wartenberg syndrome?

A

Superficial Radial Nerve compressed by scissoring action of brachioradialis and ECRL tendons during forearm pronation

54
Q

What condition is Wartenberg syndrome a/w?

A

DeQuervain’s disease in 20% - 50%

55
Q

Boundaries of carpal tunnel?

A

Lat = Scaphoid + Trapezium
Medial = Pisiform + hook of Hamate
Roof = transverse

56
Q

Contents of carpal tunnel?

A

FDP tendon
FDS tendon
FPL
Median nerve

57
Q

Causes of Carpal Tunnel syndrome?

Some associated conditions?

A

Inflamed synovium
Space occupying lesions e.g. gout
A/w: DM, obesity, RA, HypoT, Pregnancy

Inflamed synovium is commonest idiopathic cause

58
Q

Branches of Median Nerve after Carpal Tunnel?

Where do they lie?

A

Palmar digital branch
Recurrent motor branch

Palmar for palmar surface and fingertips

Recurrent for thenar muscles

PC branch lies at level of wrist flexion crease

59
Q

What wasting seen on PE of Carpal tunnel syndrome?

A

Thenar eminence wasting

60
Q

Branches of Median Nerve in forearm?

A

AIN
Palmar cutaneous nerve

AIN supplies deep muscles in anterior forearm

61
Q

Presentation for AIN syndrome

Only motor!! No sensory

A

Thumb adducted [Ape hand]
Benediction sign

62
Q

Brief description of Ganglion cyst?

A

Content: Glairy fluid (uncooked egg white colour and consistency)
2 types: simple and Compound

63
Q

Common site of ganglion cysts?

A

Grow out of tissues surrounding synovial joints and tendon sheaths

64
Q

What is Rolando fracture?

A

Completely intra-articular fracture of base of thumb

65
Q
A
66
Q

When do Dupuytren’s contractures commonly occur?

what age

A

50s-70s.
Males 2x more common.
AD inheritance

67
Q
A
68
Q

Compare muscular loss in CTS and High median nerve lesion?

A

High MN lesion = All flexors of 3.5 digits + OAF lost
CTS = Only Opponens Pollicis and APB gone

‘O’ = opponens, ‘A’ = abductor, ‘F’ = flexor

69
Q

Thenar eminence lost in what lesion? Why?

A

Opponens, Abductor, Flexor muscle lesions.
They have big thenar eminence.

70
Q

What is trigger finger?

Commonly presents with nodule at where?

A

Inhibition of smooth tendon gliding due to mechanical impingement at level of A1 pulley.
Nodule on palm in line with finger [at flexor tendon]

71
Q

Mx of trigger finger?

A

Splinting
NSAIDs
Steroids injections
Surgical release

72
Q

Mx of DeQuervain’s Tenosynovitis?

A

Conservative = thumb spica braces, injections
In Refractory cases = 1st dorsal compartment surgical release

73
Q

What conditions predispose to DeQuervain’s Tenosynovitis?

A

RA
HyperT
Pregnancy etc etc

74
Q

When to take XR post-fracture in Smith’s or Colle’s?

A

7-10 days. Ensure frac is not slipped, even when plate is used.

75
Q
A

Ortho (11 decks)

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