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Hand Flashcards

1
Q

PIP joint OA treatment

A

central fingers with no deformity get arthroplasty; border (index/ring) get fusion - create a cascade with more flexion at pinky PIP 30 to 45 in 5deg increments

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2
Q

tx of a flexible swan neck

A

PIP splinting to prevent hyperextension

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3
Q

nerve grafting based on trunk

A

upper and middle trunk do better; lower trunk generall better with transfers - this is bc of the distance from nerve to muscle

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4
Q

tendon nutrition in watershed area

A

over proximal phalanx via syovial fluid diffusion - called imbibition

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5
Q

consequence of exicsion of distal scaphoid pole in carpal instability

A

can lead to non-dissociative carpal instability

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6
Q

what is risk of 6U portal

A

high risk of injury to dorsal sensory branch of ulnar nerve

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7
Q

tx of coller button interwebspace abscess

A

dorsal and palmar incisions that do NOT cross the webspace

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8
Q

if PIP or DIP stays extended with passive wrist flexion then

A

there is a flexor tendon injury/discontinuity

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9
Q

bowstringing in thumb caused by

A

incompetent oblique pulley - equivalent to A2 pulley

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10
Q

Wasse and Flatt classificaiton applies to

A

PRE-axial (thumb) polydactyly; IV and II are most common

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11
Q

ulnar vs radial perfusion to hand

A

ulnar is dominant perfusion in most patients

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12
Q

radial digital nerve to thumb course

A

branch of median nerve that crosses the A1 pulley ulnar to radial

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13
Q

what is clinodactyly and 2 types

A

radioulnar deviation during development of fingers; usually 5th finger; simple is bony, complex is bony+ soft tissue; uncomplicated 15-45 deg; and complicated > 45deg

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14
Q

clinodactyly

A

angular deformity; usually only cosmetic; generally does not respond to splinting; 15-45 is uncomplicated; 45+ rotation is complicated

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15
Q

warm ischemia time limit

A

6 hrs if large amounts of muscle; 12 hrs if NO muscle

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16
Q

what causes Wartenberg sign

A

overpull of extensor digiti minimi

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17
Q

radial artery course at wrist and palm

A

cross over FCR and into thenar compartment to make the superficial palmar arch; deep branch passes DEEP to APL/EPB and splits head of 1st Dorsal interosseous splits into princeps policis and branch to deep arch

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18
Q

flexor tenosynovitis w.out improvement

A

if no change in 24-48 hrs repeat the I&D with extensile incision

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19
Q

tendon transfer for high radial nerve injury

A

use pronator terres to ERCB; palmaris longus to EPL; variable transfer to EDC

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20
Q

high vs low median nerve injury

A

high has insensate to the palm; high knocks out all Flexors except ulnar FDP and FCU; low median n injury only knocks out thumb opposition

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21
Q

first step for suspected guyon canal syndrome

A

EMG - not a CT scan or ultrasound to look for pathology. First need to confirm it_s a LOW ulnar nerve problem

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22
Q

3 zones of guyon canal - zone 1

A

1 - at proximal edge of volar carpal ligament and ends at nerve burfication (1cm distal to pisiform); ulnar artery bifurcates DISTAL to the ulnar nerve

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23
Q

best prognosis of birth plexus injury

A

return of biceps by 2 months; if after 5 months then incomplete recover

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24
Q

scapholunate ligament - strongest part

A

C-shaped on sagittal view, DORSAL third is the strongest part

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25
Q

structure at risk during peds trigger thumb release

A

radial digital nerve

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26
Q

max distance for nerve conduit

A

3cm

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27
Q

what tendon makes up the palmar aponeurosis

A

palmaris longus

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28
Q

low vs high ulnar injury - which has worse clawing

A

low has worse clawing bc FDP is preserved to ring and little fingers

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29
Q

superifical raidal nerve is how far from styloid

A

7cm proximal to radial styloid on ulnar side of PIN

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30
Q

tendon adhesions risk factors after repair

A

gap > 3mm, surgery, crush injury, immobilization

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31
Q

lumbrical anatomy

A

lumbrical 1 and 2 are innervated by median nerve an unipennate; 3-4 are bipennate and ulnar nerve

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32
Q

PIP arthroplasty criteria

A

must have good bone stock and sensibility of the joint; normal functioning tendons, if collaterals are out then use silicone; otherwise can use surface

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33
Q

lumbrical plius finger is

A

paradoxical extension of PIP and DIP due to flexor disruption; tx is release of lumbrical tendon. - can be caused by a long FDP graft

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34
Q

tx for fifth MC fracture

A

if comminuted and articular - ORIF

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35
Q

STT OA treated with

A

STT fusion if trapeziometacarpal is NOT involved; if metacarpal is inovlved then CMC arthoplasty or trapeziectomy

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36
Q

SSEP and pre-post ganglionic lesions

A

absent in post or combo pre/post lesions

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37
Q

acid vs alkali burns

A

acid is via liquefaction necrosis; alkali burns more subtle initially but penetrate deeper and saponification of adispose

