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ABOS PART ONE > Hand > Flashcards

Hand Flashcards

1
Q

flexor tendon blood supply in relation to the MCP

A

proximal to the MCP nutrition is via diffusion from the synovial sheath

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2
Q

function of the triangular ligament

A

prevent volar subluxation of the lateral bands

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3
Q

function of the oblique retinacular ligament

A

link PIP and DIP extension

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4
Q

relationship of cleland and graysons ligaments to the neurovascular bundle

A

cleland is dorsal, graysons is palmar/volar. Graysons ground, Clelands ceiling

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5
Q

orientation of the flexors in the carpal tunnel

A

FPL is most radial. FDP all more deep than FDS. Long and ring FDS are most volar

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6
Q

orientation of the lumbrical insertions

A

volar to the transverse metacarpal ligaments, inserting on the radial side of the extensor hood/lateral bands

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7
Q

orientation of the digital nerves in relation to the arteries

A

nerves are volar to the arteries

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8
Q

AAOS postreduction guidelines for distal radius

A

stepoff

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9
Q

treatment of EPL rupture in distal radial fx care

A

common after closed treatment, and primary repair often not possible. Either palmaris graft, or EIP-to-EPL transfer

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10
Q

this is the most common tendon injury after volar plating of DR fx

A

FPL rupture.

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11
Q

vit C dose for RSD in DR fx

A

500mg per day

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12
Q

these scaphoid fxs are more at risk of AVN

A

waist and proximal pole

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13
Q

most common mechanism of scaphoid fx

A

forced hyperextension and radial deviation

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14
Q

indications for scaphoid fxs

A

displacement >1mm, humpback deformity (35* angulation), and trans-scaphoid perilunate dislocation

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15
Q

benefits of percutaneous fixation of scaphoid fx

A

faster time to union, and faster return to activity

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16
Q

benefits of volar approach to fixing displaced scaphoid fxs

A

avoids disruption to the blood supply, which is the dorsal branch off the radial artery that enters just distal to the waist

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17
Q

SNAC wrist stages

A

1 - radioscaphoid, 2 - + scaphocapititate, 3 - + lunocapitate

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18
Q

symptomatic hook of hamate fxs that fail nonop

A

excise; ORIF has high complication and little benefit

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19
Q

relative strengths of the carpal ligament fibers

A

the dorsal ones are stronger than the volar

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20
Q

etiology of DISI

A

SLL distruption

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21
Q

3 radiographic indications of DISI

A

SL angle >70*, SL interval >3mm, cortical ring sign

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22
Q

gold standard for dx of DISI

A

wrist arthroscopy

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23
Q

this is spared in SLAC wrist

A

radiolunate articulation

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24
Q

SLAC stages

A

radial styloid beaking, radioscaphoid, midcarpal

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25
Q

in chronic SL instability this is a treatment option

A

ECU tendon graft

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26
Q

2mm of metacarpal shortening equals this amount of extensor lag

A

7*

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27
Q

deforming force in baby bennett

A

ECU

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28
Q

deforming force in bennett

A

APL and the thumb extensors, cause proximal, dorsal, and radial displacement of the metacarpal shaft. Adductor pollicis causes supination and adduction.

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29
Q

anterior oblique ligament (beak) in bennett fxs

A

connection between the volar-ulnar portion of MC shaft and the trapezium

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30
Q

why thumb MCP stability is tested in 0* and 30*

A

instability at 30* is due to UCL proper. Instability at both 0* and 30* implies injury to the volar plate and/or accessory UCL

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31
Q

stener lesion

A

interposition of the adductor pollicis aponeurosis between the avulsed UCL and its insertion on the proximal phalanx

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32
Q

PIP dorsal disloc’n

A

Injury to volar plate AND at least one collateral.

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33
Q

PIP volar disloc’n

A

Injury to central slip AND at least one collateral.

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34
Q

result of poorly treated PIP volar disloc’n

A

since these are central slip injuries, they can go on to boutonniere deformity

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35
Q

rotatory PIP dislocations hard to reduce bc

A

phalangeal condyle buttonholes through lateral bands and the central slip

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36
Q

initial mgmt of chronic injury resulting from central slip rupture

A

boutonniere deformity, needs to have maximal passive motion prior to any operative treatment. Dynamic splinting or serial casting

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37
Q

strength of flexor tendon repair proportional to

A

number of strands that cross repair

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38
Q

benefit of high-caliber suture in flexor tendon lacs

A

decreases gap formation, increases strength and stiffness

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39
Q

benefit of locking loop technique in flexor tendon lacs

A

decreases gap formation

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40
Q

why repair the epitenon in flexor lacs

A

increases repair strength by 30-50%

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41
Q

repair of the flexor tendon sheath in lac repair

A

no benefit

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42
Q

timeframe for weakness in tendon repair

A

3 weeks is weakest, and fails at the knots

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43
Q

minimum repair of flexor tendon lac to allow active motion protocol

A

4 strand repair needed for active motion

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44
Q

types and the mgmt of zone I flexor tendon injuries

A

type I retracts all the way to the palm and needs to fixed within 7-10 days. type 2 can wait 6 weeks, as the vinculae prevent retraction past PIP. Type 3 also can wait 6 weeks.

