Hand Flashcards
Contents of first dorsal wrist compartment.
APL/EPB
Contents of second dorsal wrist compartment.
ECRL/ECRB
Contents of third dorsal wrist compartment.
EPL
Content of fourth dorsal wrist compartment.
EDC/EIP
Contents of fifth dorsal wrist compartment.
EDM
Contents of sixth dorsal wrist compartment.
ECU
Location of sagittal bands.
MCP
Central slip inserts here.
Middle phalanx.
Eponym for oblique retinacular ligament.
Ligament of Landsmeer.
Prevents volar subluxation of the lateral bands.
Triangular ligament.
Prevents dorsal subluxation of the lateral bands.
Transverse retinacular ligament.
This helps link PIP and DIP joint extension.
Oblique retinacular ligament.
Action of FDS.
Flexes PIP.
Action of FDP.
Flexion DIP.
Each digit has ____ annular pulleys.
5
Each digit has ___ cruciate pulleys.
3
These pulleys prevent flexor tendon bowstringing.
A2 and A4
Most radial structure in the carpal tunnel.
FPL
Carpal tunnel contains these structures.
Median nerve, FDS x4, FDP x4, FPL.
Roof of Guyon canal.
Volar carpal ligament.
Prevalence of palmaris longus tendon.
80-85%
FCU inserts here.
Pisiform.
Number of dorsal interossei.
4
Number of palmar interossei
3
Interossei innvervation.
Ulnar.
Lumbrical muscles originate here.
Radial aspect of FDP tendons.
Radial two lumbricals innervated by this nerve.
Median.
Ulnar two lumbricals innervated by this nerve.
Ulnar.
Palmar cutaneous branch of median nerve between these two tendons.
Palmaris longus and FCR.
Crossover variations between median and ulnar nerves.
Martin-Gruber anastomoses.
Distal radius fracture morphology associated with scapholunate ligament disruption.
Isolated radial styloid fracture.
AAOS guidelines for non-op distal radius fx treatment.
- radial shortening less than 3mm
- dorsal articular tilt less than 10 deg.
- intra-articular step-off less than 2mm
Vitamin C dose of at least ____ mg/day may decrease CPRS after distal radius fx.
500 mg/day
Proximal row of carpus.
Scaphoid, lunate, triquetrum.
Distal row of carpus.
Trapezium, trapezoid, capitate, hamate.
Most common carpal fracture.
Scaphoid.
Blood supply to scaphoid.
Dorsal branch of radial artery.
Blood supply to scaphoid enters here.
Dorsal ridge just distal to waist.
Most commonly harvest vascularized bone grafting for scaphoid nonunion.
1,2 intercompartmental supraretinacular artery (a,2 ICSRA)
SNAC wrist stage I.
Radioscaphoid arthritis.
SNAC wrist stage II.
Scaphocapitate joint.
SNAC wrist stage III.
Lunocapitate joint.
Instability between individual carpal bones of single row.
Carpal instability dissociative (CID).
DISI and VISI are examples of this type of carpal instability.
CID
Instability between carpal rows.
Carpal instability non-dissociative (CIND).
Type of carpal instability secondary to perilunate dislocations.
Carpal instability complex.
Most common form of carpal instability.
DISI (CID).
Scaphoid and lunate deformities in DISI.
Scaphoid flexed, lunate extended.
Second most common form of carpal instability.
VISI.
Mayfield stages of perilunar disruption.
- Scapholunate disruption
- Scaphocapitate disruption
- Lunotriquetral disruption
- Circumferential disruption
Major deforming force of small finger CMC fracture-dislocation.
ECU
Deforming force of Bennett fractures.
APL and adductor pollicis.
This fragment is characteristically kept reduced to trapezium in Bennett fractures.
Volar-ulnar base.
This ligament keeps the volar-ulnar thumb MC base reduced to trapezium in Bennett fractures.
Anterior oblique or beak ligament.
Gamekeeper’s thumb.
Chronic thumb MCP joint ulnar collateral ligament injury.
Competent thumb ulnar collateral ligament needed for this.
