Hand Flashcards
1
Q
What is the pathologic cell type in Dupuytren’s?
A
Myofibroblasts; abundance of type III collagen
2
Q
What collagen type is pathologic in Dupuytren’s?
A
Type III collagen
3
Q
[…] branch of ulnar nerve lies under the hook
A
deep motor
4
Q
[…] view is the best radiograph to see hook of hamate fracture
A
carpal tunnel view
5
Q
Hook of hamate excision leads to 5 mm of ulnar displacement of small finger […] tendon
A
FDP
6
Q
hook of hamate should be removed […] to avoid damage to motor branch of ulnar nerve
A
subperiosteally
7
Q
What is the insertion of ECRL?
A
base of 2nd metacarpal
8
Q
What is the insertion of ECRB?
A
base of 3rd metacarpal
9
Q
What is the insertion of ECU?
A
base of 5th metacarpal
10
Q
What is the insertion of abductor pollicis longus?
A
trapezium and base of 1st metacarpal
11
Q
What is the insertion of opponens pollicis
A
1st metacarpal
12
Q
What is the insertion of opponens digiti minimi?
A
medial surface of metacarpal V
13
Q
Shortening of metacarpals may be prevented by […] ligaments in isolated fracture of the 3rd or 4th metacarpal shafts
A
transverse intermetacarpal
14
Q
What is an acceptable shaft angulation for an index or long finger metacarpal fracture?
A
10-20 degrees
15
Q
What is an acceptable shaft angulation for a ring finger metacarpal fracture?
A
30 degrees
16
Q
What is an acceptable shaft angulation for a small finger metacarpal fracture?
A
40 degrees
17
Q
What is acceptable metacarpal shaft shortening for all metacarpal fractures?
A
2-5 mm
18
Q
What is an acceptable neck angulation in an index or long finger metacarpal neck fracture?
A
10-15 deg
19
Q
What is an acceptable neck angulation in an ring finger metacarpal neck fracture?
A
30-40 deg
20
Q
What is an acceptable neck angulation in an small finger metacarpal neck fracture?
A
50-70 deg
21
Q
In a middle phalanx fracture with apex dorsal, the fracture is […] to FDS insertion
A
proximal
22
Q
In a middle phalanx fracture with apex volar, the fracture […] to FDS insertion
A
distal
23
Q
In displacement of proximal phalanx fracture, proximal fragment flexed due to […], and the distal fragment extends due to […]
A
interossei; central slip
24
Q
In the blood supply to the fingers, the dominant artery found on […] side of phalanges
A
median (more midline)
25
The digital nerves are [...] to the digital arteries
volar
26
A volar middle phalanx base fracture is due to avulsion of [...]
volar plate
27
A dorsal middle phalanx base fracture is due to avulsion of [...]
central tendon
28
Volar middle phalanx fractures are unstable if greater than [...] percent articular surface involved
40
29
Proximal phalanx fractures can be treated with buddy taping if extraarticular fractures with less than [...] degrees angulation or less than [...] shortening and no rotational deformity
10; 2 mm
30
Middle phalanx fractures can be treated with buddy taping if extraarticular fractures with less than [...] degrees angulation or less than [...] shortening and no rotational deformity
10; 2 mm
31
In treatment of middle phalanx fractures, hemi-hamate arthroplasty has shown to be a successful treatment option in those with great than [...] percent articular involvement
50
32
What is the most common complication following hand phalanx fractures?
loss of motion
33
In hand phalanx fractures, apex volar angulation effectively shortens extensor tendon and limits extension of [...] joint
PIP
34
Flexor tendon healing occurs via an [...] and [...] pathway
intrinsic; extrinsic
35
In intrinsic flexor tendon healing, the healing is produced by [...] within the tendon
tenocytes
36
In extrinsic flexor tendon healing, the healing is stimulated by surrounding [...] and inflammatory cells
synovial fluid
37
Which flexor tendon healing pathway is implicated in scarring and adhesion formation?
