Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Millers > Hand 2 > Flashcards

Hand 2 Flashcards

1
Q

What is the dominant feeder for the
Superficial palmar arch
Deep palmar arch / princeps pollicis

A

Ulnar art -> SPA

Radial art -> DPA, princeps pollicis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is hypothenar hammer syndrome
Sx
Dx
Treat

Vs ulnar tunnel syndrome (dx)

A

Prev traumatic event causes occlusion of the ulnar art at prox palm
Think: catchers, carpenters with hammers

Sx: ischemic pain, +/- Guyon compression

Dx: a-gram

Trt
- If complete arch, can ligate
- If not, reconstruct with reversed vein graft (so valves work for you not against)

vs handlebar palsy aka ulnar tunnel synd - get EMG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Treat small vessel vaso occlusive disease, examples:
Scleroderma/CREST
Thromboangiitis obliterans (Buerger)

A

Ca channel blockers
Sympathectomy

Often still progressive = digit ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which finger is most likely to affected by embolic disease? Possible sources

A

Ring finger, PIP
- PIP where vessels narrow
- Ring finger is ulnar dominant so straight shot through Guyon

Causes:
- Embolic - listen for murmur
- Vascular thoracic outlet - get bilateral BPs
- IVDU
- Ulnar art aneurysm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe the 3 stage progression of a claudication even for Raynauds

A

White digit = spastic cessation flow
Blue = cyanosis 2/2 venous stasis
Red = rebound hyperemia w/ pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the difference between Raynaud disease vs phenomenon

A

Disease: w/o underlying cause
- Symmetric

Phenomenon: underlying vaso-occlusive disease
- Asymmetric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

4 absolute indications for replant

A

1 Thumb
2 Multiple digits
3 Wrist or proximal
4 Child

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

CI for replant

A

Single digit, esp zone 2
Prolonged ischemia
Crush / avulsion
Advanced age / multiple co-morbidities
Polytrauma (aka bigger problems)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the appropriate warm/cold ischemia times for replant:
Prox to wrist
Warm:
Cold:

Digits
Warm:
Cold:

A

Ischemia time starts at injury

Prox to wrist
Warm: <6hrs
Cold: <12hrs

Digits
Warm: <12hrs
Cold: <24hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Order of replant

A

BEFANV
Bone
Extensors
Flexors
Art
Nerve (volar to art)
Vein
+/- fasciotomies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why do replants fail
<12hrs
>12hrs
>1wk
What is the most common 2ary procedure after successful replant

A

<12hrs - arterial thrombus
>12hrs - venous congestion
>1wk - infection

2ary procedure = tenolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do leeches work? What abx do you need for patients with leeches?

A

Excrete hirudin = anticoag
Cover aeromonas hydrophila - CTX or cipro

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the 8 extensor injury zones

A

ODD = joint / EVEN = bone
1 = DIP
2 = middle phal
3 = PIP
4 = prox phal
5 = MCP jt
6 = MC
7 = wrist joint / carpus
8 = forearm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Trt extensor tendon lacs

A

<50% = partial + can extend against resistance
- Early protected ROM

> 50% = suture repair, protected ROM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Explain difference in treating ST vs bony mallet

A

Zone 1 extensor injury (DIP)

ST: 6-8wks ext splinting, PIP free

Bony:
- No DIP subluxation = ext splinting
- Frag >50% ORIF
- DIP subluxation = pinning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Sequelae of missed Mallet
Trt

A

Swan neck
Central slip doubles force at PIP to hyper extend PIP
Get unopposed flexion at the DIP

Trt: central slip tenotomy
Active DIP ext still possible through oblique retinacular lig

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Zone 3 (PIP)
- Mechanism
- PE test
- Deformity if missed

A

Zone 3 (PIP) = central slip rupture
Mechanism PIP hyperflex or PIP volar dislocation

Elson test - DIP joint stays flaccid when ask to extend

Missed = boutonniere
- Triangular ligament scars short
- Lateral bands migrate volar
- PIP flexion, DIP hyperext

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Trt Boutonniere closed vs open

A

Closed - PIP ext splint 6wks, DIP free

Open: central slip repair, same splinting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the most common type of zone 5 (MCP jt) injury? Trt

A

Sagittal band rupture
Extensor tendon subluxes
Can hold up extension if passively placed there
Cannot actively extend

Trt
- Acute: 4-6wks ext splint
- Chronic: sag band repair/reconstruct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is an intrinsic minus hand

A

MCP hyperext
PIP/DIP flex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How do you test intrinsic tightness? If the test results are reversed, what is wrong?

A

Hyperext MCPs - put tension on the intrinsics
- IP little ROM

Flex MCPs - intrinsics relax
- IPs become supple

Extrinsic tightness = opposite
- PIP flexion improves with MP hyperext

22
Q

Treat intrinsic vs extrinsic tightness

A

Intrinsic: stretching -> surg release lat bands

Extrinsic: tenolysis

23
Q

What are the flexor tendon injury zones

A

1: distal FDS
2: pulleys through the fingers
- No mans land bc tendons are in a sheath - your repair is adding bulk and higher risk scarring
3: palm aka TCL to pulleys
4: carpal tunnel
5: forearm

24
Q

What flexor tendon gap increases risk for repair re-rupture

A

> 3mm

25
Q

Describe ideal suture configuration for flexor tendon repair? Where do repairs usually fail?

A

core strands = strength

  • Min 4

Dorsal sutures = stronger

Locking loop config decreases gap

+epitendinous suture = increase strength, decrease gap formation
- Running locking > simple running

Fail @ suture knots!!!