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38
Q

where do the thenar muscles originate

A

Abductor, Flexor Policis and Opponens policis all start on the transverse carpal ligament - the ADDuctor - starts LONG/middle finger MCP

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39
Q

types of nerve transfers

A

intra and extra plexal; intral includes phrenic and parts of median or ulnar; extra plexal include intercostals, contralateral C7 and hypoglossal

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40
Q

long thoracic is made up of which roots

A

C5-6-7

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41
Q

adv of full thickness skin graft

A

includes sweat, hair, and nerve endings - better sesnation and more durable so less contraction

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42
Q

best conditions for tenolysis

A

local tendon adhesions, no contractures, full PROM; motivated

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43
Q

MCP collateral ligaments are most taught at what position

A

MCP flexion at 90

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44
Q

3 zones of guyon canal - zone 2

A

between palmaris brevis fascia and pisohamate/pisometacarpal ligaments - deep motor branch hooks around the hamate

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45
Q

which ligament stays connected in perilunate dislocation

A

SHORT radiolunate

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46
Q

mannerfelt lesion

A

FPL rupture due to bony prominence of scaphoid rubbing on tendon

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47
Q

STAGE 2 SLAC defined by

A

arthritis of entire radioscaphoid joint - radioLUNATE is spared

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48
Q

wassel IV is

A

doubel proximal and distal thumb phalanx

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49
Q

FDS rupture in RhA - tx

A

observation

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50
Q

2 rows of carpal bones

A

proximal contains the scaphoid, lunate, triquetrum, pisiform; distal is capitate, hammate, trapezoid; trapezium

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51
Q

transfers for LOW radial nerve injury

A

same as brand minus those for ERCB - wrist extension is preserved

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52
Q

course of palmar cutaneous branch of median nerve

A

exits median nerve 5cm proximal to wrist crease; runs in FCR /palmaris longus interval and goes superifical to carpal tunnel to supply sensation to thenar eminence

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53
Q

martin gruber connection

A

connection between median/ulnar nerve proximal to AIN branch or within FDP (15% of people)

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54
Q

1st step in scaphoid non-union diagnosis

A

CT through scaphoid axis

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55
Q

froment sign

A

ulnar nerve injury causing except thumb IP flexion for pinch

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56
Q

what is effect of delayed, >6mons nerve repai

A

decreases number of regenerating axons and their response to growth factors

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57
Q

tx of scaphoid non union with humpback

A

MFC graft and fixation

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58
Q

tx of severe wrist-finger contracture

A

PRC with wrist fusion

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59
Q

tx of boutoneiire

A

splint for 1st step; then 2nd line is recon of extensor/central slip; 3rd line is generally PIP fusion/arthroplasty if rigid

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60
Q

SNAP testing in pre-vs post-ganglioninc injury

A

in PRE ganglionic injury patient may be INSESNATE but show a NORMAL SNAP with absent motot

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61
Q

where is 3-4 portal

A

1cm distal to listers

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62
Q

order of innervation for PIN

A

ECU is FIRST to return, EIP is LAST

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63
Q

2nd line tx of swan neck

A

FDS tenodessis, and fowler central slip tenotomy to reduce PIP hyperextension +/- intrinsic release

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64
Q

Dorsal interossei muscle belleies

A

SUPERFICIAL belly goes UNDER sagittal hood to ABDUCT; DEEP belly goes OVER the sagittal band and helps extend MCP

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65
Q

lunula

A

white portion of proximal nail

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66
Q

Riche-cannieu connection

A

connection between median/ulnar nerve in FPB - 50-77% of people

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67
Q

high chance of what with hemidiaphragm paralysis

A

C5 nerve root avulsion

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68
Q

loss of finger extension in RhA Differential

A

Sagital band rupture, extensori tendon rupture, PIN palsy due to elbow synovitis, or MCP flexion contracture;

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69
Q

concern for gout and infection what next

A

start abx and get Cx as first next step

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70
Q

most common pattern fo supraclavicular BPI

A

all roots avulsed - up to 75-80% of traumatic BPI

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71
Q

FCR tendonitiis is a/w

A

Scaphotrapezial OA

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72
Q

stage 3 SLAC tx

A

Fourc corner fusion; then PRC; total wrist fusion

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73
Q

FCR in LRTI resotres which ligament

A

the intermetacarpal ligament

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74
Q

spiral bands relationship to NV bundler

A

it is DORSAL to NV bundle and inserts on lateral digital sheet

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75
Q

denervation changes in EMG are seen when

A

as early as 10-14 days in proximal musclce; and 4-6 weeks in distal - look for fibrillations and sharp waves

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76
Q

axonotmesis and wallerian degen

A

DOES occur on the part NOT connected to the cell body

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77
Q

brachial artery and median nerve anatomy

A

brachial Aa is LATERAL to medial nerve at elbow/antecubital fossa

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78
Q

after burn care what position to splint hand

A

splint in intrinsic plus to AVOID intrinsic minus

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79
Q

thoracodorsal comes off which cord

A

POSTERIOR cord

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80
Q

VISI vs DISI

A

SL is strong dorsally so if its out you get DISI; LT is strong volarly so if its out you get VISI

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81
Q

what stimulates tendong fibroblasts

A

platelet-derived GF stimulates fibroblasts to proliferate and make collagen I

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82
Q

pre-axial polydactyly

A

thumb side; more common in white; generally SPORADIC

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83
Q

weakest link at tendon repair is

A

suture KNOT

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84
Q

vascular supply of the hypogastric aa flap

A

superficial inferior epigastric artery

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85
Q

MSC nerve gets contributions from which roots

A

C5-7

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86
Q

nerve action potentials positivs vs negative

A

negative indicates neuropraxia; positive indicates axonotmesis (good recovery)

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87
Q

which is more pain full - pre or post ganglioninc

A

pre ganglionic is more painful with more dysesthesias etc

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88
Q

central cord vs spiral cord in Dupuytrens

A

central cord does NOT involve NV bundle and causes MCP contracture; spiral cord is PIP contracture and will merge with grayson lig

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89
Q

why does raidal nn injury above elbow lead to weak grip

A

secondary to lost wrist extension

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90
Q

tendon transfer for high radial nn injury

A

pronator terres to ERCB, Palmaris longus to EPL; and FCR to EDC

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91
Q

characterisitic of radial longitutidinal deficiency

A

thumb aplasia or hypoplasia; elbow contracture and radial deviation of hand

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92
Q

tx of radial longitudinal deficiency

A

stretch the radial soft tissue with casting then centralize ulna with ring MC or index MC

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93
Q

typical nerve transfers for C5-6 injuries

A

spinal accessory to suprascapular; triceps branch of radial to axillary and ulner nerve fasical to help biceps

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94
Q

most common congential hand difference

A

syndactyly

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95
Q

paronychium

A

lateral nail fold

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96
Q

radial nerve injury timing of tendon transfers

A

can do early within a week with single extensor to behave as a splint; delayed is generally performed at 6-18months

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97
Q

steroid for lateral epicondylitis - outcomes

A

better relief at 6 weeks; but increased persistent pain at 1 year

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98
Q

best case for nerve conduit

A

sensory nerve with gap < 10mm

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99
Q

what transfer for axillary n injury

A

use triceps branch of radial nn to axillary (leechavengvang transfer)

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100
Q

most common extra articular manifestation of RhA

A

subQ nodules

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101
Q

pediatri trigger finger treatment

A

relase of A1 and partial A2, A3 release AND release of 1 slip of FDS

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102
Q

with ulnar drift without MCP disease what is the soft tissue recon

A

address the extensor subluxation; collateral ligament laxity; synovitis, and volar plate disruption

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103
Q

lumbicals start and insert WHERE

A

start on FDP and insert on RADIAl side of extensor apparatus

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104
Q

what is assoc with failure of inject DeQ

A

EPB subsheaths

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105
Q

opponens digit minimi role

A

supinates litter finger MCP to allow thumb opposition

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106
Q

FDP rupture in RhA

A

fusion of DIP

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107
Q

PRC vs 4 Corner

A

PRC disadvantages - lost wrist ROM and grip strength; AVOID if capitate head has degen; 4 Corner - lunate; capitate; hamate; triquetrum - keeps 60% of motion; 80% grip strength

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108
Q

intrinsic vs extrinsinc tendon healing

A

intrinsic is from within tendon and predominates with early motion; extrinsic is from tendon sheath and predominates with immobilization

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109
Q

tx for stage 3b keinboch

A

PRC; preserves grip strength and motion.

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110
Q

in RhA - tx of FPL rupture

A

if advanced disease just do IP fusion; otherwise FDS transfer or graft with spur resection

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111
Q

principles of distal forearm or wrist replant

A

bone shortening to allow tension free anastomosis; repair ALL cutaneous sensory branches

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112
Q

thumb hypoplasia epidemiology

A

bilateral and M=F incidence

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113
Q

median nn route into forearm

A

through sup, and deep heads of pronator terres

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114
Q

max time to mobilize after collagenase for duputrens

A

up to 7 days; best time is 24-48hrs

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115
Q

median ulnar interconnections called

A

martin-gruber in forearm; riche cannieu in hand. Motor interconnections from median to ulnar

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Perfectly
116
Q

thumb hypoplasia classification

A

Buck -Gramcko - 1 is smaller but normal; 2 is skinny phalanx and small with variable thena muscles and CMC instability; III is missing proximal metacarpal and thenars; IV is a floating/thumb nubbin; V is most common - absent thumb

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117
Q

tx of raynaud vasospasm

A

ca channel blocker, then botox A injection

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118
Q

what nerve is at risk with 3-4 portal

A

Sup radial sensory nn about 16mm away

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119
Q

extrinsic wrist ligaments whats stronger

A

VOLAR

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120
Q

stennar lesion

A

thumb ucl tears and flips outside the joint and lays on TOP of the adductor apponeurosis- needs surgery will not heal on its own

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121
Q

what is pathologic widening on SL gap

A

> 3mm; if a NON-stress xray its automaticlally static unstable or DISI

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122
Q

tx of lupus in hadn

A

spinting and MCP soft tissue treatments have HIGH failure rates; generally arthroplasty or fusion for MCP; and fusion of PIP/DIP