Pinch.
In a Stener lesion, this is interposed between avulsed MCP joint UCL and its insertion site on base of proximal phalanx.
Adductor pollicis aponeurosis.
Dorsal PIP joint dislocation may injure this.
Volar plate.
Volar PIP joint dislocation may injure this.
Central slip.
Inadequately treated central slip injury will lead to this.
Boutonniere deformity.
Splint in this position after PIP joint volar dislocation.
Full extension.
Irreducible DIP dislocation are due to interposition of this.
Volar plate.
Chronic mallet finger may lead to this deformity
Swan neck.
This epynonymous test for acute central slip rupture.
Elson’s test.
In boutonneire’s deformity, these sublux volarly.
Lateral bands.
Extensor zone V injury here.
Over MCP joint.
Extensor Zone IV injury here.
Over proximal phalanx.
Extensor zone III injury here.
Over PIP joint.
Extensor Zone VI injury here.
Over metacarpal.
Extensor Zone VII injury here.
Over wrist joint.
Risk of repaired tendon rupture greatest at this time.
3 weeks post repair.
Failure of tendon repair generally occurs here.
At suture knots.
Zone I flexor tendon injury.
FDP avulsion distal to FDS insertion.
Classification of FDP avulsion injuries.
Leddy and Packer.
Type I – retraction into palm
Type II – remains in digital sheath, implication that supporting vincula intact
Type III – bony fragment attached to tendon stump stopped at A4 pulley
Location of Zone II flexor tendon injury.
Between FDS insertion and distal palmar crease.
location of Zone III flexor tendon injuries.
Between distal palmar crease and distal end of carpal tunnel.
Location of Zone IV flexor tendon injuries.
Carpal tunnel.
Trigger finger at this pulley.
A1.
First line of trigger finger treatment.
Corticosteroid injection into A1 pulley.
This first dorsal compartment tendon may have multiple slips.
APL
This first dorsal compartment tendon may have its own separate compartment.
EPB
Intersection syndrome symptoms occur here.
4-5 cm proximal to radiocarpal joint.
Intersection syndrome occurs at the junction of tendons in these compartments.
First (APL/EPB) and second (ECRL/ECRB).
Nail plate originates from this.
Germinal matrix.
Lies directly beneath nail plate and contributes keratin to increase plate thickness.
Sterile matrix.
Crescent-shaped white structure at junction of sterile and germinal matrices.
Lunula.
Lies between distal nail bed and skin of fingertip.
Hyponichium.
Distal margin of the proximal nail fold.
Eponychium (cuticle).
Lateral margins of the nail fold.
Paronychium.
2-octylcyanoacrylate.
Dermabond.
Fingertip injuries without exposed bone.
Heal by secondary intention.
Dorsal thumb injury best covered with.
First dorsal metacarpal artery kite flap.
Degree of lengthening from Z-plasty (a) 30 deg, (b) 45 deg, (c) 60 deg.
25%, 50%, 75%
Viable warm ischemia time for amputated digit.
12 hours.
Viable cold ischemia time for amputated digit.
24 hours.
Viable warm ischemia time for amputation proximal to carpus.
6 hours.
Viable cold ischemia time for amputation proximal to carpus.
12 hours.
Contraindications to digit replantation (5).
- Single digit (esp index)
- Crush injury
- Prolonged ischemia
- Segmental amputation
- Level of amp within flexor zone II
Most common cause of early (12 hrs) replantation failure.
Arterial thrombosis from persistent vasospasm.
Most common cause of failure after 12 hrs of replant.
Venous congestion or thrombosis.
Medicinal leeches technical name.
Hirudo medicinalis.
Medicinal leeches produce this.
Hirudin.
Leech therapy infection with this.
Aeromonas hydorphila.
Prophylactic abx with leech therapy.
Ceftriaxone or ciprofloxacin.
Factor most predictive of digit survival after replantation.
Mechanism of injury.
Main contributor to superficial palmar arch.
Ulnar artery.
Main contributor to deep palmar arch.
Radial artery.
