Hand

Question 1

comm probs

Answer 1

N disorders
Dupuytrens
Stenosing disorders
OA
RA
Lumps
Soft tiss inj
Bony inj

Question 2

CTS

Answer 2

Lateral 3.5 digits parasthesia/numb
Thenar wasting
Tunnel contents- FDS, FDP FPL, median N
Nocturnal symps
Phalens and tinnels
Electrophysiology
Motor APB test
Causes- idio, hypothyr, preg, frac distal red, amyloidosis, occupat vibrat, genet, smok, DM, peyronies. 
Tx- treat cause, night splint, ster injec, surg (cut flexor retinac under local)

Question 3

Testing Ns

Answer 3

Radial- sensory snuffbox. Motor ext eg EPL thumb ext.
median- sensory lat 3/3.5 digit, test side index. Motor always APB thumb to ceiling ag resis. Ok sign.
Ulnar- sensory ulnar 1.5/2 digit, test 5th. Motor finger abduc, finger crossing inrteross. Froments sign pos if bend thumb as using FPL.

Question 4

Testing tendons

Answer 4

FDP- hold PIP (FDS) and bend tip
FDS- hold 3 fingers straight, bend other
FPL- thumb bends when ext wrist
PL tend thumb to little finger
EPL- lift thumb to ceiling
EI and EDM extra tendons allow ext while fist.

Question 5

N disorder symps

Answer 5

Parasthesia
Numb
Pain
Weakness
Loss dexterity
Wasting

Question 6

ulnar N inj

Answer 6

Cubital tunnel 95%, guyons, iatrogenic.
Motor- intrinsics, adduc pollicis, ADM, FDP.
Wasting eg inteross, hypothenar.
Claw.
Tx- decomp in wrist. In elbow can decomp or trasnposit N to front elbow.

Question 7

N inj types

Answer 7

Neuropraxia- press on N temp blocks conduc. MILD.
Axonotmesis- N sheath intact but axons disrup. MOD.
Neurotmesis- whole N disrup. SEV.

Question 8

radial N inj

Answer 8

Wrist drop. 
Sat night palsy neuropraxia. 
Risk dam in humeral frac. 
Motor- wrist and finger extensors, EPL. 
Tx- physio and wait if neuropraxia, neurolysis if N caught in scar tiss/arnd frac, N graft if N cut, tendon transfer eg P teres or FCU then retrain brain.

Question 9

N probs

Answer 9

C spine- disc SC comp
Brachial plexus- cervical rib
N disorder eg DM, MS

Question 10

N summary

Answer 10

ID nerve and site
Elim other probs
Rel and transpose
Repair
Neurolysis
N graft
Tend transfer

Question 11

dupuytrens

Answer 11

worsening finger deform, not v pain.
Palmar fascia bundles
Assoc with plantar fibromatosis foot nodules, peyronies dis.
PIPJ diffic to mx, full fasciotomy, addit releases collaterals and volar plate, skin graft or Z plasty, recurrence, garrods pads post PIPJ nodule.
MCPJ easy to correct, (segmental/full/norm) fasciotomy, also collagenase injec.
Threshold? 30 deg. ?able to flatten hand.
RF- caucasian blonde blue eye, male, anti epil eg phenytoin.

Question 12

trigger finger

Answer 12

Tendon nodules
Jumping, sticking, clicking, locking, passive straightening.
Flexor tend stuck under A1 pulley
Tx- injec, surg rel
Congenital 6mnth- 2yo. Stuck bent as lack strength. Often self resolve.

Question 13

De quervans tensosynovitis

Answer 13

Thickened tend sheath arnd EPB and abduc PL tend
Tets- fist then ulnar dev
Injec but risk skin depigm or fat nec
Release

Question 14

flexor tend inj eg cut

Answer 14

Casacde, tenodesis test, squeeze test, FDS and FDP test.

Repair surg

Question 15

CMCJ OA

Answer 15

More in wom, often bilat

Tx- conservative, trapeziectomy, repl not v succ.

Question 16

hand OA

Answer 16

Vs RA, OA has- good bone stock, linked pattern, no soft tiss isuues, less disabling as us one jnt, no osteopenia.
Heberdens DIPJ osteophytes, bouchard PIPJ
MCPJ tx arthroplasty
PIPJ fusion or arhtroplasty
DIPJ fusion

Question 17

hand RA

Answer 17

Sudd loss ext, swell, pain
Most comm cause spont tend rupt
Leg bef arm, prox to distal, pain and lof imp surg indics, deform, systemic probs eg interstit fibrosis.
Tend rupt- flexors and extensors, infilt, attrit, buddying, transfers
Subluxation of tend- can go from ext to flex
Nerve inj- comp by synovitis, neuropathy, the neck risk phrenic N.
jnt effects- wrist, MCPJ, swan neck, boutonniere

Question 18

ganglion

Answer 18

Lump full synovial fluid, moveable.
Occas aching
Flucs size
Self resolve

Question 19

Tumours

Answer 19

Giant cell tum of tend sheath
Endochondroma
Malig tum

Question 20

Lump classif

Answer 20

Origin- soft tiss/bone
Composit- cystic, solid, mixed
Nature- benign, malig
Tx- ignore eg ganglion, monit eg giant cell tum, biop, excise.
Cystic- ganglion wrist, mucous cyst finger.
Soft tiss solid- giant cell tum of tend sheath.
Bone endochondroma.

Question 21

finger frac.

Answer 21

Displ- accept posit, closed reduc, open reduc.
Look for rot
Stabil- buddy strapping, splintage, int fix
Rehab

Question 22

ROM

Answer 22

MCP 85 deg flex
PIP 110 deg
DIP 65
Wrist 60 deg flex, 60 ext
Radio ulnar dev arc 50 deg

Question 23

Test vasc

Answer 23

Radial and ulnar pulse
Allens test
Cap refill

Question 24

Volkmanns isch contracture

Answer 24

Folls interup brach A near elbow.
Musc nec causes flexion deformity
Tx like compartm synd

Question 25

ulnar claw

Answer 25

Hyperext medial MCPJ in 4th and 5th digits as medial lumbricals paral so cant oppose. Unopposed ED.
Flex IPJ in 4th and 5th digits as medial lumricals and interossei cant oppose. Unopp FDP.
Pradox- higher inj at elbow means medial FDP and FCU paral so less flexion deformity BUT also less func.