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123
Q

lowest revision rate for PIP arthroplasty

A

silicone volar approach is best; surface replacement dorsal is worst

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124
Q

minimum nerv graft length

A

10% longer than the gap to avoid tension

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125
Q

surgery for herpetic whitlow

A

CONTRAindicated due to bacterial superinfection

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126
Q

epitendinous repair points

A

improves tendon contour, enhances repair strength, and reduces gap formation; running stitch has lower tensile strength than crossed stich or locked mattress

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127
Q

extensor tendon repairs

A

if > 50% then repair otherwise observe. Proximal injuries do better

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128
Q

x finger vs rev x finger flap

A

rev is the adipofascial tissue used to cover the DORSAL aspect of adjacent finger. X-finger is for the volar side only

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129
Q

most common carpal coalition

A

lunotriquetral - most common in blacks; usually Asx

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130
Q

macrodactyly epidemiology

A

typically UNIlateral; radial digits

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131
Q

if you lose wrist extension you also lose

A

grip strength

132
Q

main fragment in bennet fracture

A

volar ulnar fragment attached to ant oblique ligament; APL and Adductor Policis pulls the thumb MC dorsal-radial

133
Q

tx of Stage 2 SLAC

A

PRC vs 4 Corner Fusion, (other options include radioscapholunate fusion; total wrist fusion, total wrist arthroplasty)

134
Q

where is the parona space

A

between the FDP and pronantor quadratus fascia - facilitates communication between radial and ulnar fascia

135
Q

kleinert vs duran rehab

A

both are low force low excursion - Kleiner uses dorsal blocking splint with wrist at 45 flexion and elastic bands from fingers to palm.

136
Q

anconeus innervated by

A

radial nerve; NOT PIN

137
Q

marjolin ulcer is what type of CA

A

squamous cell ca

138
Q

contribution to wrist motion radiocarpal vs midcarpal

A

Wrist flexion - 60% is midcarpal, 40% is radiocarpal; Wrist Extension 33% of motion is midcarpal; 66% is via radiocarpal

139
Q

nerve transfer for shoulder abduction and Ext rot

A

use spinal acessory and transfer to suprascapular nerve in nerve transfer

140
Q

EIP anatomy

A

runs MOST distal muscle belly; the tendon of EIP is ULNAR to the EDC tendon for index

141
Q

lumbrical plus deformity

A

due to excess intrinsic tightness leading to IP joint EXTENSION when attempting to perform IP flexion

142
Q

how to recon a thumb with Wassel duplication

A

must preserve the radial componetns and ulnar components from either side and conjoin to the better developed digit

143
Q

tx of AVN of capitate

A

if no collapse or arthritic change consider vascular bone graft; if collapse and capitate OA - the mid carpal fusion

144
Q

post-axial polydactyly

A

pinky side; Auto Dominant and more common in African americans

145
Q

volar plate anatomy

A

starts at A2 pully and inserts on P2 - prevents hyperextension

146
Q

what percent of distal radius fractures lead to intercarpal instability

A

30% of DISPLACED and INTRAARTICULAR DR frx lead to this

147
Q

in phase tendon transfers for hand-wrist

A

wrist extension, finger flexion and thumb adduction OR wrist flexion finger extension, thumb ABDuction

148
Q

tx of advanced glenohumeral dysplasia from brachial plexus injury

A

external rotation humerus osteotomy

149
Q

dx and tx of fanconi’s

A

mitomycin C or diepoxybutane chromosome challenge - tx with bone marrow txp

150
Q

pseudogout

A

ROD shaped, weakly positive birefringent crystals - calcium pyrophosphate

151
Q

what axial flap is for elbow area

A

anconeus flap supplied by descending branch of profunda brachii

152
Q

what percent of trigger thumb resolves spont.

A

30-65%

153
Q

what motion is allowed in PIP extension splint

A

DIP flexion/extension to reduce gap in extensor tendon injury

154
Q

tendon transfer for intrinsics in ulnar nn injury

A

use slips of FDS and suture to dorsal aspect of lateral bands

155
Q

gout crystals

A

NEEDLE like; NEGATIVE birefringement monosodium crystals

156
Q

transverse retinacular ligmaent role and location

A

runs at level of PIP and prevents DORSAL subluxation

157
Q

what is natatory ligament and role

A

superficial fibers of transverse metacarpal ligament IN the WEBSPACE - prevents digital abduction

158
Q

eponychium

A

dorsal nail fold - proximal to nail plate - adds shine to the nail

159
Q

rehab protocols for fingers

A

passive protocols - low force, high excursion, Kleinert and Duran; early AROM - moderate force and high excursion (dorsal block splint); and synergistic motion - low force high excursion - uses acitve wrist extension and passive digit motion

160
Q

DRUJ portal

A

1cm proximal to 4-5 radiocarpal portal

161
Q

annular pulley of the thumb

A

A1 and obliqu are most important, A1 is at MCP; A2 is at the IP joint

162
Q

scaphoid non union with humback deformity tx

A

free vascularized medial femoral condyle graft

163
Q

warm perfused digits with blisters tx

A

if hand is perfused and warm; no reason for rewarming bath - surgical debridement of blsiters