Extrinsic
38
During which phase of tendon healing is linear collagen formation seen?
remodeling
39
During which phase of tendon healing does the tendon tolerate active range of motion?
remodeling
40
The remodeling phase of tendon healing occurs during which time frame?
> 28 days
41
During which phase of tendon healing is disorganized collagen seen on histology?
fibroblastic
42
What is the innervation of FDS?
Median nerve
43
What is the most radial structure in the carpal tunnel?
FPL
44
[...] closest flexor tendon to the median nerve
FCR
45
What is the insertion of FCR?
base of 2nd metacarpal
46
What is the insertion of FCU?
pisiform, hook of hamate, and the base of the 5th metacarpal
47
[...] located at the level of the proximal phalanx where FDP splits FDS
Camper's chiasm
48
Which annular pulleys arise from the periosteum?
A2 and A4
49
Which annular pulleys arise from the volar plate?
A1, A3, A5
50
The [...] pulley is the most important pulley to prevent flexor tendon bowstringing of the thumb
oblique
51
In Zone [...] FDP and FDS are in same tendon sheath
2
52
In a zone II flexor tendon injury, the tendons can retract if the [...] are disrupted
vincula
53
The carpal tunnel is in which flexor tendon zone?
4
54
In a zone 4 flexor tendon injury, the transverse carpal ligament should be repaired in a [...] fashion if tendon bowstringing is present.
lengthened
55
Flexor tendon repair and controlled mobilization is indicated in flexor tendon lacerations greater than [...] percent of tendon width
60
56
Flexor tendon laceration can be treated non operatively if the laceration is less than [...] percent of the tendon width
60
57
In flexor tendon repair, the [...] is more important than the number of grasping loops
number of core suture strands that cross the repair site
58
[...] core strands provide adequate strength for early active motion in repair of flexor tendon injuries
4-6
59
In flexor tendon repairs, circumferential epitendinous sutures improves strength of repair by add [...] percent to tensile strength
20
60
In flexor tendon repairs, the ideal core suture purchase is [...] mm from cut edge
10
61
Pulley management in flexor tendon repairs demonstrates [...] percent of A2 and [...] percent of A4 can be incised with little resulting functional deficit
25; 100
62
In zone 2 FDS injuries, repair of [...] improves gliding compared to repair of [...]
one slip; both slips
63
Flexor tendon repairs are weakest between postoperative days [...]
6-12
64
Flexor tendon repair site gaps greater than [...] mm are associated with an increased risk of repair failure
3
65
What is the safe dose of epinephrine injection in the fingers?
1:400,000 to 1:100,000 is safe; 1:100,000 is used
66
In timing for tenolysis following flexor tendon repair, wait for soft tissue stabilization (great than [...] months) and full passive motion of all joints
3
67
Tendon adhesions following flexor tendon repairs is highest in zone [...] injuries
II
68
In re-ruptures of flexor tendon repairs, if less than [...] of scar is present, resect the scar and perform primary repair
1 cm
69
What is the most common anatomic location for a scaphoid fracture?
Waist
70
What is the blood supply to the scaphoid?
dorsal carpal branch (branch of the radial artery)
71
The dorsal carpal branch enters scaphoid in a nonarticular ridge on the [...] surface and supplies proximal 80% of scaphoid via retrograde blood flow
dorsal
72
A minor blood supply to the scaphoid is the [...] (branch of volar radial artery)
superficial palmar arch
73
Scaphoid fractures managed with immobilization and have less than [...] mm displacement have union rate of 90%
1
74
Scaphoid fixation with percutaneous screw is indicated with displacement greater than [...] but without significant angulation or deformity
1 mm
75
Percutaneous screw fixation of a non displaced scaphoid waist fractures [...] time to union
decreases
76
Percutaneous screw fixation of a non-displaced scaphoid waist fracture [...] return to work/play
faster
77
Percutaneous screw fixation of a non-displaced scaphoid waist fracture has [...] cost to casting
equivalent
78
Open reduction of scaphoid fractures is indicated when there is a [...] degree scaphoid humpback deformity
15
79
A [...] approach is best for proximal pole scaphoid fractures
dorsal
80
A [...] approach is indicated in scaphoid waist and distal pole fractures
volar
81
A [...] approach is indicated in scaphoid fractures with humpback flexion deformities
volar
82
A volar approach to the scaphoid uses the interval between [...]
