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Netter's Orthopaedics > Hand > Flashcards

Hand Flashcards

1
Q

Significance of proximal palmar crease?

A

Appx site of the superficial palmar arch

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2
Q

Significant of distal palmar crease?

A

site of MCP joints (dorsally)

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3
Q

Bennett’s fracture. Deforming force?

A

Base of thumb metacarpal fx (type 1): intraarticular fracture with proximal and radial dx of 1st metacarpal. Triangular bone fragments. APL deforms

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4
Q

Rolando fracture. Complications?

A

Base of thumb metacarpal fx (type 2): Intraarticular fracture with Y-shape. DJD after

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5
Q

Flexed fingers point to:

A

Tuberosity of scaphoid

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6
Q

Most common metacarpal fracture?

Most common anatomic location?

A

5th MC

Neck of MC

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7
Q

Boxer’s fracture?

A

Base of 5th MC

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8
Q

Gamekeeper’s thumb

A

Thumb MCP joint proper ulnar collateral ligament injury from forced radial deviation. Ski pole injury often. Stener lesion seen. Test at 30° flexion

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9
Q

Stenor lesion?

A

When adductor aponeurosis falls under torn ulnar collateral ligament, producing a palpable mass.

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10
Q

Mallet finger?

A

Rupture of the extensor tendon from distal phalanx. Bony avulsion from EDU seen.

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11
Q

Jersey finger?

A

FDP avulsion from P3 (avulsion fracture from volar base of P3)

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12
Q

Flexor tendon zones I-V and Thumb I-III

A

I: distal to FDS inertion
II: Flexor retinaculum. No man’s land. avoid A2 and A4.
III: Palm.
IV: Carpal tunnel. Release and repair TCL during repair
V: Wrist and forearm.
Thumb I: Distal to FPL insertion
Thumb II: Thumb flexor retinaculum. Preserve either A1 or oblique pulley
Thumb III: Thenar eminence. Do not operate in this zone due to recurrent motor branch of median n

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13
Q

Extensor tendon zones I-IX

A 
I: DIP joint. Mallet finger
II: Middle phalanx
III: PIP joint. Central slip injury. If triangular ligament is disrupted, lateral bands migrate volarly resulting in boutinniere finger. 
IV: Proximal phalanx
V: MCP joint. Injury from fight bite. Repair tendon and sagittal bands as needed
VI: Metacarpal. 
VII: Wrist
VIII: Distal forearm. At MSC jxn
IX: proximal forearm.
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14
Q

Draw flexor tendon sheath

A

A1 MCPJ, A2 proximal phalanx, A3 PIPJ, A4 middle phalanx, A5 DIPJ.

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15
Q

What can cause trigger finger?

A

Tight A1 ligament

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16
Q

Significance of Anterior oblique CMC ligament?

A

Ulnar side of 1st MC base to tubercle of trapezium. Beak ligament. Holds fragment in Bennett’s fx. Primary restraint to subluxation.

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17
Q

Significance of dorsal radial CMC ligament?

A

Dorsal trapezium to dorsal MC base. Strongest ligament. Torn in dorsal dx.

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18
Q

Cam effect in MC head and collateral ligament

A

Tight in flexion, loose in extension

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19
Q

Significance of Grayson’s ligament

A

Volar to neurovascular bundle, stabilizes skill in NV bundle.

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20
Q

Sig. of Cleland’s ligament

A

Dorsal to NV bundle. Stabilizes skin during flexion/extension.

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21
Q

Flexion and extension of MCP joint

A

Flexion - IO muscles + lumbricals

Extension - EDC via sagittal bands

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22
Q

Flexion and extension of PIPJ and DIPJ

A

PIPJ - flexion via FDS and FDP, extension via EDC and lumbricals via lateral bands
DIPJ - flexion via FDP, extension via EDC and oblique retinacular ligament.

23
Q

Parona’s space

A

Between flexor tendons and PQ. Possible horseshoe abscess.

24
Q

Heberden’s and Bouchard’s nodes

A

Seen in OA. Heberden’s at DIPJ (more common), Bouchard’s at PIPJ.