164
Q

ulnar nerve and FCU anatomy

A

the nerve is RADIAL to FCU

165
Q

early AROM vs PROM motion protocols

A

similar rates of rerupture, more motion and less contractures with AROM

166
Q

raynauds like sx but Ulnar only - what is dx

A

hypothenar hammer syndrome caused by ulnar artery thrombosis

167
Q

what is terminal branch of MSC nerve

A

Lateral antebrachial cutaneous

168
Q

ulnar ligaments of thumb - proper vs accessory

A

proper runs from the prox phalax to MCP head; accessory runs from MCP head to volar plate

169
Q

what is oberlin transfer

A

using two fascicles of ulnar nerve to restore elbow flexion; can also augment with median nerve fasicle

170
Q

CT myelography will show what in nerve root avulsion injury

A

pseudomyelomeninogcele at 3-4 weeks after injury

171
Q

tendon transfer for low median nn injury

A

goal is to restore fxn of thumb opposition 4 ways - FDS, EIP, Abd Digit Minimi; or least valuable is a palmaris longus transfer

172
Q

tx of PIP dupuytresn greater than 60

A

better to fuse

173
Q

borders of guyons canal

A

hook of hamate radially, pisiform ulnar, sits on the TCL and motor branch dives into hypothenar aponeurosisi made by abductor digit minimi

174
Q

which fingers is PIP silicone arthroplasty not ideal

A

active patient for index and long finger - high rate of failure

175
Q

deforming forces on bennet frx

A

AbdPL, AddPB, EPL, EPB - all pull dorsal, radial and proximal

176
Q

what is the course of the pretendinous band of the skin

A

travels superficial to transverse fibers of palmar aponeurosis - inserts skin at MCP - trifurcates into radial and ulnar spiral cords and a central band

177
Q

cubita tunnel is exacerabted by what position

A

elbow flexion and shoulder abduction

178
Q

epineural repair vs fascicle repair

A

neither is superior

179
Q

first step for eval of ulnar vascular AVM

A

ultrasound doppler - then can proceed with angio

180
Q

scaphoid pole frx tx

A

even if non-displaced treat with screw fixation - high rate of displacement and nonunion.

181
Q

types of jersey finger

A

type 1 avulses off and retracts to palm, vascularity is disrupted and needs fixation in 7-10days; type 2 is to PIP and vinculum are intact; 3 is with bone piece - 2and 3 can be fixed in weeks

182
Q

tx of raynauds with ulceration

A

start with topical nitrates which increase cGMP to vasodilate finger vessels

183
Q

carpal instability timeline chronic

A

after 6 weeks its chronic

184
Q

recurrent motor branch of median nerve supplies

A

ABDuctor policis brevis; FPB, and Opponens Policis

185
Q

trigger finger more common in these conditions

A

RhA, DM, HypoThyroid, Sarcoid, Gout or pseudogout, amyloidosis

186
Q

main stabilizers of thumb CMC joint

A

dorsal ligamentous complex - dorsoradial ligament and posterior oblique ligament; and the DEEP anterior oblique ligament

187
Q

what must preserved in 4C fusion or PRC

A

Radioschaphocapitate ligament - otherwise will see ulnar translocation of carpus

188
Q

radial bursa is located

A

at MCP joint and extends 1-2cm proximal to radial tranverse carpal ligament - continuous with FPL sheath

189
Q

Flexor pollicis BREVIS innervation

A

dual innervation - superifical is median nerve; deep head is ulnar nerve

190
Q

Dorsal intercarpal ligament is between

A

triquetrum and scapho/trapezoid/capitate

191
Q

first dorsal wrist compartment

A

APL and EPB; APL usually has 2 slips

192
Q

compartments of the hand

A

thenar, Adductor policis, hypothenar compartment, 4 dorsal, 3 volar interosseous compartments, and carpal tunnel

193
Q

replant b/w DIP and PIP

A

generaly good outcomes

194
Q

tendon transfer for high median nn injury

A

Brachioradialis to FPL; side to side suturing of FDP of index and long fingers to rest of the digits

195
Q

last muscle innervated by radial nerve

A

EIP is the last muscle BUT; the last testable one is EPL

196
Q

where do first and second dorsal compartments’ tendons cross

A

approximately 7cm proximal to wrist

197
Q

supply of free fibula flap

A

peroneal artery or branch of ant tib artery

198
Q

holt-oran syndrome

A

radial longitudinal deficiency with cardiac structure issues - AV septal defects(TBX5 gene)

199
Q

rigid swan neck deformity

A

if joint disease - fusion; if joint is preserved - dorsal capsule release; mobilize lateral band and release collaterals and extensor tenolysis

200
Q

triagnular ligament role

A

prevents VOLAR subluxation of lateral bands at middle phalanx

201
Q

common digital nerves of median nerve sit between

A

flexor tendons and superfiical palmar arch

202
Q

how to identify EIP tendon in 4th compartment

A

has the most distal muscle belly

203
Q

vascular supply of groin flap

A

superficial cicrumflex iliac artery, runs along the inguinal ligament

204
Q

distal radius frx redisplacement was related to

A

initial dorsal angulation exceeding 20 degrees, dorsal comminution, extension into the radiocarpal joint, concomitant ulna fracture, and age older than 60 years

