Hand Flashcards
tx of traumatic sagittal band injury
leads to extensor tendon subluxation; in pro athelte -open repair; in others extension splinting if acute (< 4-6weeks)
PIN innervation
EDC, EDM, ECU, EPB, EPL, EIP, APL and SOMEtimes ECRB
kids with radial defects need what other work up
Echo, Renal US, CBC - looking for VATER or VACTERL or fanconis anemia
surgery for DIP joint fracture
if > 30% of joint surface
which frx to use dorsal extension block
PIP fracture dislocation with < 40% joint surfac; if JUST dislocation - splint
peds thumb trigger finger- what age
typically by age 2; non op after age 3 does not work
what is lumbrical plus
FDP rupture and retraction leads to paradoxixal IP joint extension when trying to flex
segmental nerve injuries use which graft
collagen conduit
annular pulley order
A1,3,5, over the joints. C1,2,4
size limits of volar island flap
2.5 to 3.5 cm defect on volar aspect
pip joint fractures - does anatomic reduction matter
no
pre vs post axial poly dactyly
pre is thumb side duplication; post is small finger side
which polydactyly in whites needs a work up
POST (pinky side) axial
thrombosis after digit replantation
venous/congestion is typically WITHIN 12 hours ; arterial is after 12 hours
cubital tunnel syndrome structures
MCL and Osbournes ligament - ulnar nerve
endo vs epi vs perineurium
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
tx of stage 3 SLAC
4 corner fusion
grayson and clelands lig with Dupuytrens
only Graysons is involved
tx of hemmorrhagic blister
drainage with skin left intact - do NOT debride or if intact; leave alone in dry dressings
stages of Kienbocks
Lichtman 1. normal xr, needs MRI; 2. sclerosis; 3. sclerosis + collpase; 4. adjacent degeneratio
flap for dorsal thumb defects
Kite flap from 1st dorsal metacarpal artery
tx of DRUJ OA in laborer
ulnar hemiresection + TFCC recon in heavy laboroer
darrach procedure
resection of distal ulna head (only for elderly/low demand)
after nerve injury, which part does wallerian
distal segment does wallerian degen (phagocytes eat the nerve)
Blauth IIIA and IIIB
presence of cmc joint stability in Blauth IIIA. The CMC joint must stable for grasp and pinch.
arterial blood supply to a medial gastroc flap
sural artery.
Wafer procedure
ulnar prominence with impingment and TFCC tear
basis for claw hand
weak intrinsics; strong extrinsics - called intrinsic minus
causes of intrinsic minus
Volkmann’s contractre; leprosy; HMSN, ulnar or median nerve palsy; compartment syndrome/crush injury
recurrence with DIP cyst aspiration
up to 40 %
contraindiciation to moberg flap
if its > 1.5cm- otherwise it would increase stiffness
CMC and MCP arthritis
resection arthroplasty of CMC with MCP fusion - when MCP is > 40 deg
MCP hyperextension
0-10 is non-op; 10-20 deg is perc pinning; 20-40 capsulodesis
zone 1 jersey finger tx
surgery
when should you replant at zone 2
only with thumb
when to repair ring avulsion injuries`
ONLY if no bone, tendon or nerve injury - vascular is ok
hand amputation tx
if zone 3 or proximal you should replant
structures needing release in peds trigger
A1; A2 or A3 sometimes; FDS slips (notta nodule)
what is associated with thumb hypoplasia
radial aplasia; thrombocytopenia, renal CNS CV abnormalities
structure at risk b/w palmaris longus and FCR
cutaneous branch of median nerve
extension vs neutral splinting for CTS
extension is more functional but can worsen symptoms; neutral is best for night time - least pressure
cause of madelung
impaired growth of volar/ulnar phsysis of Distal radius due to either bony lesion or vicker’sligament
lethal condition a/w radial club hand
Fanconi’s anemia - auto recessive; get CBC, c-some analysis - typically noted at 6-9 years;
z plasty lengthening amounts
30 deg, 45 deg and 60 deg gives 25-50-75% respectively
tx of macrodactylyl
fuse physis when finger reaches length of same sex parent