FCR and radial artery
83
Higher rates of scaphoid nonunion is seen in [...] pole fractures
proximal
84
Scaphoid fracture displacement greater than [...] is a risk factor for nonunion
1 mm
85
A scaphoid humpback malunion is caused by the [...] ligament
scapholunate interosseous
86
What is the innervation of ECU?
PIN
87
In a 5th carpometacarpal joint (CMCJ) dorsal fracture-dislocation, the 5th metacarpal is displaced dorsally and proximally by the pull of the [...] muscle
extensor carpi ulnaris (ECU)
88
At the DIP and PIP joints, accessory collateral ligament inserts onto the [...]
volar plate
89
At the [...], the volar plate forms two checkrein ligaments
PIP joint
90
At the PIP joint, the volar plate forms two [...] ligaments
checkrein
91
In the hand, the central slip inserts inserts on dorsal base of [...] phalanx
middle
92
The Elson test assess the integrity of the [...]
central slip
93
PIP dorsal dislocations can lead to a [...] deformity
swan neck
94
PIP volar dislocations can lead to a [...] deformity
boutonniere
95
Dorsal PIP dislocations result in shearing off the volar plate from the [...] phalanx
middle
96
In a rotational and volar PIP dislocation, one of proximal phalangeal condyles buttonholes between the [...] and [...]
central slip; lateral band
97
In a simple volar PIP dislocation, the [...] ruptures
central slip
98
If a PIP joint dorsal dislocation is unstable after reduction apply a [...] splint
extension blocking
99
For volar PIP dislocations, apply a [...] spilnt for 6-8 weeks
extension
100
In closed dorsal PIP dislocations, reduction is usually prevented by [...] interposition
volar plate
101
In open dorsal PIP dislocations, reduction is usually prevented by [...]
FDP tendon
102
In lateral PIP dislocations, reduction is usually prevented by [...] interposition
lateral band
103
In PIP dislocations, a swan neck deformity occurs secondary to a [...] injury
volar plate
104
In PIP fracture dislocations, if greater than [...] percent of of P2 articular surface is involved, the fracture is considered unstable
50
105
PIP fracture dislocations can be treated with closed reduction and splinting if less than [...] percent of the articular surface is involved
40
106
In closed dorsal DIPJ dislocation, [...] interposition is most common block to reduction
volar plate
107
The [...] demarcates the sterile from germinal matrix beneath the nail
lunula
108
A volar Moberg advancement flap can be used if a volar thumb defect is less than [...]
2 cm
109
A volar thumb soft tissue injury with less than a 2 cm defect can be treated with a [...] flap
volar Moberg advancement
110
Volar thumb injuries with greater than 2 cm defect are treated with a [...] flap
FDMA
111
A FDMA flap is used to treat volar thumb soft tissue defects measuring greater than [...]
2 cm
112
A dorsal thumb soft tissue defect requiring coverage is treated with a [...] flap
FDMA
113
Straight or dorsal oblique finger tip lacerations can be treated with a [...] flap
V-Y advancement
114
A reverse cross finger flap is indicated in adults with [...] lacerations
dorsal finger & MCP
115
Thenar flaps can be used in volar oblique finger tip lacerations to index or middle finger in patients less than [...] years
30
116
Ring finger injuires in zone II have better cosmesis and grip strength with what treatment?
4th ray resection and 5th ray transposition
117
Ring finger injuires in zone II have better [...] and [...] with 4th ray resection and 5th ray transposition
cosmesis; grip strength
118
What is the warm ischemia time distal to the carpus?