205
Q

vascularity of medial gastroc flap

A

sural artery

206
Q

what is the tendon transfer for C8-T1 injury

A

Brachioradialis to FPL; ECR to FDP; and EIP for Thump opposition

207
Q

stages of SLAC

A

1 is Scapohoid and Radial styloid degenerate, 2 is entire Radioscaphoid; 3 is Radioscaphoid + capitolunate; 4 is pan carpal OA

208
Q

grayson ligament

A

originates from flexor sheath runs volar to the NV bundle and is perpendicular to digital axis

209
Q

superficial palmar arch and median nerve

A

its SUPERFICIAl to medial nerve

210
Q

rewarming guidelines for frost bite

A

40-42 celsius (104-108F) for 30 min

211
Q

6U vs 6R portals

A

on either sde of the Extensor Ulnar carpi tendon

212
Q

main tendon transfer for HIGH median nn injury

A

brachioradialis to FPL; restore index FDP by side to side suturing of all finger FDP in distal forearm

213
Q

SLAC wrist leads to limits in what motion

A

extension and radial deviation

214
Q

Tx of RhA MCP Disease

A

if just ulnar drift with preserved MCP - soft tissue realignment; if developing disease then MCP arthroplasty; if THUMB MCP - then fusion; if Thumb MCP AND IP - arthroplasty

215
Q

acute vs chronic paronychia

A

chronic general requires removal of nail plate and skin down to germinal matrix to clear. Routine oral Abx is not sufficient

216
Q

syndactyly - where is most common

A

3rd web space; then 4 then 5

217
Q

PIP collateral ligaments

A

tight throughout ROM; proper is from prox phalanx head to middle phalanx; accessory is onto the volar plate again

218
Q

cause of failure for STSG and FTSG

A

hematoma or seroma

219
Q

Annular pulleys 1- 5

A

1,3,5 start on the palmar plate of the MCP, PIP, and DIP; A2 and A4 are on the proximal and middle phalanx

220
Q

intial tx of non-hemorrahgic blisters on fingers

A

LIMITED debridement and unroofing

221
Q

what does apical endodermal ridge control

A

proximal to distal growth

222
Q

ulnar nerve course in relation to UCL

A

runs OVER the UCL

223
Q

aphalagia is

A

absence of phalanx - can use a non-vascular toe transfer before 12 -18 months or a vascularized to transfer

224
Q

nerve grafting for upper trunk - why?

A

bc shortens the time to reinnverate shoulder before end plate changes

225
Q

parital extensor lac repair

A

if MORE than 60% but still partial rupture - use a core suture

226
Q

causes of VISI (LT disruption)

A

can be normal varient of liagmentous laxity; rheumatoid; volar RL ligament injury or also DIC injury

227
Q

distal pole scaphoid excision is for

A

STT OA; failed STT fusion; scaphoid non-union

228
Q

high vs low ulnar nerve injury- which has worse clawing

A

LOW has worse clawing

229
Q

FDP muscle bellies of fingers

A

long, ring and samll have COMMON muscle bellies

230
Q

how to test central slip injury

A

flex PIP to 90 and perform resisted extension of DIP - should cause DIP hyperextension - ELSON test

231
Q

prioritis of tx for BPI

A

elbow flexion; shoulder stability; hand sensibility; Wrist extension/finger flexion; wrist flexion/finger extension and lastly intrinsics

232
Q

capitate articulates with

A

MC 2-3-4 via 3 facets (index, long, ring)

233
Q

TAR vs Fanconi’s Anemia

A

both have radial dysplasia but TAR patients have low platelets at birth which eventually normalize; Fanconis have normal platelets which then become pancytopenic

234
Q

contribution of vincula to motion

A

at PIP and DIP vincula can contribute 60-90%

235
Q

most important factor for nerve recovery

A

AGE of patient

236
Q

def of perionychium

A

area includes the nail, nailbed, and surrounding skin

237
Q

ulnar nerve arrises from WHAT cord

A

Medial cord - c8-t1; sometimes c7

238
Q

what position to cast DRUJ dislocation

A

PRONATION

239
Q

1 vs 2 vs 3rd deg burns

A

1 is epidermis only and no blisters, 2 is dermis with regen potential and blisters nerves are INTACT so it hurts; 3rd deg is below nerves so actually not very painful

240
Q

TFCC tear with ulnar positive

A

must do a shortening procedure, if < 2mm positive then wafer, if > 2mm positive than diaphysea shortening

241
Q

suprascapular nerve comes off which trunk

A

SUPERIOR

242
Q

spontaneous resolution of peds trigger thumb

A

30-60%

243
Q

which tendon has separate subsheat in DeQ

A

EPB - 40% have separate sheath

244
Q

vascular supply of the lat dorsi flap

A

thoracodorsal A, branch of the Subscapular artery

245
Q

tx of campodactyly < 30 deg

A

passive stretching and splinting; good prognosis for kids under 3

246
Q

neuropraxia and wallerian degen

A

DOES NOT OCCUR

247
Q

tx of DRUJ OA

A

Darrach resection - down side is ulnar instability; distal ulna hemi resection with tendon interposition (Bowers) - preserves TFCC insertion); Ulnar head or DRUJ arthroplasty

