Hand

Question 1

In which conditions is pollicization indicated?

Answer 1

Blauth 3b and above or traumatic injuries with unstable CMC.

Question 2

What does the index MP become after pollicization?

Answer 2

Thumb CMC.

Question 3

What does the index PIP become after pollicization?

Answer 3

Thumb MCP.

Question 4

What does the index DIP become after pollicization?

Answer 4

Thumb IP.

Question 5

What function does the extensor digitorum communis serve after pollicization?

Answer 5

Function of the abductor pollicis longus.

Question 6

What structure attaches to the radial lateral band to perform the function of the abductor pollicis brevis?

Answer 6

Dorsal interosseous.

Question 7

Fill in the blank: Pollicization is indicated in traumatic injuries where the CMC is not _______.

Answer 7

[stable].

Question 8

True or False: The flexor digitorum profundus serves the function of the flexor pollicis longus after pollicization.

Answer 8

True.

Question 9

What are the three joints that need to be replaced during pollicization?

Answer 9

• CMC
• MCP
• IP

Question 10

What is the acronym LOAF used to describe?

Answer 10

Intrinsic muscles innervated by the median nerve

LOAF stands for: Lumbricals to index and long, Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis (superficial head).

Question 11

List the sites of compression for the ulnar nerve.

Answer 11

• Between the heads of the flexor carpi ulnaris
• Arcade of Struthers
• Osborne’s ligament
• Anconeus epitrochlearis
• Guyon’s canal

These sites are common areas where the ulnar nerve can become compressed and lead to symptoms.

Question 12

What are the common sites of compression for the median nerve?

Answer 12

• Supracondylar process
• Ligament of Struthers
• Lacertus fibrosis
• Between the heads of the pronator teres
• Leading edge of the FDS aponeurosis
• Carpal tunnel

These are common anatomical locations where median nerve compression occurs.

Question 13

True or False: The ligament of Struthers is a canal from the medial triceps to the intermuscular septum.

Answer 13

False

The ligament of Struthers is a fibrous band, not a canal, and it connects the supracondylar process to the medial epicondyle.

Question 14

What is best treatment for a patient with fibrillations and no MUPs on EMG?

Answer 14

Open carpal tunnel release with campus transfer- transferring palmaris longis tendon with strip of palmaris aponeurosis to insertion of abductor pollicis breves to improve thumb opposition
Surgical release alone would not improve opposition when MUPs absent

Question 15

What is the space of parona

Answer 15

Located in distal forearm, deep to FDP tendons and superficial to pronator quadratus- how infection can spread between thenar and hypothenar spaces

Question 16

Vaughn Jackson syndrome

Answer 16

In untreated rheumatoid arthritis, attritional rupture of extensor tendons over ulnar head

Question 17

Wartenberg syndrome

Answer 17

Cheiralgia paresthetica, compressive neuropathy of superficial radial sensory nerve at the wrist, typically 9cm proximal to radial styloid

Question 18

Madelungs deformity

Answer 18

Congenital deformity, due to deficiency of ulnar volar distal radial physis
Can present with symptoms of ulnar impaction syndrome and ulnar/volar displacement of carpus

Question 19

Kienbock’s disease

Answer 19

Vascular necrosis of the lunate

Question 20

Preiser disease

Answer 20

Vascular necrosis of the scaphoid

Question 21

What points of compression for radial tunnel syndrome?

Answer 21

Arcade of froshe(proximal aponeurotic edge of superficial head of supinator), ECRB, leash of henry(radial recurrent vessels), fibrous bands anterior to radiocapitellar joint, between two heads of supinator muscle

Question 22

What is the most common malignant bony tumor of the hand

Answer 22

Chondrosarcoma

Question 23

Ulnar forearm flap is innervated by what?

Answer 23

Medial antebrachial cutaneous nerve

Question 24

Radial forearm flap is innervated by what?

Answer 24

Lateral antebrachial cutaneous nerve

Question 25

Primary mechanism by which vascularized bone graft aids in healing?

Answer 25

Osteogenesis

Question 26

When do you see osteoconduction

Answer 26

Calcium hydroxyapatite and cortical bone grafts Creeping substitution

Question 27

What type of products cause osteoinduction

Answer 27

Cancellous bone grafts and BMP Growth factors stimulate stem cells to become osteoblasts and form bone

Question 28

What does negative Allen’s test mean?

Answer 28

Patient does not have dual blood flow to the hand

Question 29

What is parsonage turner syndrome

Answer 29

Brachial neuritis, can be preceded by viral illness Two phases: first- shoulder pain as presenting symptom, second- flaccid paralysis Any nerve within brachial plexus can be affected

Question 30

What is camptodactyly

Answer 30

Flexion contracture at PIP joint MC small and ring fingers MC in infancy or adolescence Can be treated with passive stretching and splinting but may require FDS tenotomy or FDS transfer to radial lateral band if full active PIP extension can be achieved with MCP flexion

Question 31

How do you test the proper and accessory portions of the ulnar collateral ligament of the thumb

Answer 31

Thumb in 30 deg flexion for proper ligament and full extension for the accessory ligament

Question 32

Where do dorsal ganglions most commonly come from?

Answer 32

Scapholunate joint

Question 33

Where do volar ganglion cysts most commonly originate?

Answer 33

Radioscaphoid or STT joints

Question 34

What muscles are most affected in forearm compartment syndrome?

Answer 34

FDP, FPL are in deep volar compartment

Question 35

How to remember wassel classification of thumb duplication?

Answer 35

For types 1-6, count the number of abnormal or duplicated bones

Question 36

What structures are involved in spiral cords of PIP joint

Answer 36

“Plastic Surgeons Look Good” Pretendinous band, spiral band, lateral digital sheath, Grayson ligament