12 hours
119
What is the cold ischemia time distal to the carpus?
24 hours
120
In replantations, pulse oximetry less [...] percent indicates potential vascular compromise
94
121
In fingertip replantations, [...] secondary to vasospasm is most common cause of early replant failure
thrombosis
122
In leech therapy, what bacterial infection can occur
Aeromonos hydrophila
123
What prophylactic antibiotics are used in leech therapy?
Ciprofloxacin or Bactrim
124
What is the MOA of ciprofloxacin?
inhibits DNA gyrase (topoisomerase II and topoisomerase IV)
125
Replantation failure is most frequently caused within 12 hours by [...] from persistent vasospasm
arterial thrombosis
126
Replanted digits have [...] percent of total motion
50
127
Following finger replantation surgery, [...] is most common secondary surgery
tenolysis
128
In reperfusion injury, the mechanism thought to be related to ischemia-induced [...] conversion to [...]
hypoxanthine; xanthine
129
What is the best adjunctive therapy agent to treat reperfusion injury?
allopurinol
130
What is the antidote to epinephrine vasoconstriction in the digits?
Phentolamine
131
What approach is used in proximal pole scaphoid fracture ORIF?
dorsal approach
132
Displaced scaphoid distal pole and waist fractures are typically approached [...], especially if there is a humpback deformity;
volarly
133
A partial laceration (up to 75%) of a flexor tendon has been shown to effectively be repaired without gap formation with [...] repair.
an epitendinous only; (ie no core strands)
134
Volar thumb defect <2 cm can be best covered with a [...] flap.
Moberg advancement volar
135
Dorsal thumb laceration with exposed tendon would be most appropriately treated with a [...] flap
first dorsal metacarpal artery
136
Which gene is affected in radial clubhand?
Sonic hedgehog
137
How does thrombocytopenia absent radius (TAR) differ from radial club hand?
Thumb is usually present (thumb is usually not present in radial club hand)
138
What is the treatment for Fanconi anemia?
Bone marrow transplant
139
What additional tests should be performed in radial club hand to screen for associated conditions?
CBC, renal ultrasound, and echocardiogram
140
In radial club hand, hand centralization can be performed if good […] motion and […] function exist
Elbow; biceps
141
What is Wartenberg syndrome?
entrapment of the superficial sensory branch of the radial nerve.
142
On NCS, distal sensory latency of greater than [...] are abnormal for CTS
3.2 ms
143
On NCS, motor latencies [...] are abnormal for CTS
4.3 ms
144
Proximal injuries to the ulnar nerve may benefit from [...] transfer of the AIN to deep motor branch of ulnar nerve to improve early hand intrinsic function
end-to-side
145
Proximal injuries to the ulnar nerve may benefit from end-to-side transfer of the [...] to deep motor branch of ulnar nerve to improve early hand intrinsic function
AIN
146
Proximal injuries to the ulnar nerve may benefit from end-to-side transfer of the AIN to [...] branch of ulnar nerve to improve early hand intrinsic function
deep motor
147
In order to improve shoulder abduction and external rotation, a [...] nerve transfer to suprascapular nerve can be performed
spinal accessory nerve (CN XI)
148
A [...] branch of radial nerve to axillary nerve transfer can be performed to improve shoulder abduction and flexion.
medial triceps motor
149
To improve elbow flexion, an Oberlin transfer of [...] branch of ulnar nerve to biceps brachii branch of musculocutaneous nerve can be performed
FCU motor
150
To improve shoulder external rotation, the [...] can be transferred to infraspinatus
lower trapezius
151
To improve thumb opposition in median nerve neuropathy, an [...] to APB transfer can be performed
EIP
152
To improve thumb flexion in a median nerve neuropathy, a [...] to FPL transfer can be performed
Brachioradialis
153
In nerve grafting, create tension-free repair by using a graft that is at least [...] percent longer than gap
10
154
Autologous nerve graft is gold standard for defects greater than [...]