25
Q

MCP nodes

A

Seen in OA

26
Q

Dupuytren’s contracture

A

Flexion contracture of 4th and 5th fingers. Palpable nodules. Caused by myofibroblast proliferation creating cords of type 3 collagen.

27
Q

Four cardinal signs of Kanavel

A

Sings of purulent tenosynovitis:

1) Pain on extension
2) Fusiform swelling
3) Slight flexion
4) Tenderness along tendon sheath

28
Q

1/2LOAF1/2

A 
Median n innervates (motor recurrent branch)
1/2 lumbricals
Opponens pollicis
Abductor pollicis brevis
1/2 flexor pollicis brevis
29
Q

Hoffman’s

A

Flick middle finger DIPJ into flexion. If thumb IPJ flexes, myleopathy

30
Q

Profundus test

A

Stabilize PIPJ in extension, flex DIPJ only. FDP pathology

31
Q

Sublimbus test

A

Extend all fingers, flex one PIPJ at a time. FDS pathology

32
Q

Froment’s sign

A

Hold paper with thumb and index finger. Pull paper. If thumb IP flexion is positive, suggest adductor pollicis weakness/ulnar nerve palsy.

33
Q

CMC grind test

A

Axial compress and rotate CMC joint. Pain = arthritis

34
Q

Finger instability test

A

Stabilize proximal joint, apply varus/valgus stress. Laxity=collateral ligament instability

35
Q

Thumb instability test

A

Stabilize MCP, apply valgus stress in extension and 30° of flexion. Laxity at 30° indicates ulnar collateral ligament injury. Laxity in extension indicates accessory collateral/volar plate injury

36
Q

Brunnell-Littler test

A

Extend MCPJ, passively flex PIPJ. If easier to flex PIPJ in MCPJ flexion, tight intrinsic muscles

37
Q

Elson test

A

Flex PIPJ 90° over table edge, resist P2 extension. If the DIPJ extends (via lateral bands) indicates central slip injury (boutonniere)

38
Q

Which lumbricals are unipennate vs bipennate

A

1/2 are unipennate (median nerve)

3/4 are bipennate (ulnar nerve)

39
Q

What are the actions of dorsal and palmar interossei

A

DAB

PAD

40
Q

Innervation of FPB

A

Deep head by ulnar n, superficial head by median n.

41
Q

Radial and Ulnar artery continuation in the hand.

A

Radial artery’s deep branch runs through the 1st dorsal interosseous and becomes the deep palmar arch.
Ulnar artery’s superficial branch branch terminates as the superficial palmar arch

42
Q

Relationship of deep and superficial palmar arches?

A

Superficial arch is distal to deep arch. Limit of superficial arch is called Kaplan’s line.

43
Q

Kaplan’s line?

A

Distal limit of superficial palmar arch

44
Q

Swan neck deformity cause

A

FDS insertion/volar plate injury, associated with RA.

45
Q

Boutonniere deformity cause

A

Central slip of EDC and triangular ligament injury. Lateral bands subluxate volarly which hyperflexes PIPJ.

46
Q

Common bacteria in human/animal bites

A

Staph, strep
Human: Eikenella
Animal: Pasturella

47
Q

Retinacular cyst

A

Ganglion type cyst of flexor tendon sheath.

48
Q

Syndactyly

A

Failure of finger tissue differentiation (fused fingers)

49
Q

Camptodactyly

A

Congenital finger flexion abnormality. Usually PIPJ of small finger.

50
Q

Clinodactyly

A

Deviation of finger in coronal plane. Usually radial deviation of small finger. Due to delta shaped middle phalanx.

51
Q

Preaxial polydactyly

A

Duplicate thumb. 7 types, #4 most common.

52
Q

Constriction band syndrome

A

Bands lead to digit necrosis or diminished growth.

53
Q

Volar approach to finger

dangers

A

Digital artery/nerve, flexor tendons. NV bundle is lateral to tendon sheath.

54
Q

Mid-lateral approach to finger

dangers

A

Digital artery/nerve

Netter's Orthopaedics (7 decks)

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