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45
Q

how quadrigia occurs

A

if an injured 3-4-5 FDP is advanced more than 1cm, the remaining 3-4-5 digits will not flex anymore once the repaired digit bottoms out.

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46
Q

commonality b/t kleinert and duran OT protocols

A

both restrict active flexion for 6 weeks

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47
Q

how flexion is performed with the kleinert and duran protocols

A

in the kleinert passive flexion performed with bands (?) and duran it is performed with the other hand (COMPLIANCE)

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48
Q

difference bt pediatric and adult trigger thumbs

A

in peds the pathology is in the tendon itself, rather than the tendon sheath

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49
Q

treatment for pediatric trigger finger

A

a simple A1 pulley release may not be enough. May need to release A3, or resect FDS slip

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50
Q

this % gets better with injection of DQ synovitis

A

80%

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51
Q

this tendon often has more than one slip when surgically treating 1st dorsal compt synovitis

A

APL

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52
Q

this tendon often has its own compartment when surgically treating 1st dorsal compt synovitis

A

EPB

53
Q

intersection syndrome

A

inflammation/bursitis bt the 1st and 2nd dorsal extensor compartments

54
Q

this motion can lead to traumatic subluxation of the ECU tendon

A

hypersupination and ulnar deviation

55
Q

rate of incidental TFCC tears in wrist scopes

A

50%

56
Q

ulnar variance with pronation

A

positive

57
Q

ulnar variance with supination

A

negative

58
Q

these two ligaments have their origins on the TFCC

A

ulnolunate and ulnotriquetral ligaments

59
Q

percent of load borne by the TFCC at neutral ulnar variance

A

20%

60
Q

surgical considerations in ulnocarpal impaction syndrome

A

if the DRUJ is free of arthritis, you can shorten the ulna

61
Q

threshold for removal of nail plate in subungal hematoma

A

> 50%

62
Q

why are FTSG better for fingertip injuries

A

sensibility, durability

63
Q

flap for volar oblique fingertip injury

A

cross-finger

64
Q

flap for volar oblique fingertip injury to the index or middle digit

A

either cross-finger, or can do thenar flap

65
Q

who would get a thenar flap, and what are the concerns

A

flap for volar oblique fingertip injury to the index or long, and can get PIP stiffness especially if older

66
Q

flap for transverse or dorsal oblique fingertip injury

A

V-Y advancement

67
Q

flap for transverse or volar oblique fingertip injury of the thumb

A

moberg

68
Q

probably created a few of these in the mgmt of fingertip injuries treated by acute shortening

A

lumbrical plus finger can result from violation of the FDP insertion and retraction. This pulls on the lateral bands (and the extensor mech) through the lumbricals, as they originate on the now shortened FDP

69
Q

this flap is done for dorsal thumb skin loss

A

kite flap (1st dorsal metacarpal artery)

70
Q

these are preferred for coverage of dorsal hand wounds

A

STSG

71
Q

these are preferred for coverage of volar hand wounds and fingertips

A

FTSG

72
Q

this provides 75% lengthening along the central limb of a flap

A

60* Z-plasty

73
Q

blood supply for gracilis flap

A

medial femoral circumflex

74
Q

blood supply for latissimus flap

A

thoracodorsal

75
Q

blood supply for serratus flap

A

serratus branch of the subscapular artery

76
Q

blood supply for anterolateral thigh flap

A

descending branch of the lateral femoral circumflex

77
Q

blood supply for lateral arm flap

A

posterior branch of the radial collateral artery

78
Q

amputations in zone II: replant?

A

nope

79
Q

amputations in zone I: replant?

A

relative indication to replant distal to the FDS insertion

80
Q

amputations at the wrist level: replant?

A

wrist level and proximal is indication to replant

81
Q

amputations in polytrauma: replant?