5 cm
155
In nerve grafting, conduits made up of type I collagen rely on [...] formation to serve as a scaffold for host cell Schwann cells to build upon
fibrin clot
156
Free tissue transfer within [...] days for severe trauma in the upper extremity has been shown to decrease complication rates
7
157
Complete disruption of arteriolar flow to the carpal tunnel occurrs at [...] mmHg
60-80
158
Most common cause of idiopathic CTS is [...]
inflamed synovium
159
Carpal tunnel borders include the [...] and [...] radially
scaphoid tubercle; trapezium
160
Carpal tunnel borders included the [...] and [...] ulnarly
hook of hamate; pisiform
161
What is the most radial structure in the carpal tunnel?
FPL
162
On US, increased cross-sectional area (CSA) of the median nerve greater than [...] at the level of the pisiform/proximal edge of transverse carpal ligament is associated with CTS
>10mm²
163
Long term results of endoscopic carpal tunnel release are [...] compared to open CTR
equivocal (the same)
164
In carpal tunnel release, grip strength is expected to return to 100% preoperative levels by [...] weeks postop
12
165
Are prophylactic antibiotics, systemic or local, indicated for patients undergoing a clean, elective carpal tunnel release?
No
166
Kaplan's cardinal line approximates the [...] arch
superficial palmar
167
What is the most common complication following carpal tunnel release?
Scar tenderness
168
Is injury to the recurrent motor branch of the median nerve high in open or endoscopic CTR?
open
169
What is the most common site of entrapment in cubital tunnel syndrome?
between FCU heads
170
EMG/NCS with conduction velocity less than [...] m/sec across elbow is diagnostic for cubital tunnel syndrome
50
171
Iatrogenic injury to a branch of the [...] nerve during cubital tunnel release may cause persistent posteromedial elbow pain
medial antebrachial cutaneous
172
The medial antebrachial cutaneous nerve crosses the field [...] cm distal to the medial epicondyle
3
173
What is the most common etiology of ulnar tunnel (Guyon's canal) syndrome?
ganglion cyst
174
What structure makes up the floor of Guyon's canal?
Transverse carpal ligament
175
What structure makes up the roof of Guyon's canal?
Volar carpal ligament
176
What structure makes up the radial border of Guyon's canal?
hook of hamate
177
What structures makes up the ulnar border of Guyon's canal?
pisiform, pisohamate ligament, abductor digiti minimi muscle
178
What is the inheritance pattern of Dupuytren's disease?
autosomal dominant with variable penetrance
179
What pathologic cells are seen in Dupuytren's?
myofibroblasts
180
In Dupuytren's myofibroblasts differ from fibroblast as the myofibroblast has intracellular [...] aligned along long axis of cell
actin filaments
181
In Dupuytren's, adjacent myofibroblasts connect via extracellular [...] to act together to create contracted tissue
fibronectin
182
In Dupuytren's there is an increase in ratio of type [...] to type [...] collagen
type 3 to type 1
183
Garrod disease is an ectopic presentation of what disease?
Dupuytren's
184
What are Garrod's nodes seen in Dupuytrens?
knuckle pad disease
185
A spiral cord in Dupuytren's typically inserts distally into the lateral digital sheet then into [...] ligament
Grayson's
186
A spiral cord in Dupuytren's travels [...] the neurovascular bundle displacing it central and superficial
under
187
A spiral cord in Dupuytren's displaces the neurovascular bundle [...] and [...]
central (midline); superficial
188
A central cord in Dupuytren's causes a [...] joint flexion contracture
MCP
189
Which two fancy hand ligaments in the digits are not involved in Dupuytren's disease?
Cleland's and transverse ligament
190
What injectable can be used in the treatment of Dupuytren's disease?
collagenase clostridium histolyticum (CCH) injections
191
Partial palmar fasciectomy for Dupuytren's is indicated in MCP flexion contracture greater than [...] degrees
30
192
Collagenase injections for Dupuytren's selectively target collagen types [...]