248
Q

palmaris longus is absent in

A

15% of unilateral wrist and 7% of bilateral wrists

249
Q

are gender or diabetes rf for poor outcomes after CTR

A

NO - severity on Electrodiagnositc studies is however

250
Q

fight bite bacterai

A

m/c is still staph and strep, but need to cover from GR- Eikinella

251
Q

zone of polarizing activity (ZPA) modulated by

A

sonic hedgehog and controls radio-ulnar or A/P development

252
Q

perilunate dislocaiton classifcation

A

mayfield stage 1-4; 1 is SL; 2 Capitolunate; 3 is LT; 4 is capitate pushes the lunate out into volar dislocation -short radiolunate remains intact

253
Q

tx for supination deficit in CP or quadriplegia

A

prontator terres muscle transfer; if fixed pronation deformity may need to release the pronator quadratus

254
Q

tx of multiple extensor tendon ruptures

A

use middle FDS as transfer and palmaris graft

255
Q

Elson test

A

ability to extend PIP at 90 flexion - indicates central slip injury

256
Q

SLAC stages

A

1 - SL pain, normal xray, positive watson; 2 - dynamic; incompetent or incomplete SL ligament - leads to positive stress xray; 3- - static- instability seen on NON_stress xray; 4 - DISI

257
Q

what is arcade of Frosche

A

fibrous band of supinator that can pinch the PIN

258
Q

Radioscapholunate fusion - how to reduce non union

A

excise the distal pole; also helps with flexion arc

259
Q

how does SNAP (Sensonry Axn potential) help localize injury

A

they are INTACT in preganglioninc injury -but clinically are insensate

260
Q

Lunotriquetral ligament - strongest part

A

Volar portion is the strongest

261
Q

when to do nerve surgery

A

before 6months after 12 its better to do tendon transfers

262
Q

order of hand joints OA prevalance

A

DIP; CMC, PIP, MCP; similar in men and women until menopause then more common in women

263
Q

what position to fuse DIP in OA

A

10-20 deg of flexion

264
Q

what is BRAND transfer

A

high radial nerve injury transfer - FCR to EDC, Pron Terres to ERCB, Palmaris to EPL

265
Q

extensor tendon to germinal matrix distance

A

1.2 to 1.4mm

266
Q

poland syndrome

A

syndactyly and chest wall abnormalities including absent pec major

267
Q

intrinsic tightness leads to what motion

A

limited PIP flexion when MCP are extended; but returns to normal in MCP flexion

268
Q

what percent of midde phalanx leads to PIP instability

A

20% is always stable, 60% is always unstable; in between needs a good exam

269
Q

exensor zone injuries of 3,4,5,6

A

3 is over central slip; 4 is prox phalanx, 5 Is MCP joint and 6 is MCP shaft, 7 is wrist, 8 is distal forearm

270
Q

in DeQuervains what tendon has extra slips

A

EPB

271
Q

main stabilizers for pinch THUMB and INDEX

A

UCL for Thumb and RCL for Index

272
Q

does dupuytrens affect transverse bands

A

no; they are perpedicular to pretenidnous cords and lie dorsal to this. The vasculartiy is DORSAL (or DEEP) to these transverse bands

273
Q

flexor digiti minimi is absent in what percentage of hands

A

15-20%

274
Q

cleland ligament

A

originates from phalanx - runs DORSAL to NV bundle

275
Q

what part of TFCC has blood supply

A

peripheral volar, dorsal, ULNAR

276
Q

complication of scaphoid pole excision in STT OA

A

DISI due to short scapohoid level arm

277
Q

attrition of volar beak lig in thumb leads to

A

degen OA of thumb CMC joint

278
Q

how much tfcc can you debride

A

up central two-thirds before compromising DRUJ instability

279
Q

caput ulae syndrome

A

seen in RhA with ulnar disloction of carpus and ultimately radial deviation - tx with ECRL to ECU transfer

280
Q

BEST replant outcomes

A

mid-distal forearm

281
Q

what is end to side nerve transfer

A

donor nn is inserted into opened perineurium of receipient to accelerate regeneration

282
Q

best view for dorsal screw penetration in Distal radius orif

A

flexed wrist tangential view

283
Q

proximal phalanx replants

A

NO -lots of adhesions - zone 2 - contraindicated

284
Q

scaphoid vascularity

A

proximal 70% is via dorsal radial artery; distal 30% Is via palmar

285
Q

peds phalangeal NECK frx treatment

A

generally unstable; try closed reduction with pinning or perc reduction with open fixation

286
Q

what does pseudomeningocele on CT myelo mean

A

PREganglionic injury- nerve root avulsion

287
Q

common palmar digital arteries come from

A

supeificial palmar arch which is DISTAL to the deep palmar arch

288
Q

motor supply of ulnar nerve

A

ring and little FDP, interossei, deep FPB, adductor aponeurosis, hypotenar musc.