A

along with psych conditions, polytrauma pts may be poor replant candidates

82
Q

sequence for replant of a single digit amputation

A

bone, extensors, flexors, artery, vein, nerve

83
Q

sequence for replant of multiple digit amputation

A

thumb, long, ring, small, index

84
Q

what else can be measured besides pulse ox in replanted digit

A

skin surface temperature; 2* in an hour indicates decreased perfusion

85
Q

most predictive of digit survival after replant

A

mechanism of injury, then probably ischemia time

86
Q

failure of replant within 12 hours

A

arterial vasospasm

87
Q

failure of replant after 12 hours

A

venous congestion

88
Q

this goes with leech therapy for late replant failure

A

cipro or rocephin; leech saliva has aeromonas in it

89
Q

most commonly performed procedure after successful replant

A

tenolysis

90
Q

ring avulsion injuries

A

treatment depends on vascularity first, then bony or tendon injury. 1 - circulation intact, salvage with coverage. 2 - circulation disrupted, but no gross bony or tendon injury, revascularization. 3 - complete degloving, needs amp’d.

91
Q

this class of meds may help with raynaud’s dz

A

calcium channel blockers

92
Q

these muscles are the most vulnerable to ischemic forearm contracture

A

FDP and FDL

93
Q

imaging in frostbite

A

bone scan

94
Q

these are last to go in compression neuropathy

A

pain and temperature sensation

95
Q

viral illness preceding neuritis

A

parsonage-turner

96
Q

semmes weinstein test this

A

cutaneous pressure threshold; large nerve fibers (which are first to be affected in compressive neuropathy)

97
Q

greater than this 2 point is abnormal sensation

A

6mm

98
Q

most common cause of CTS in peds

A

mucopolysaccharidoses

99
Q

injection rate of success in CTS

A

80% after 6 weeks, but only 20% of those are symptom-free at 1 year. Surgery is less successful for those in which injections don’t work

100
Q

how to distinguish pronator syndrome from carpal tunnel syndrome on sensation alone

A

palmar cutaneous branch of the median nerve won’t be affected in CTS (comes off prior)

101
Q

sites of pronator compression

A

ligament of struthers, lacertus fibrosis (biceps aponeurosis), two heads of pronator teres, FDS aponeurosis

102
Q

testing for pronator syndrome

A

pain with resisted elbow flexion in forearm supination, and forearm pronation with elbow extended

103
Q

pronator syndrome associated with this and improves if you treat it

A

medial epicondylitis

104
Q

compressive neuropathy with pure motor loss

A

AIN syndrome. FPL, FDP to 1st, pronator quadratus

105
Q

testing for pronator quadratus involvement in AIN syndrome

A

pain on resisted pronation with elbow flexed

106
Q

AIN syndrome could be confused for this

A

Mannerfelt lesion in RA. This is FPL rupture.

107
Q

floor of the cubital tunnel

A

MCL and elbow capsule

108
Q

wartenberg sign

A

pinky abduction and extension when trying to adduct; ulnar nerve compression

109
Q

threshold for diagnosis of ulnar compression based on conduction velocity

A

conduction velocity less than 50m/sec

110
Q

ulnar decompression vs transposition

A

no difference

111
Q

most common cause of ulnar tunnel syndrome

A

ganglion cyst

112
Q

PIN syndrome exam

A

radial deviation with wrist extension (ECRL innervated higher)

113
Q

sites of PIN compression

A

CHEFS - capsule, leash of Henry, ECRB, arcade of Frohse, supinator (distal edge)

114
Q

most important prognostic factor for nerve recovery after injury

A

age

115
Q

indication for nerve conduit in digital nerve

A

gap larger than 8mm

116
Q

this type of plexus injury has the worst prognosis

A

preganglionic

117
Q

most important predictor of success in operative mgmt of CP

A

voluntary muscle control

118
Q

this has not demonstrated a benefit over placebo or corticosteroids in CMC arthritis

A

off-label hyaluronic acid

119
Q

there is evidence that this has similar outcome to more complicated basal joint arthritis treatments

A

trapeziectomy

120
Q

first to be affected in vaughn-jackson syndrome

A

EDM

121
Q

direction of progression in vaughn-jackson

A

from the EDM radially

122
Q

mannerfelt lesion

A

attritional FPL rupture, due to volar STT joint osteophyte

123
Q

treatment of mannerfelt lesion

A

direct repair fails, so tendon transfer more desirable

124
Q

this might be the initial presentation of RA MCP joint involvement

A

extensor lag

125
Q

why RA MCP’s deviate ulnarly

A

pannus stretches the weaker radial sagittal bands

126
Q

this is a temporary solution in RA MCP treatment

A

synovectomy and centralization of the extensor tendons

127
Q

perilunate dislocation begins with

A

scaphoid extension, then scaphoid failure

128
Q

mayfield progression

A

scaphoid extension, scaphoid failure, distal row dissociation, triquetral hyperextension, lunotriquetral ligament failure, dorsal dislocation of the carpus

ABOS PART ONE (11 decks)

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