I and III
193
Collagenase for Dupuytren's has low activity against type [...] collagen (in basement membrane of blood vessels and nerves) explaining the low neurovascular complication rate
IV
194
Following partial fasciectomy for Dupuytren's, early active range of motion starting postoperative day [...] is commenced.
5-7
195
Basilar Thumb Arthritis is caused by attenuation of the [...] ligaments
volar beak (aka anterior oblique) and dorsoradial
196
Concomitant MCP [...] deformity can be seen in basilar thumb arthritis
hyperextension
197
Concomitant carpal tunnel syndrome can be seen in up to [...] percent of basilar thumb arthritis
50
198
What tendon runs through the palmar groove seen on the trapezium?
FCR
199
The [...] ligament is the primary stabilizing static restraint to subluxation of CMC joint
anterior oblique volar beak
200
Stage I of first CMC arthritis is defined as joint space [...]
widening
201
CMC thumb arthrodesis for CMC arthritis in which patient population?
Stage II-III in young male laborers
202
[...] tendon most commonly used in LRTI to suspend 1st metacarpal, can also use [...] or [...] for suspension
FCR; ECRL; APL
203
In treatment of MCP hyperextension seen in basilar thumb arthritis, fusion is indicated for MCP hyperextension greater than [...] degrees
40
204
Biomechanical factors thought to be associated with Kienbock's disease include [...] ulnar variance and [...] radial inclination
negative; decreased
205
Which imaging modality is most useful once lunate collapse has already occurred?
CT
206
An adolescent with radiographic evidence of Kienbock's and progressive wrist pain can undergo temporary [...] pinning
scaphotrapeziotrapezoidal
207
Which vascularized graft provides the greatest arc of motion of the most commonly used arterial pedicles for Kienbock's disease?
4th + 5th extensor compartmental artery
208
Chronic SL ligament injury creates a [...] deformity
DISI
209
In a DISI deformity, the scapholunate angle is greater than [...] degrees
70
210
In a SLAC wrist, the first joint affected is the [...] joint
radioscaphoid
211
Which joint is spared in a SLAC wrist?
radiolunate
212
In a SLAC wrist, initially the radioscaphoid joint is affected and progresses to [...] joint
capitolunate
213
In a SLAC wrist, the capitate subluxates [...] on the lunate
dorsally
214
In a SLAC wrist, PA radiograph will reveal greater than [...] diastasis between the scaphoid and lunate
3mm
215
The [...] ligament should be preserved to prevent ulnar subluxation after proximal row carpectomy
radioscaphocapitate
216
PRC is excision of which bones?
scaphoid, lunate, triquetrum
217
A PRC is contraindicated with [...] arthritis
caputolunate
218
A scaphoid excision and 4 corner fusion is contraindicated with [...] arthritis
radiolunate facet
219
[...] gives best pain relief and good grip strength at the cost of wrist motion
Wrist fusion
220
A free antegrade lateral arm flap (LAF) is supplied by [...] artery
posterior radial collateral
221
What is the innervation of adductor pollicis?
deep branch of the ulnar nerve
222
What is the innervation of opponens pollicis?
recurrent motor branch of the median nerve
223
Carpal tunnel release (CTR) has shown increased patient-reported outcomes compared to conservative management at [...] and [...] months.
6; 12
224
A motor conduction velocity of less than [...] m/s is considered abnormal for carpal tunnel
52
225
Injury to the [...] nerve in CTR leads to a lumbrical minus deformity of the index finger due to lumbrical weakness.
proper digital nerve of the index finger
226
What clinical finding is characteristic of involvement of the natatory ligament in Dupuytren's disease?
Web space contracture
227
Maintaining volar translation of the lunate after reduction of a comminuted distal radius fracture is recommended to help restore [...]
volar tilt
