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hand Flashcards

1
Q

what is the central slip

A

terminal EDC tendon, inserts on base of middle phalanx, PIP extension

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2
Q

what is the terminal extensor tendon

A

convergence of lateral bands (contributions from common extensor and intrinsics), inserts on base of distal phalanx

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3
Q

whats the most radial structure in the carpal tunnel

A

FPL tendon

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4
Q

action of intrinsics

A

flex MCP and extend PIP

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5
Q

where do lumbricals originate

A

radial aspect of FDP tendon

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6
Q

where do lumrbicals insert

A

radial lateral bands

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7
Q

lumbrical innervation

A

radial two innervated by median nerve, ulnar two by ulnar nerve

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8
Q

which muscles are innervated by the median nerve

A

pronator teres, FDS, FCR, PL, radial two lumbricals.

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9
Q

what does AIN innervate

A

FPL, index and long FDP (long 50% of the time), PQ

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10
Q

what does the recurrent motor branch of the median nerve innervate

A

APB, opponens pollicis, superficial head of FPB

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11
Q

what does the ulnar nerve innervate

A

FCU, ring/small/long (50% of the time) FDP, ulnar two lumbricals

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12
Q

what does the deep motor branch of the ulnar nerve innervate

A

interossei, ADM, flexor digiti minimi, palmaris brevis, deep head of FPB

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13
Q

what does the radial nerve innervate

A

lateral brachialis, triceps, anconeus, BR, ECRL, ECRB

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14
Q

what does the PIN innervate

A

APL, EPB, EPL, EIP, EDC, EDM, ECU, supinator

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15
Q

scaphoid view xray

A

30 degrees wrist extension, 20 degrees ulnar deviation

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16
Q

most common vascularized bone graft for proximal pole scaphoid AVN

A

1,2 ICSRA (dorsal distal radius) - but not if humpback deformity

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17
Q

what approach do you use for a scaphoid humpback deformity

A

volar

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18
Q

SNAC stage 1

A

radioscaphoid arthritis

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19
Q

SNAC stage 2

A

involvement of scaphocapitate joint

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20
Q

SNAC stage 3

A

involvement of lunocapitate joint

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21
Q

treatment for SNAC stage 1

A

distal pole excision or radial styloidectomy

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22
Q

treatment for SNAC stage 2 or 3

A

PRC (lose some motion and strength), 4 corner fusion, wrist fusion

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23
Q

ligament disrupted in DISI

A

scapholunate (dorsal fibers stronger)

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24
Q

ligament disrupted in VISI

A

lunotriquetral interosseous ligament (volar fibers stronger)

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25
Q

what ligament must be preserved in PRC and why

A

radioscaphocapitate ligament to prevent ulnar subuxation

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26
Q

acceptable angulation for metacarpal neck fractures

A

index and long fingers <15-20, ring <30-40, small <70

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27
Q

acceptable angulation for metacarpal shaft fracture

A

index and long <10, ring and small <30

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28
Q

deforming forces in bennett fracture

A

APL and thumb extensors displace shaft proximal, dorsal, radial. adductor pollicis supinates and adducts shaft

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29
Q

extensor tendon zones

A

1 - at/distal to DIP, 2 - middle phalanx, 3 - PIP, 4 - proximal phalanx, 5 - MCP, 6 - metacarpal, 7 -wrist, 8 - distal forearm

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30
Q

mallet finger

A

zone 1 extensor tendon injury

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31
Q

treatment for acute mallet finger

A

in first 12 weeks - full-time DIP joint extension splinting x 6 weeks, part time x 4-6 weeks. ORIF if large bony fragment (>50%)

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32
Q

what percentage of extensor tendon laceration requires operative repair

A

> 50%

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33
Q

boutonierre deformity

A

zone 3 extensor tendon injury (central slip at PIP). volar subluxation of lateral bands causes DIP hyperextension

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34
Q

what percentage of flexor tendon laceration requires operative fixation?

A

> 60%

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35
Q

when is the risk of flexor tendon rupture greatest after repair?

A

3 weeks, failure occurs at suture knots

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36
Q

flexor tendon zones

A

1 - distal to FDS insertion, 2 - FDS to A1, 3 - palm, 4 - carpal tunnel, 5 - forearm

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37
Q

what is the most likely block to reduction for galeazzi

A

ECU

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38
Q

what position do you splint in for galeazzi with reducible DRUJ

A

supination

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39
Q

what deformity can occur with a chronic mallet finger?

A

swan neck deformity

40
Q

what causes a boutonierre deformity?

A

central slip disruption/zone 3 extensor tendon injury

41
Q

what structure is most likely to be injured during a pediatric trigger thumb release?

A

radial digital nerve

42
Q

flap options for volar proximal finger

A

cross finger flap, axial flag flap

43
Q

flap options for dorsal proximal finger

A

reverse cross finger flap, axial flag flap

44
Q

flap options for volar thumb

A

Moberg (<2 cm), FDMA (>2 cm), neurovascular island flap (up to 4 cm)

45
Q

flap options for dorsal thumb

A

FDMA

46
Q

flap options for first web space

A

z-plasty with 60 degree flaps, posterior interosseous fasciocutaneous flap

47
Q

most frequent cause of early (within 12 hours) replantation failure

A

arterial thrombosis from persistent vasospasm

48
Q

most frequent cause of replantation failure after 12 hours

A

venous congestion or thrombosis

49
Q

treatment for a chemical burn with hydrofluoric acid

A

calcium gluconate

50
Q

most important predictor of digit survival after replantation

A

mechanism of injury

51
Q

blood supply for ALT flap

A

descending branch of lateral femoral circumflex

52
Q

blood supply for gracilis flap

A

medial femoral circumflex

53
Q

warm ischemia time for replant

A

<6 hours if proximal to carpus, <12 hours for digit

54
Q

cold ischemia time for replant

A

<12 hours proximal to carpus, <24 hours for digit

55
Q

infection common with leech treatment

A

aeromonas hydrophilia

56
Q

EMG changes seen with muscle denervation

A

fibrillations, positive sharp waves, fasiculations

57
Q

structure at risk with a carpal tunnel incision that’s too radial

A

recurrent motor branch of median nerve

58
Q

endoscopic vs open carpal tunnel release

A

better short term results with endo, same long term. most common complication = incomplete release

59
Q

when does strength return after open carpal tunnel?

A

pinch in 6 weeks, grip in 3 months

60
Q

what is pronator syndrome

A

median nerve compression in forearm

61
Q

sites of compression in pronator and AIN syndrome

A

supracondylar process, ligament of struthers (between supracondylar process and medial epicondyle), bicipital aponeurosis/lacertus fibrosis, 2 heads of pronator, FDS aponeurotic arch

62
Q

sensory symptoms that differentiate pronator syndrome from carpal tunnel

A

symptoms in palmar cutaneous branch distribution

63
Q

borders of cubital tunnel

A

floor - MCL and elbow capsule, walls - olecranon and medial epicondyle, roof - FCU fascia and arcuate ligament of Osborne

64
Q

sites of compression in cubital tunnel syndrome

A

acrade of struthers (fascial thickening at hiatus of medial IM septum 8cm prox to med epicondyle), medial head of triceps, medial IM septum, Osborne ligament, anconeus epitrochlearis, between 2 heads of FCU, aponeurosis at proximal edge of FDS

65
Q

most common cause of ulnar tunnel syndrome

A

ganglion cyst

66
Q

borders of Guyons canal

A

floor - transverse carpal ligament. roof - volar carpal ligament, radial - hook of hamate, ulnar - pisiform and abductor digiti minimi

67
Q

sites of compression in PIN syndrome

A

fascial bands at radial head, recurrent leash of Henry, edge of ECRB, Arcade of Frohse (most common, proximal supinator), distal supinator

68
Q

what is radial tunnel syndrome

A

lateral elbow/radial forearm pain with no motor or sensory symptoms

69
Q

where is the superficial sensory branch of radial nerve compressed in Wartenberg syndrome

A

between BR and ECRL with forearm pronation

70
Q

what is disrupted in neurapraxia

A

myelin sheath only

71
Q

early tendon transfer for wrist flexion contracture in CP

A

FCU to ECRL/ECRB

72
Q

what nerve is at risk with the approach to the cubital tunnel

A

medial antebrachial cutaneous

73
Q

vascularized bone graft for Stage i-IIIa keinbocks

A

4+5 ECA

74
Q

how does collagen change in dupuytrens

A

increase in ratio of type III to type I

75
Q

most common malignant soft tissue tumor in the hand

A

epithelioid or synovial sarcoma

76
Q

where does the princips pollicis artery originate?

A

radial artery or deep palmar arch

77
Q

most common malignancy of the hand

A

squamous cell carcinoma

78
Q

two structures not involved in dupuytrens

A

cleland ligaments, transverse palmar ligament

79
Q

empiric antibiotic treatment for dog and cat bites

A

ampicillin/sulbactam and amoxicillin/clavulanate

80
Q

signals that control proximal to distal limb development

A

AER, fibroblast growth factor

81
Q

signals that control radial to ulnar growth

A

ZPA, sonic hedgehog protein

82
Q

signals that control dorsal to volar growth

A

wingless type pathway (wnt), LMX-1 protein

83
Q

what structure is at risk in pediatric trigger thumb release

A

thumb radial digital nerve

84
Q

inheritance of syndactyly

A

autosomal dominant, reduced penetrance, variable expression

85
Q

inheritance of postaxial polydactyly (small finger duplication)

A

10x more common in blacks, autosomal dominant

86
Q

cause of madelung’s deformity

A

disruption of volar ulnar physis of distal radius, tethered by Vicker’s ligament

87
Q

genetics of madelung’s

A

x-linked dominant mutation in SHOX gene (Leri-Weill dyschondrosteosis)

88
Q

how much can a z-plasty lengthen at an angle of 30, 45, and 60 degrees

A

30 - 25%, 45 - 50%, 60 - 75%

89
Q

amount of extensor lag seen for each mm of phalangeal shortening

A

12 degrees

90
Q

are dorsal or volar intercarpal ligaments stronger?

A

dorsal

91
Q

order of tendons in first extensor compartment

A

EPB is ulnar to APL , APL frequently has multiple slips

92
Q

progression of arthritis in SLAC wrist

A

radial styloid, radioscaphoid, lunocapitate, radiolunate

93
Q

order of ligament failure in perilunate instability

A

scapholunate, capitolunate, lunotriquetral, dorsal radiocarpal

94
Q

what is vicker’s ligament and where does it run

A

causes madelung deformity, tethers volar ulnar corner of distal radius to lunate

95
Q

what position is the DRUJ most stable in

A

supination

Miller (12 decks)

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