289
Q

symphalangism definition

A

failure to differentiate IP joints - usually ulnar

290
Q

brown streak in nail bed needs

A

BIOPSY - can result In subungual melonoma

291
Q

cuff surgeries for GH dysplasia from brachial plexus injury

A

selective release of pec major, subscap and coracobrachialis with lat dorsi and teres major transfers to help External rotation

292
Q

first muscle innervated by radial nerve

A

brachioradialis in anterior compartment -early return of this can portend a early return to fxn in nerve injury cases

293
Q

which muscles are key to testing for BPI

A

rhomboids and serratus - dorsal scapular nn and long thoracic - if normal then indicates a POST ganglionic injury

294
Q

hyponychium

A

skin imemdiate distal and palmar to the nail - at jxn of sterile matrix and fingertip skin

295
Q

downside of volar approach to MCP during dislocation

A

injury to nerves as they get pushed closer to skin

296
Q

best fusion rate in fingers seen with

A

headless screws

297
Q

tendon healing stages

A

first 7 days macrophage and fibroblasts migrate and eat debris; week 1-3 is proliferation of unorganized type 3 collagen and neovascularization and fibroblasts - still week; at week 3-12 strengthening begins

298
Q

consequence of untreated volar dislocation with frx at PIP

A

Boutonierre - the central slip which attaches to dorsal middle phalanx will become incompetent resulting in volar sublux of lateral bands

299
Q

cervical paraspinal EMG in POST-ganglionic injury

A

IS NORMAL

300
Q

hand vascular arches

A

superficial arch is more distal and supplies ulnar digital artery as well as common digital arteries to middle and ring finger; deep arch gives of to thumb and index

301
Q

which tfcc tear to repair

A

acute ulnar based is best

302
Q

endo, peri, epineureum

A

endo is around nerve fibger; peri is around the fascicle; peripheral nerve is surrounded by EPIneurium

303
Q

watson test for SL competnece

A

the wrist is moved to radial deviation and scaphoid should normally FLEX; if its OUT volarpressure from examiner will keep the scaphoid dorsally and painfully displaced - once pressure is discontinued it CLUNKS back in place and releives the pain

304
Q

what part of A2 pulley is most important

A

distal 50% is most important

305
Q

injury to vessel during Dupuytrens

A

if vasospasm from traction or extending the contracted digit then flex finger and warm saline + topical lidocaine; phentolamine can be given for prolonged vasospasm; if cut then needs primary repair

306
Q

do ALL dupuyrens nodules become cords

A

no they appear earlier but do not necessarily progress

307
Q

Bouvier test for PIP fxn

A

assesement of clawing - neutral wrist, MCP flexion and asses if PIP can actively extend - if they cannot then need to connect tendon to lateral band

308
Q

why is isolated C8-T1 relatively contraindicated for BPI surgery

A

bc more predictable to do nerve or distal tendon transfers

309
Q

tx of Swan Neck in CP

A

central slip tenotomy to balance extensor mechanism over PIP and DIP

310
Q

nerve surgery vs tendon transfers

A

generally after 12 months tendon transfers are recommended; nerve surgery should be within 6 months

311
Q

rate of EPL rupture with distal radius

A

5% at most

312
Q

DIP arthroplasty vs arthrodesis

A

similar outcomes with pain and function but higher faiure with arthroplasty

313
Q

causes of DISI or SL disruption

A

Kienbock, Radiolunate injury, Dorsal intercapral ligament injury; distal radius frx/nonunion

314
Q

triquetrum articulations

A

distally hammate, radially with lunate, volarly with pisiform

315
Q

what is best prognosis of brachial plexus birth injury

A

return of antigravity biceps by 2 months

316
Q

3 zones of guyon canal - zone 3

A

include the sensory branch; remains superficial; innverates palmaris brevis and sensation to little finger and ulnar ring finger

317
Q

visceral vs parietal paratenon

A

visceral lines the tendon; parietal lines the undersurface of the sheath

318
Q

which tendon has multiple slips in DeQ

A

APL - has wide variability in insertions and slips

319
Q

Parona’s space,

A

lies bw the fascia of the pronator quadratus muscle and FDP conjoined tendon sheaths. Infection tracking through this space presents as a horseshoe abscess.

320
Q

Wassel II is

A

Double distal phalanx

321
Q

what collagenasse is used for Dupuytrens

A

clostridium histolyticum; low activity against collagen IV and has lowere recurrence at MCP vs PIP

322
Q

optimal flexion for ring pIP

A

40 degrees; in general ulnar digit PIP flexion is important to preserve for power grip

323
Q

hook of hamate is site of origin for

A

flexor digiti minim and opponens digit minimi

324
Q

traumatic amp proximal toFDS insertion

A

contraindicated to replant

325
Q

thenar space is separated from mid palm space by

A

septum at the long finger metacarpal

326
Q

dorsal extrinsic ligaments of wrist

A

Dorsal radiocarpal (inserts on the lunate and triquetrum); and the dorsal INTERcarpal - triquetrum to scaphoid/trapezoid/capitate

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