26
Q

Why do you do early motion for flexor tendon injuries (3 reasons)? What is the rehab guideline? Who does this not apply to

A

Positive feedback loop = faster strength at repair site
Decrease adhesions
Better excursion

Rehab:
- Dorsal block 6wks
- Then 30deg wrist flex
- Then 70deg MCP flex
- Active motion 4-6wks

Doesnt apply KIDS!! Cast 4wks - they’ll get it back

27
Q

What pulleys must stay intact during flexor tendon repair

A

A2 + 4

Other windows you make through pulleys - dont repair bc sutures will narrow the tunnel / scar

28
Q

What is a jersey finger? Complication of repair? Trt chronic injury?

A

Jersey finger = FDP avulsion (zone 1)
- Classification based on amt of retraction

Complication = overtighten (bc maybe delayed or super retracted) = quadrigia
- 1 finger too tight, so the others cant completely flex into the fist

Chronic: do not address if FDS is intact

29
Q

Treatment algorithm for partial flexor tendon lacs
<25%
25-50%
>50%

A

<25% - trim
25-50% - epitenon repair
>50% - core and epitenon repair

Protected mobilization for all

Res study Q: <60% debride, >60% epitend only (no benefit to core suture)

30
Q

What is lumbrical plus finger
- Causes
- Treat

A

Flex finger - IP extends
- FDP retracted -> tensions the extensor mechanism

Causes: loss of FDP insertion
- Distal finger amp
- Missed lac

Trt = lumbrical release

31
Q

What is quadrigia

A

FDP has a common muscle belly
Because 1 is overtensioned, that sets max tension for all, so the others can’t get full flexion
Weak grasp - can’t make a fist because only 1 finger hits max flexion
Forearm pain (common muscle belly)
Dont advanced FDP >1cm w/ repair

32
Q

Hand infections
Most common bug:
Cat bites + drug
Human bites + empiric coverage

A

Most common bug: S.aureus
Cat bites + drug: pasteurella -> augmentin
- Cat teeth puncture = worse
- Dog bites tear
Human bites: eikenella -> IV amp/sulbac or PO augmentin

33
Q

What are the lab stains for atypical microbacterium? What are the bugs?
What do you see on the stains?
Trt

A

Mycobacterium marinum

Ziehl Neelsen staining
Lowenstein Jensen 28-32deg

See NON-case granulomas on biopsy (if TB they are caseating)

Trt: clarithromycin, sulfonamides, rifampin, ethambutol, and trimethopriam sulfamethoxazole

34
Q

What is the lab prep for fungus

A

KOH prep

35
Q

What is the lab test for herpes

A

Tzank smear

36
Q

How do hand infections move into the forearm/become horseshoe? How might an infection here present?

A

Parona’s space
Floor = PG
Roof = flexor tendons

Infx here can present as acute CTS

Forearm: radial or ulnar bursa
Wrist: Parona -> carpal tunnel
Hand -> digits:
Thenar = thumb, index
Mid palmar = long, ring
Hypothenar spaces = small

37
Q

Most common bug for cellulitis

A

Group A beta hemolytic strep

Think nec fasc if not improving since same bug!

38
Q

Herpetic whitlow:
Which bug
At risk population
Test
Trt

A

Which bug - HSV 1
At risk population - kids, dental workers, resp therapists
Test - Tzanck prep
Trt - acyclovir, don’t I&D!

39
Q

Paronychia:
Location of infection
Bug

A

Eponychial fold - extends above/below plate
S.aureus (+/- mouth flora)

40
Q

Felon:
Location of infection
Bug
Trt

A

Closed space infx = septated digital pulp

S.aureus

I&D + abx

41
Q

FTS:
Bug

A

S.aureus

42
Q

Collar button abscess:
Where
Trt

A

Subfascial webspace
Presents as dorsal web swelling that spreads the fingers apart
I&D w/ dorsal and volar incisions

43
Q

Treat high pressure injection injuries
Name 3 negative prognostic factors

A

Immediate I&D - often repeat
Broad IV abx
Amp common

Negative prog factors:
1. Late presentation (>10hrs)
2. Higher pressure
3. Oil based paints

44
Q

What is intersection syndrome
Trt

A

Pain bet 1st/2nd extensor compartments
Cause = 2nd compartment stenosis (ECRb/l)
Crepitance
Inject&raquo_space;> OR

45
Q

Keys for adequate DeQuervains decompression

A

Anatomic variants:
Multiple APL slips
Separate EPB compartments

46
Q

What is lateral epicondylitis
Trt

A

ECRB tendinosis (not tendonitis)
- No inflam cell infiltrate
- Angiofibroblastic hyperplasia - failed attempts at healing microtears
Trt: nonop > debridement repair vs aconeus flap

47
Q

What is medial epicondylitis
Trt

A

Same as lateral but at FCR/PT junction
R/o associated cubital tunnel syndrome

48
Q

Distal biceps
- Where does it attach on the bicipital tuberosity
- Where does long head vs short head insert vs function
- What is the origin and insertion of lacertus

A

Where does it attach on the bicipital tuberosity : ULNAR

Where does long head vs short head insert vs function
- Long head PROX - supinates
- Short head DISTAL - elbow flexor

What is the origin and insertion of lacertus
O: short head
I: forearm fascia

49
Q

Pros/cons distal biceps repair 1 vs 2 incision

A

1 incision
- More LABC sx from retractor traction

2 incision
- Higher HO
- In theory more anatomic repair gets you more supination (debatable)

50
Q

What is the anatomic site and nerve compressed at each of the following:
1. Lacertus fibrosus
2. Ligament Struthers
3. Arcade of Froshe

A
  1. LF = biceps aponeurosis
    AIN
  2. Lig Struthers = medial distal humerus
    Medial n
  3. Arcade Froshe = prox supinator
    PIN

Millers (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions