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Ravi Board/OITE Prep > Hand > Flashcards

Hand Flashcards

1
Q

tx of traumatic sagittal band injury

A

leads to extensor tendon subluxation; in pro athelte -open repair; in others extension splinting if acute (< 4-6weeks)

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2
Q

PIN innervation

A

EDC, EDM, ECU, EPB, EPL, EIP, APL and SOMEtimes ECRB

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3
Q

kids with radial defects need what other work up

A

Echo, Renal US, CBC - looking for VATER or VACTERL or fanconis anemia

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4
Q

surgery for DIP joint fracture

A

if > 30% of joint surface

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5
Q

which frx to use dorsal extension block

A

PIP fracture dislocation with < 40% joint surfac; if JUST dislocation - splint

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6
Q

peds thumb trigger finger- what age

A

typically by age 2; non op after age 3 does not work

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7
Q

what is lumbrical plus

A

FDP rupture and retraction leads to paradoxixal IP joint extension when trying to flex

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8
Q

segmental nerve injuries use which graft

A

collagen conduit

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9
Q

annular pulley order

A

A1,3,5, over the joints. C1,2,4

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10
Q

size limits of volar island flap

A

2.5 to 3.5 cm defect on volar aspect

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11
Q

pip joint fractures - does anatomic reduction matter

A

no

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12
Q

pre vs post axial poly dactyly

A

pre is thumb side duplication; post is small finger side

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13
Q

which polydactyly in whites needs a work up

A

POST (pinky side) axial

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14
Q

thrombosis after digit replantation

A

venous/congestion is typically WITHIN 12 hours ; arterial is after 12 hours

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15
Q

cubital tunnel syndrome structures

A

MCL and Osbournes ligament - ulnar nerve

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16
Q

endo vs epi vs perineurium

A

endo is around the axon; peri covers nerve fasicles and has high tensile strength; protects from edema; epi is supportive sheath around peripheral nerves that cushion against external pressure - loose mesh of collagen

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17
Q

tx of stage 3 SLAC

A

4 corner fusion

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18
Q

grayson and clelands lig with Dupuytrens

A

only Graysons is involved

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19
Q

tx of hemmorrhagic blister

A

drainage with skin left intact - do NOT debride or if intact; leave alone in dry dressings

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20
Q

stages of Kienbocks

A

Lichtman 1. normal xr, needs MRI; 2. sclerosis; 3. sclerosis + collpase; 4. adjacent degeneratio

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21
Q

flap for dorsal thumb defects

A

Kite flap from 1st dorsal metacarpal artery

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22
Q

tx of DRUJ OA in laborer

A

ulnar hemiresection + TFCC recon in heavy laboroer

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23
Q

darrach procedure

A

resection of distal ulna head (only for elderly/low demand)

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24
Q

after nerve injury, which part does wallerian

A

distal segment does wallerian degen (phagocytes eat the nerve)

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25
Q

Blauth IIIA and IIIB

A

presence of cmc joint stability in Blauth IIIA. The CMC joint must stable for grasp and pinch.

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26
Q

arterial blood supply to a medial gastroc flap

A

sural artery.

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27
Q

Wafer procedure

A

ulnar prominence with impingment and TFCC tear

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28
Q

basis for claw hand

A

weak intrinsics; strong extrinsics - called intrinsic minus

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29
Q

causes of intrinsic minus

A

Volkmann’s contractre; leprosy; HMSN, ulnar or median nerve palsy; compartment syndrome/crush injury

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30
Q

recurrence with DIP cyst aspiration

A

up to 40 %

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31
Q

contraindiciation to moberg flap

A

if its > 1.5cm- otherwise it would increase stiffness

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32
Q

CMC and MCP arthritis

A

resection arthroplasty of CMC with MCP fusion - when MCP is > 40 deg

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33
Q

MCP hyperextension

A

0-10 is non-op; 10-20 deg is perc pinning; 20-40 capsulodesis

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34
Q

zone 1 jersey finger tx

A

surgery

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35
Q

when should you replant at zone 2

A

only with thumb

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36
Q

when to repair ring avulsion injuries`

A

ONLY if no bone, tendon or nerve injury - vascular is ok

37
Q

hand amputation tx

A

if zone 3 or proximal you should replant

38
Q

structures needing release in peds trigger

A

A1; A2 or A3 sometimes; FDS slips (notta nodule)

39
Q

what is associated with thumb hypoplasia

A

radial aplasia; thrombocytopenia, renal CNS CV abnormalities

40
Q

structure at risk b/w palmaris longus and FCR

A

cutaneous branch of median nerve

41
Q

extension vs neutral splinting for CTS

A

extension is more functional but can worsen symptoms; neutral is best for night time - least pressure

42
Q

cause of madelung

A

impaired growth of volar/ulnar phsysis of Distal radius due to either bony lesion or vicker’sligament

43
Q

lethal condition a/w radial club hand

A

Fanconi’s anemia - auto recessive; get CBC, c-some analysis - typically noted at 6-9 years;