Initial treatment of frostbite.
Rapid rewarming in water bath at 40-42 deg C.
Surgical debridement or amputation after frostbite done at this time.
Delayed.
Inability to discern two-point greater than ___ mm is considered abnormal.
6 mm
Most sensitive carpal tunnel syndrome provacative test.
Carpal tunnel compression test.
Abnormal distal sensory latencies.
More than 3.5 msec
Abnormal motor latencies.
More than 4.5 msec
Courses between the supracondylar process and the medial epicondyle.
Ligament of struthers.
Supracondylar process best seen on this x-ray.
Lateral or elbow or humerus.
Differentiates pronator teres syndrome from AIN syndrome.
AIN syndrome has no sensory component.
Floor of cubital tunnel.
MCL and elbow joint capsule.
Walls of cubital tunnel.
Medial epicondyle and olecranon.
Roof of cubital tunnel made up of these (2).
- FCU fascia
2. Arcuate ligament of osborne
Most common cause of ulnar tunnel syndrome.
Ganglion cyst.
Roof of Guyon canal.
Volar carpal ligament.
Floor of Guyon canal.
Transverse carpal ligament.
Radial border of Guyon canal.
Hook of hamate.
Ulnar border of Guyon canal.
Pisiform and abductor digit minimi.
Zones of the Ulnar tunnel (3).
Zone 1 – proximal to bifurcation of ulnar nerve. Mixed motor/sensory
Zone 2 – deep motor branch. Pure motor symptoms
Zone 3 – distal sensory branches. Pure sensory
Sites of compression in PIN compression syndrome (5).
- fascial band at radial head
- recurrent leash of henry
- edge of ECRB
- arcade of Frohse (proximal edge of supinator)
- distal edge of supinator
Broad types of thoracic outlet syndrome (2).
- Vascular
2. Neurogenic
Adson test for thoracic outlet syndrome.
Patient arm at side, hyperextension of neck, rotate head to affected side. Results in diminished radial artery pulse.
Vascular thoracic outet syndrome caused by this.
Subclavian vessel compression or aneurysm.
Neurogenic thoracic outlet syndrome described as this.
Entrapment neuropathy of lower trunk of brachial plexus.
Essential for work up of neurogenic thoraic outlet syndrome.
Cervical and chest radiographs.
Most important prognostic factor for nerve recovery.
Age.
Wallerian degeneration in these two types of nerve injuries.
Axonotmesis and neurotmesis.
Brachial plexus injuries at this location have worst prognosis.
Preganglionic (nerve root).
Most reliable clinical sign of nerve regeneration and recovery after brachial plexus injury.
Advancing Tinel sign.
Oberlin nerve transfer.
Ulnar nerve branch to FCU transfer to musculocutaneous nerve to help restore elbow flexion.
Most important predictor of success in upper extremity surgery for CP spasticity.
Voluntary muscle control.
Thumb in palm deformity in CP is corrected with this (3).
- Release/lengthening of adductor pollicis, first dorsal interosseous, flexor pollicis brevis, FPL
- First webbed space Z-plasty
- Tendon transfer to augment thumb extension/abduction
Amplitude or muscle excursion is proportional to this when doing tendon transfers.
Length of the muscle.
These types of muscle transfers are easiest to rehabilitate.
Synergistic.
This amount of motor strength lost after transfer.
One grade of motor strength.
Vaughan-Jackson syndrome.
Extensor tendon rupture in RA, starting with EDM.
Carpus subluxes in these directions in RA (2).
Volarly and ulnarly
Difference in MCP deformity in juvenile versus adult RA.
Adult MCP ulnar deviation. Juvenile RA MCP radial deviation.
Eponym for systemic juvenile RA.
Still disease.
Nail pitting and sausage digits.
Psoriatic arthritis.
Pencil-in-cup deformity.
Psoriatic arthritis.
Kienbock disease.
Idiopathic osteonecrosis of the lunate.
First line of surgical treatment for Kienbock disease.
Joint leveling procedure (radial shortening to neutral or ulnar positive).
Association exits between Dupuytren’s diseaes and occupation. True or false?
False.
Predominant cell type in Dupuytren’s fascia.
Myofibroblasts.
These ligaments are not involved in Dupuytren’s.
Cleland.
This structure leads to PIP contracture in Dupuytren’s disease.
Spiral cord.
In Dupuytren’s, the spiral cord puts the neurovascular bundle at risk by displacing it in this direction.
Centrally and superficially.
Dupuytren’s of the plantar fascia of foot.
Ledderhose disease.
Dupuytren’s of the penis.
Peyronie’s disease.
Procedure of choice for Dupuytren’s.
Open limited fasciectomy.
Hueston test for Dupuytren’s.
Inability to place hand flat on tabletop.
This procedure for Dupuytren’s no longer favored due to high complication rate.
Total palmar fasciectomy.
Most common complication after fasciectomy for Dupuytren’s is this.
Recurrence.
Most common soft tissue mass of the hand and wrist.
Ganglion.
Most wrist ganglion’s originate from this articulation.
Scapholunate.
These occur at dorsum of DIP joint in patients with osteoarthritis.
Mucous cysts.
Second most common soft tissue mass of the hand.
Giant cell tumor of tendon sheath.
Treatment of giant cell tumor of tendon sheath.
Marginal excision.
Slow-growing, nontender, multilobulated mass on volar aspect of a digit.
Giant cell tumor of tendon sheath.
Smooth muscle tumor in finger characterized by pain and cold intolerance.
Glomus tumor.
Treatment of glomus tumor.
Marginal excision.
Most common malignancy of the hand.
Squamous cell carcinoma.
Most common subungual malignancy.
Squamous cell carcinoma.
Most common metastatic cancer to hand.
Lung.
Location of paronychia.
Eponychium.
Location of felon.
Pulp space.
Herpetic whitlow caused by this.
HSV 1
Horseshoe abscess is based on communication between flexor tendon sheaths of these fingers.
Thumb and small finger.
Most common organism in necrotizing fasciitis.
Group A beta-hemolytic strep.
Limb bud appears during this week of gestation.
4th
Most congential anomalies occur by this time.
The end of embyrogenesis at 8 weeks.
This structure mediates proximal to distal growth of limb.
Apical ectodermal ridge.
This structure mediates anterior to posterior growth of limb.
Zone of polarizing activity.
Pathway important for anterior to posterior growth.
Sonic hedgehog gene.
Pathway important for dorsoventral axis growth.
Wnt signalling.
Most common congenital hand anomaly.
Polydactyly.
Syndactyly results from failure of this.
Apoptosis to separate digits.
Pure syndactyly has this inheritance pattern.
Autosomal dominant.
Most common preaxial polydactyl thumb type.
Type IV – duplicated proximal phalanx
If duplicate thumbs of equal size, preserve this side.
Ulnar thumb to retain ulnar collateral ligament for pinch.
Critical structure when evaluating thumb hypoplasia.
CMC joint.
Determines whether hypoplastic thumb can be reconstructed or requires poliicization.
CMC joint.
Disruption of the volar ulnar physis of distal radius.
Madelung deformity.
Implicated tether structure in Madelung deformity.
Vickers ligament.
Primary restraint to valgus stress within functional elbow ROM.
Anterior bundle of medial collateral ligament.
Histologic finding in lateral epicondylitis.
Angiofibroblastic hyperplasia.
Location of partial distal biceps tears.
Radial side of tuberosity footprint.
Technique for superior strength for distal biceps repair.
Endobutton.
Risk of single incision technique for distal biceps repair.
Neurologic injury (PIN and LABCN).
Risk of two incision technique for distal biceps repair.
Radioulnar synostosis.
Anterior bundle of MCL of elbow inserts here.
Sublime tubercle on ulna.
Posterolateral elbow rotatory instability caused by this.
Incompetence of lateral UCL.
Highest stress of elbow MCL on this phase of throwing.
Late cocking.
Osteophytes here block fulle xtension with valgus extension overload of elbow.
Posteromedial olecranon process.