max amount of distance for FDP repair
must be < 1cm; if longer consider staged or grafting with palmaris; silicone rod for collapses sheath
deep vs superficial palmar arch
deep is more proximal and radial artery; superificial is supplied by ulnar artery and is distal
grip at pinch strengthe after CTS release
typicall by 3 months its at 100% or higher
Bunnell’s test
increased PIP flexion when you go from MCP extension to MCP flexion - indicates intrinsic tightness
central slip injury causes
boutonniere
replantation order
bone; extensor tendons; flexor tendons; artery; then vein or nerve; last skin
ischemia time
12 hrs for cold , 6 for warm
main complication of distal phalanx orif
symptomatic hardware requiring removal
order of SLAC wrist degen changes
Radioscahpoid, capitolunate, lunate is last to go if at all
function of proper and accessory collateral lig in thumb
both restrain against radial deviation - PCL is for flexion; ACL is extension
1st dorsal compartment contents
APB, EPL
complication with correct syndactyly
Web creep, the most common complication of this procedure, is the distal migration of the web commissure seen in surgically corrected syndactyly patients.
what is often torn in volar PIP dislocation
Central slip
most common dorsal ganglion in hand
via wrist in SL ligament
spiral cord in Dupuytrens
spiral cord will be lateral and deep to the NV bundle
composition of spiral cord in Dupuytrens
pretendinous band, spiral band, grayson ligament, and latearl digitial sheath
spiral cord’s effect on NV bundle
displaces it centrally and superficially
central cord in Dupuytrens
extension of pretendinous band - causes PIP contracture
best finger rehab protocols are
low force, high excursion
wassel thumb classification (1-6)
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
what does NOT run in the carpal tunnel
FCR
risk factors for amniontic band syndrome
low birth weight and premature < 37 weeks
meisser corpuscle
rapid adapting sensory receptor - sensitive to touch
merkel’s skin receptor
slow adapting - detect (sustained) pressure, texture, low Hz vibration and eval by 2 point discriminiation
Pacinian corpuscles
respond to high Hz vibration and rapid indentations of the skin
Ruffini corpuscles
slow adpating for skin stretch
tx of hypothenar hand syndrome
there are 2 components, thrombosis and aneurysm; if thrombosis > 2 weeks conservative; < 2 weeks fibrinolysis; if aneurysm then excision and repair or vein graft
sx of madelungs
ulnocarpal impaction; reduced forearm rotation; median nerve compression
bilateral madelung seen with
Leri Weil (SHOX gene) sex dominant mutation
dorsal wrist compartment 4 contents
PIN and EDC
thumb flaps
if volar and < 2cm - Moberg; if > 2cm then FDMA flap
cross finger flap indiciations
volar based injuries to non-thumb digits
thenar flap for
volar based injuries to index and middle
low vs high median n compression
in low mostly thumb opposition is lost; in high thumb opposition, IP flexion and middle finger flexion have to be addressed
beurgers and smoking cessation
leads to decreased disease progression and decreased amputation
which nerves recover best
radial, musculocutaneous; and femoral
Froments sign
using FPL (AIN) to compensate for thumb opposition due to ulnar nerve deficit
Kienbock stage 3 vs 4 tx
stage 3 - STT fusion w or w/o lunate excision or PRC: stage 4 is always PRC
lumbrical plus
loss of FDP function (either severed or too long) can lead to paradoxial PIP EXTENSION with attempted flexion
Apert syndrome
fgfr2- facial dysmorphia and complex syndactyly
nat hx of peds trigger thumb
60% resolve without tx; of those that done; the flexion improves a lot
which polydactyly is more common in African Americans
post-axial (pinky side)
tx of pediatric collapsed thumb
serial splinting
cuase of peds collapsed thumb
absence of EPB and or EPL