44
Q

z plasty lengthening amounts

A

30 deg, 45 deg and 60 deg gives 25-50-75% respectively

45
Q

tx of macrodactylyl

A

fuse physis when finger reaches length of same sex parent

46
Q

max amount of distance for FDP repair

A

must be < 1cm; if longer consider staged or grafting with palmaris; silicone rod for collapses sheath

47
Q

deep vs superficial palmar arch

A

deep is more proximal and radial artery; superificial is supplied by ulnar artery and is distal

48
Q

grip at pinch strengthe after CTS release

A

typicall by 3 months its at 100% or higher

49
Q

Bunnell’s test

A

increased PIP flexion when you go from MCP extension to MCP flexion - indicates intrinsic tightness

50
Q

central slip injury causes

A

boutonniere

51
Q

replantation order

A

bone; extensor tendons; flexor tendons; artery; then vein or nerve; last skin

52
Q

ischemia time

A

12 hrs for cold , 6 for warm

53
Q

main complication of distal phalanx orif

A

symptomatic hardware requiring removal

54
Q

order of SLAC wrist degen changes

A

Radioscahpoid, capitolunate, lunate is last to go if at all

55
Q

function of proper and accessory collateral lig in thumb

A

both restrain against radial deviation - PCL is for flexion; ACL is extension

56
Q

1st dorsal compartment contents

A

APB, EPL

57
Q

complication with correct syndactyly

A

Web creep, the most common complication of this procedure, is the distal migration of the web commissure seen in surgically corrected syndactyly patients.

58
Q

what is often torn in volar PIP dislocation

A

Central slip

59
Q

most common dorsal ganglion in hand

A

via wrist in SL ligament

60
Q

spiral cord in Dupuytrens

A

spiral cord will be lateral and deep to the NV bundle

61
Q

composition of spiral cord in Dupuytrens

A

pretendinous band, spiral band, grayson ligament, and latearl digitial sheath

62
Q

spiral cord’s effect on NV bundle

A

displaces it centrally and superficially

63
Q

central cord in Dupuytrens

A

extension of pretendinous band - causes PIP contracture

64
Q

best finger rehab protocols are

A

low force, high excursion

65
Q

wassel thumb classification (1-6)

A

1 -bifid distal phalanx, 2. dupilicat distal phalanx, 3. duplicate distal phalanx with forked middle phalanx; 4. double phalanxes, 5. doubles with bifid metacarpal; 6. double digit all the way to Metacarpal; 7. triphalanx

66
Q

what does NOT run in the carpal tunnel

A

FCR

67
Q

risk factors for amniontic band syndrome

A

low birth weight and premature < 37 weeks

68
Q

meisser corpuscle

A

rapid adapting sensory receptor - sensitive to touch

69
Q

merkel’s skin receptor

A

slow adapting - detect (sustained) pressure, texture, low Hz vibration and eval by 2 point discriminiation

70
Q

Pacinian corpuscles

A

respond to high Hz vibration and rapid indentations of the skin

71
Q

Ruffini corpuscles

A

slow adpating for skin stretch

72
Q

tx of hypothenar hand syndrome

A

there are 2 components, thrombosis and aneurysm; if thrombosis > 2 weeks conservative; < 2 weeks fibrinolysis; if aneurysm then excision and repair or vein graft

73
Q

sx of madelungs

A

ulnocarpal impaction; reduced forearm rotation; median nerve compression

74
Q

bilateral madelung seen with

A

Leri Weil (SHOX gene) sex dominant mutation

75
Q

dorsal wrist compartment 4 contents

A

PIN and EDC

76
Q

thumb flaps

A

if volar and < 2cm - Moberg; if > 2cm then FDMA flap

77
Q

cross finger flap indiciations

A

volar based injuries to non-thumb digits

78
Q

thenar flap for

A

volar based injuries to index and middle

79
Q

low vs high median n compression

A

in low mostly thumb opposition is lost; in high thumb opposition, IP flexion and middle finger flexion have to be addressed

80
Q

beurgers and smoking cessation

A

leads to decreased disease progression and decreased amputation

81
Q

which nerves recover best

A

radial, musculocutaneous; and femoral

82
Q

Froments sign

A

using FPL (AIN) to compensate for thumb opposition due to ulnar nerve deficit

83
Q

Kienbock stage 3 vs 4 tx

A

stage 3 - STT fusion w or w/o lunate excision or PRC: stage 4 is always PRC

84
Q

lumbrical plus

A

loss of FDP function (either severed or too long) can lead to paradoxial PIP EXTENSION with attempted flexion

85
Q

Apert syndrome

A

fgfr2- facial dysmorphia and complex syndactyly

86
Q

nat hx of peds trigger thumb

A

60% resolve without tx; of those that done; the flexion improves a lot

87
Q

which polydactyly is more common in African Americans

A

post-axial (pinky side)

88
Q

tx of pediatric collapsed thumb

A

serial splinting

89
Q

cuase of peds collapsed thumb

A

absence of EPB and or EPL

Ravi Board/OITE Prep (9 decks)

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